Key Facts About the End of Life Option Act for Patients & Families
- The End of Life Option Act, (also referred to as the California aid-in-dying law), went into effect on June 9, 2016.
- Under this law, only California residents who are 18 years of age or older who have received a terminal diagnosis from their physician of six months or less can begin the process of requesting an aid-in-dying prescription.
- Participation in the End of Life Option Act is voluntary every step of the way – for patients, health care providers, health systems, pharmacists and insurers. No one can be forced to participate.
- A request for the aid-in-dying drug must come directly from the terminally-ill patient. No one can request the drug on behalf of the patient.
- Patients must be able to make their own medical decisions and speak for themselves.
- The aid-in-dying prescription request cannot be written into an advance directive, living will or Physician Order for Life-Sustaining Treatment (POLST). Learn more about POLST in California.
- The law requires patients and their physicians to go through several steps before the aid-in-dying medication can be prescribed, including verbal requests, a written request, consultation with a second participating physician, and completion of several forms.
- The law requires that your doctor talk with you about the importance of informing family and significant others, however, you are not required to inform your family or significant others.
- The law requires that your doctor discusses with you alternatives, including palliative care, pain management, and hospice care.
- Patients who go through all the steps to obtain the prescription can ultimately decide NOT to take the drug. In Oregon, which has a similar law, more than one-third of people who get the aid-in-dying prescription never take the drug.
- A terminally-ill patient must be physically and mentally able to take the drug themselves, without assistance.
- California law does not require insurance plans to cover the aid-in-dying drugs. Some health plans have announced they will cover the cost of the drugs, others will not. Contact your health plan for details.
- Medi-Cal, which is California’s version of the federal Medicaid program for low-income residents, will cover the cost of the drugs using non-federal funds.
- Medicare, the federal program for people over 65, will not cover the drugs.
- Under California law, patients cannot be denied health insurance, life insurance or annuities because they are pursuing aid-in-dying.
- Taking an aid-in-dying drug under the law will not be viewed as suicide, assisted suicide, homicide or elder abuse. If all of the requirements of the End of Life Option Act are followed, the patient’s death certificate should indicate they died from an underlying illness and that death occurred naturally.
For an overview of the law and more information, see the main End of Life Option Act page.
What do I need to do to prove that I am a California resident?
Patients must be a California resident in order to use the End of Life Option Act. Under the law, California residency must be demonstrated through any of the following means:
(A) Possession of a California driver license or other identification issued by the State of California.
(B) Registration to vote in California.
(C) Evidence that the person owns or leases property in California.
(D) Filing of a California tax return for the most recent tax year.
How do I find participating doctors?
Currently, there is no statewide list of physicians who are participating in the End of Life Option Act. Patients interested in exploring the End of Life Option can begin by talking with their primary physician. If the primary physician is unwilling or unable to participate they may be willing to provide a referral. If they are not willing to provide a referral to another physician, the patient will need to seek a participating provider on their own.
Several large health systems in California have said they will allow their physicians and staff to participate, but individual physicians who work for these health systems still have the option to participate or not, depending on their own beliefs. Prospective patients can contact the Patient Care Services department at the hospital or health system to ask questions about aid-in-dying and the provider’s level of participation.
Catholic-affiliated health systems and hospitals, such as those under Dignity Health, will not participate, nor will their doctors and staff.
California’s Veteran’s homes and providers of services operated under the U.S. Department of Veteran’s Affairs will also not participate in aid-in-dying.
Will insurance cover the cost of aid-in-dying drugs?
Every commercial insurance provider who provides coverage to patients in California will have a policy defining the level and type of coverage they provide for care and management of patients who are participating in the California End of Life Option Act. Likewise, each insurer will also have a policy about any offered coverage for aid-in-dying medication. You should call your insurer for details.
Medicare does not cover services for participation in the End of Life Option Act.
The Medi-Cal program will cover the cost of care and medication for patients wishing to participate in the End of Life Option Act but participation may require that patients establish a relationship with a participating “Fee-for-Service” Medi-Cal provider that is outside the system where they usually get their care. Medi-Cal patients are encouraged to contact their healthcare provider office for more information.
If I ingest an aid-in-dying drug and die, how will that affect my life insurance or will?
The California End of Life Option Act legislation specifically states that participation in the California End of Life Act and death from ingesting aid-in-dying medication cannot affect any life insurance or impact any will. Death by ingestion of aid-in-dying medication cannot be considered suicide and suicide will not be listed on the death certificate.
Do I need an advance directive or POLST form?
Advance care planning is important for all individuals regardless of your current health because it encourages you to examine and share your goals of life, goals of care and treatment wishes with family and medical providers. Advance care planning is particularly important for those who are considering aid-in-dying.
While instructions or requests for aid-in-dying cannot legally be written in to an advance directive or Physician Orders for Life-Sustaining Treatment (POLST) form, these documents can and should be used to clarify an aid-in-dying patient’s desire to avoid cardiopulmonary resuscitation (CPR) or life-sustaining medical treatment if the patient has an immediate health crisis prior to using the aid-in-dying drug, or if the aid-in-dying process does not go smoothly.
An advance directive is used to legally name a health care decisionmaker and provide instructions for that individual regarding your treatment wishes. Learn more about advance directives.
POLST is designed specifically for people who are seriously ill or near the end of life. POLST is a form that clearly states what level of medical treatment a patient wants toward the end of life. Printed on bright pink paper, and signed by both the patient AND a physician, nurse practitioner or physician assistant, POLST is a medical order which helps give seriously ill patients more control over their treatment. California law (AB 3000, Chapter 266) requires that a POLST form be followed by healthcare providers and provides immunity to those who comply in good faith.