Summary of Events and Fees: 

While the focus of our practice is on medical aid in dying, our broader goal is to help provide a smooth and peaceful death that may or may not include medical aid in dying.

To get started:

• Fill out an intake form and return it to us. Thalia DeWolf, RN, will contact you.
  (To obtain the form and briefly describe your circumstances, send a message to: )
• “First verbal request” – no charge – Dr. Shavelson or Dr. Spangler will contact you by TeleHealth (phone, Facetime or Skype), usually within a day of receiving your intake form. If that first request is appropriate, it will start the law’s 15-day waiting period. There is no charge for this TeleHealth meeting.
• Obtaining and reviewing medical records –  $500 – will be billed via email, and can be paid by credit card, after the First Verbal Request (above), if the patient agrees to continue beyond the first verbal request with our medical care.
  
• Home visit and continued comprehensive end-of-life care – $2500 – The fee for to finalize the intake process and continue with comprehensive care is due once the intake visit is scheduled, with payment by check or credit card.  Please note that this one-time fee for finalizing intake and comprehensive end-of-life care is independent of outcome. There is no refund if the patient dies without taking aid-in-dying medications. Once paid, there are no further fees for our care.* (See below for possible costs of care from others.)

 

Please note: While the focus of our practice is on medical aid in dying, our comprehensive service is to provide a smooth and peaceful death that may or may not include medical aid in dying. Our commitment to patients and families does not end if a patient decides not to take medications to die or becomes ineligible to take them, but rather includes all aspects of impending death–from improving life while death approaches to providing the best death possible with or without medical aid in dying. Our agreement with patients and families is to be their medical guide to life as death approaches and then through the death itself. 

 

• Attendance at Aid in Dying: On the date of your aid in dying, the doctor and/or nurse will be present at the bedside with you and your family, to guide you through the process. This is included in our comprehensive end-of-life care, without additional fees.

*NOTES:

The End of Life Option Act requires a second opinion from another doctor, a “consulting physician.” That consulting doctor may or may not charge an additional fee.  

Our fees do not include the cost of the aid-in-dying medications — usually about $700, paid to the pharmacist.  NOTE: If, rarely, a patient’s aid in dying pharmacology is complex or becomes so and the doctor must provide additional medications on scene, there will be a reimbursement fee for the medications, usually $50 to $200.  

There is a travel fee for travel greater than 50 miles round trip from Berkeley.  The fee is $1 per mile, round trip. 

The above fees apply only if Dr. Shavelson or Dr. Spangler is the Attending Physician for the End of Life Option Act.  Some patients already have an Attending Physician and have asked us to be the 2nd or Consulting Physician.  If Dr. Shavelson or Dr. Spangler only provides this service as Consulting Physician, there is a one-time fee of $500.

PLEASE NOTE that patients with difficulties in meeting the above fees should feel free to discuss this with Bay Area End of Life Options.  Our goal is that no patient should be denied treatment because of inadequate funds. 

Details of Events:  

A consultation with Dr. Shavelson or Dr. Spangler is commonly initiated when a patient who has less than six months to live is considering all possible options for their death, including physician aid in dying.  This consultation can be initiated by the patient or, with the patient’s permission, by the doctor or a family member. The most common first contact is by email () or telephone with our nurse manager, Thalia DeWolf, R.N.  She will send you (email, fax) a short Patient Intake Form, or you can fill out our online form.

Once we have your basic information on a Patient Intake Form, Dr. Shavelson or Dr. Spangler will contact you by phone, Facetime or Skype for a “first verbal request” for aid-in-dying.

There is no charge for this initial contact and evaluation. There is also no charge for our doctors to talk with the patient’s doctors if they are in need of information about the End of Life Option Act. 

Please note that Bay Area End of Life Options will encourage you and help you not only to continue care with your regular physicians but to make every attempt to have your own doctors talk with you and evaluate all of your end-of-life needs and choices.

If the initial contact shows that it is appropriate to continue, Dr. Shavelson or Dr. Spangler will review your medical records and then arrange a first-visit home evaluation.  This consists of a home visit with the patient (with family or caregivers present if desired). The doctor will review all the relevant medical information, examine the patient, and discuss at length all potential options available to the patient as death approaches.

The goal of the first visit is to evaluate the patient’s end-of-life care and help maximize that care. As such, it is highly recommended that all patients requesting an end-of-life consultation are also enrolled in a hospice program or receive care from a palliative care physician (a specialist in symptom management). Another part of the initial evaluation is to ascertain whether, among many choices that will be described, physician aid-in-dying is appropriate and legal for the patient and their circumstances.

If as a result of this first visit Dr. Shavelson or Dr. Spangler and the patient agree that it is appropriate for them to continue as the attending physician for the patient’s terminal illness (to supervise end-of-life care, possibly including an aid-in-dying medication), our practice will consult with the patient, the family, the patient’s doctors and hospice staff. We will guide communication to educate and advocate for the best end-of-life care for that individual patient’s needs and desires. We will maintain communication with the patient and caregivers by phone, email and, when suitable, repeated home visits. If appropriate, our doctors will prescribe aid-in-dying medications. A member of our practice, most likely the doctor you are most familiar with or our nurse will be present at the bedside when the medications are taken.

The above can occur only if:

• The patient is no longer participating in any curative or life-prolonging treatment of their underlying terminal disease, but rather has chosen to receive intensive treatment of symptoms as death approaches. This signifies that the patient understands and agrees that their end-of-life care no longer requires their specialist’s treatment of the underlying disease, but rather treatment of the symptoms of dying.
• The patient has an appropriate and persistent desire to consider the possibility of ending their life with an aid-in-dying medication, and the patient’s usual physicians will not or cannot provide physician-aid-in-dying.
• The patient agrees, if at all possible, to be in a hospice program.
• The patient understands that, by transferring their end-of-life care to Dr. Shavelson or Dr. Spangler, they will guide, provide and manage that care, assuring that palliative care (symptom control) is maximized and that all options toward death are discussed, considered and understood, including physician aid-in-dying as one possible option among many.  Please note carefully that being a patient of Dr. Shavelson or Dr. Spangler does not imply or guarantee that they will provide an aid-in-dying medication, rather that they will help you through many end-of-life possibilities and this may or may not include an aid-in-dying medication.

If the patient does take an aid-in-dying medication, Dr. Shavelson and/or Dr. Spangler will write the prescription for that medication, supervise the process and, if the patient wishes, a member of our practice will be present at the bedside to manage the taking of medications and counsel the patient and family on the day of the patient’s death.