End of Life Option Act

End of Life Option Act: Frequently Asked Questions

Patients can make informed decisions about end-of-life care by exploring their options. There are many resources for those living with a terminal disease, including hospice care and palliative care.

Below is information for John Muir Health patients about California’s End of Life Option Act.

What Is the “End of Life Option Act”?

The Act is a California law that became effective June 9, 2016. It allows patients who have a terminal disease (with a life expectancy of 6 months or less) to request an aid-in-dying drug prescription from their doctors.

Participation in the Act is voluntary for patients, doctors, nurses, and staff.

Who Can Use the Act?

Qualifying patients who can use the Act are those who have a terminal disease and who:

• are at least 18 years of age and able to make medical decisions;
• are California residents;
• have been told by two doctors that the terminal disease will probably end their life within six months;
• are asking to use the Act voluntarily without any pressure from anyone;
• make two oral requests at least 15 days apart and one written request on the appropriate form;
• are willing to meet with at least two different doctors to discuss their request, receive information about the Act, and learn about other ways to manage the terminal disease; and
• are able to take the aid-in-dying drug without help from anyone.

What Steps Do Patients Take to Use the Act?

Patients and their doctors must follow these steps:

1. If patients ask for information about the Act, John Muir Health team members who are well versed in the requirements will inform them about the Act, and will provide educational materials.
2. Doctors who take care of patients for terminal diseases must tell them that they believe the disease cannot be cured or reversed, and believe that the patients have six months or less to live.
3. Patients must tell their doctors twice in person that they want the aid-in-dying drug prescription. There must be at least 15 days between the two requests. No one else may make the request on a patient’s behalf.
4. Patients must complete and sign the appropriate form telling their doctors that they want the aid-in-dying drug prescription.
5. Patients must talk about their decision alone with their doctor. No one else can be present, except an interpreter if needed.
6. Patients must see a second doctor who agrees with the diagnosis and prognosis of the first doctor.
7. If the main doctor or the second doctor believes that there are indications that the patient has a mental health issue that impairs judgement or if there are indications that the patient lacks capacity to make medical decisions, either doctor may refer the patient to a mental health specialist for an assessment.
8. Patients must talk with their main doctor and the second doctor about:
   • How the aid-in-dying drugs will affect the patient
   • How death might not come right away
   • Other ways to deal with the patient’s terminal disease
   • How patients may change their minds and take back the request at any time
   • How patients don’t have to take the aid-in-dying drug even if they receive the prescription. Patients should keep the drugs in a safe place at all times
   • That patients are advised to tell their loved ones about their decision
   • The importance of having someone nearby when the patient takes the drugs
9. If patients and their doctors agree that the requirements have been met, doctors may write the drug prescription. If any of the patient’s doctors do not agree that the patient can meet all of the requirements, the doctors will not write an aid-in-dying drug prescription. Please note: There are special rules about how patients obtain the drugs.
10. Within 48 hours before taking the drug, patients must complete and sign the appropriate form that says that they decided to take the prescription drug and no one is forcing them to take it.

If Patients Ask For the Aid-In-Dying Drug Prescription, Do Doctors Have to Prescribe It?

No. A doctor’s participation in the Act is voluntary. Doctors will speak with patients about other ways they can be supportive during the terminal disease.

If Patients Ask Doctors For the Aid-In-Dying Drug Prescription, Do Patients Have to Take It?

No. If a patient asks for the drug prescription and their doctors agree that the patient qualifies, the patient does not have to take it. Please note: patients who decide to take the drug may not take it on John Muir Health premises or in any public place.

How Does the Law Protect Patients?

The law says that:

• Doctors must feel certain that patients qualify to use the Act by meeting all of the requirements.
• Doctors must feel certain that patients are voluntarily making the request without any pressure from anyone else.
• Two people must be present to see that the patient signed the appropriate form and they each must also sign the form. The two people will not sign the form if they believe a patient is not able to make medical decisions.
• Doctors may not sign forms for patients.
• Only one person signing the form may be related to the patient. And at least one person must be someone who does not work for John Muir Health.
• John Muir Health will provide a certified interpreter if a patient needs one. The interpreter who helps cannot be related to the patient.
• Patients can change their mind at any time. No one but the patient can decide to take the drug prescription and the patient has to take the drug without help from anyone else.

How Does the Act Affect a Patient’s Insurance, Will or Other Contracts?

The Act states what insurance companies and others can or cannot do. For example:

• They cannot deny health insurance just because a patient asked for the aid-in-dying drug prescription.
• They will not offer information about aid-in-dying drug prescriptions unless patients request it. They also cannot discuss the cost of aid-in-dying drug prescriptions with patients unless patients have requested the information.
• They cannot refuse treatment for a patient’s disease at the same time they offer coverage for aid-in-dying drug prescriptions.
• They cannot deny life insurance benefits because patients have used the Act.
• They cannot require that patients receive an aid-in-dying drug prescription or prevent them from doing so based on a will, contract or other agreement.

Patients wanting to learn more about the End of Life Option Act can call our information line at (925) 296-7349 and leave contact details. A team member will then contact the patient to discuss the Act.