Lisa Klinger, J.D. and Lynne Calkins, CRNP spoke to club members at our June meeting to clarify the provisions of the California End of Life Option Act that just went into effect June 9. Lisa has specialized in employee benefits and employment law for 32 years but since 2014 she has been a volunteer with Compassion and Choices. Lynne Calkins is a Nurse Practitioner with over 24 years of experience and has been an End-of-Life Consultation Volunteer with Compassion and Choices since 2011. They both provided an interesting overview of the new law emphasizing the key elements we all need to understand.
The California End of Life Option Act went into effect June 9, 2016. It allows an adult California resident who is terminally ill and who has the capacity to make medical decisions to request a prescription from his or her physician for life-ending medication. The individual must be able to ingest or self-administer the medication. The new California law is similar to the Death with Dignity laws in Oregon and Washington.
To request the medication, an individual must make two oral requests (at least 15 days apart) and one written request to his/her “attending” physician (probably the primary care physician, although it could be another physician or a hospice medical director). The written request must be made using the form provided by the State of California, “Request for an Aid-in-Dying Drug to End my Life in a Humane and Dignified Manner”. The form must be signed by two adult witnesses, at least one of whom will not inherit anything under the patient’s will. The form need not be notarized.
Once a patient requests the medication, the physician must refer the patient to a “consulting” physician who also must examine the medical records and confirm that the patient is terminally ill and has a prognosis of not more than six months to live. If either physician thinks the patient might be suffering from impaired judgment due to a mental disorder, they must refer the patient to a mental health specialist. Before prescribing the aid-in-dying medication, the attending physician must meet alone with the patient and confirm the patient is acting voluntarily and the request is not coming from coercion.
It’s important to be prepared well in advance of ill health. All individuals, whether or not terminally ill, are urged to call their doctors and ask whether they would prescribe the medication if the individual were to become terminally ill in the future. No one is required to participate under the End of Life Option Act, and some doctors have said they will not. If your doctor would not honor your wishes, you should know that sooner rather than later, in case you want to request a referral to a doctor who will participate under this new law.
Other health care providers who are not required to participate are pharmacies, hospitals, hospices, health facilities, and assisted living facilities. You should inquire now if this might affect your future decisions on where to receive health care or where to live. Health care providers who elect NOT to participate must have a written policy stating this and must notify people of their policy.
If a friend or loved one asks you to be present when they ingest the medication, you don’t have to worry about being charged with a crime or subject to a civil lawsuit for being present at their death. You can even help the patient by preparing the aid-in-dying drug, but you cannot help them ingest it.
Taking the aid-in-dying drug does not affect life insurance, health insurance or annuity policies — any differently than the effect if the individual died a natural death from the underlying disease. The law specifically provides that the sale, procurement, or issuance of an insurance policy, or the rate charged for it, cannot be conditioned on or affected by whether the person requests (or rescinds a request for) the aid-in-dying drug.
Helpful Websites and Phone Numbers
It is important to talk with your family and friends now, as well as your doctor, about what you want if you someday have a terminal disease. You can get information and helpful sample forms at Compassion and Choices website and a toolkit. (e.g. a “Good to Go” toolkit, Advance Directive, additional directives for Dementia, or to request a transfer from a hospital that will not honor your wishes, and an Assisted Living Facility Rider).
Additional resources can be found on the End Of Life Option website via a portal that provides information on participating health systems in a visitor’s ZIP code. There is also a free information hotline, (800) 893-4548. There is also a free, confidential Doctor to Doctor consultation hot line at (800) 247-7421 which connects physicians to doctors with years of experience in end-of-life care options, including medical aid in dying.