Steps for Aid-in-Dying

California’s End-of-Life Option Act outlines specific requirements and procedures before an aid-in-dying prescription can be given to a patient, and before the patient can take the aid-in-dying medications:

  • Attending Physician: The patient must select and be cared for by an end-of-life attending physician, who supervises the entire aid-in-dying process and reports the documentation and results to the California Department of Public Health.
    The attending physician can be the patient’s primary care physician, oncologist, palliative care or hospice physician, or another appropriate physician the patient chooses.
    (Note: Any physician can choose not to participate in the End of Life Option Act.)
  • The attending physician will:
    • Ascertain Eligibility: The patient must be
      • 18 years or older.
      • Terminally ill with a six-month or less prognosis
      • Mentally competent to make medical decisions for themselves
      • Physically able to swallow about 1/2 glass of liquid medications (or to self-administer the medications through a feeding tube)
      • A resident of California
    • Refer the patient to a consulting physician:
      • The End of Life Options Act requires that a second-opinion physician confirms (or denies) that the patient’s diagnosis and 6-month or less time to live are correct. The consulting physician must review the patient’s medical records and speak with and examine the patient. The attending physician will receive and record the opinion of the consulting physician.
    • Evaluation by a mental health specialist: If the attending or consulting physician finds any doubt about the patient’s mental or emotional capacity to make medical decisions, the attending physician will obtain a consultation from an appropriate mental health specialist.
    • Verbal requests:
      • The attending physician will accept and record the patient’s initial verbal request for aid-in-dying medications.
      • At least 15 days after the first verbal request, the attending physician will accept and record the patient’s second verbal request.
    • Written requests:
      • CHA Form 5-5: “Request for Aid-in-Dying Drug To End My Life in a Humane and Dignified Manner.” The patient fills this out and signs this form and gives it to the attending physician, who records it in the patient’s medical record.
        • The signing must be observed by two witnesses, not including the attending physician or consulting physician. The witnesses also sign the form.
      • CHA Form 5-6: Final Attestation Form 
        • The patient fills out and signs the “Final Attestation for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner.” The attending physician receives this form and enters it in the patient’s medical record. This form must be signed no longer than 48 hours before the patient takes the aid-in-dying medication.
      • Pharmacist contact: The patient signs a written consent for the attending physician to contact a pharmacist to fill the aid-in-dying medication for that patient.
    • Coercion evaluation: The attending physician must speak with the patient alone to ascertain that there has been no coercion or undue influence on the patient’s decision.
    • Patient counseling:  The attending physician must counsel the patient on multiple aspects of the process, and this must include (below, a selection of but not all requirements):
      • Advising the patient at each of the above steps that at any time and in any manner the patient may choose not to take the aid-in-dying medication.
      • The probable result of ingesting the aid-in-dying drug (rapid death).
      • The feasible alternatives or additional treatment options, including, but not limited to disease treatment, comfort care, hospice care, palliative care including (if needed) palliative sedation, and aggressive pain control.
      • The strong recommendation that another person should be present when the patient ingests the aid-in-dying medication.
      • The strong recommendation that the patient advise family and next-of-kin of the ingestion of an aid-in-dying medication.
      • Advise the patient of the strongest recommendation for participation in hospice or other palliative care program.
    • Writing the prescription:
      • When all of the above requirements are fulfilled (other than signing of Form 5-6), the attending physician provides a selected pharmacist with the prescription for the aid-in-dying medications.
      • The attending physician arranges with the patient and pharmacist the manner in which the patient can obtain the aid-in-dying medications.
    • Taking the Aid-in-Dying medications:
      • Anyone can prepare the medications (mixing capsule contents with water, adding sweetened juices, and other steps) and hand the medications to the patient.
      • The patients must take the medications on their own, i.e. the medication must be self-administered. No one can aid the patient in doing this. The law states that: “Self-administer” means a qualified individual’s affirmative, conscious, and physical act of administering and ingesting the aid-in-dying drug to bring about his or her own death. 
      • The attending physician and patient can decide if the attending physician will be present during the ingestion of the aid-in-dying medication.
    • The Death Certificate: The attending physician signs the death certificate, using the terminology felt to be most accurate for this patient (i.e. cancer, heart disease, other). Note that the law states clearly that “…actions taken in accordance with the End of Life Option Act” shall not, for any purposes, constitute suicide, homicide, or elder abuse under the law.” Life insurance and other policies can not be affected by the decision to use an aid-in-dying medication.
    • Report to the California Department of Public Health: The attending physician files a full report with the California Department of Public Health, as outlined in the End of Life Option Act.
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