Frequently Asked Questions

  • Who is eligible for aid in dying under the End of Life Option Act (ABx2 15)?

Any terminally ill adult California resident with intact decisional capacity has the right to request her/his attending physician for an ‘aid-in-dying’ drug prescription.  A terminal diagnosis is defined as a known incurable serious illness that has been medically confirmed. The attending physician must determine and document that the patient has an anticipated lifespan of six (6) months. or less.

  • How many doctors are required to evaluate the patient ?

    • The patient’s attending physician (the physician primarily responsible for managing their illness) must decide that the patient is terminal and has the capacity to make medical decisions. The patient must see a second (consulting) physician, who must confirm the patient’s prognosis, diagnosis, and capacity to make medical decisions. A consulting physician must also verify the voluntary nature of the patient’s request for aid in dying. Both doctors should document their opinion about the patient’s (i)diagnosis, (ii)prognosis, (iii) decision making capacity and (iv) the voluntary nature of their request for aid in dying in the medical records. The attending physician should also document the two verbal and the written request initiated by the patient in the electronic medical records.
  • How should the patient ask for aid in dying?

  • The patient must make a direct request to the attending physician.The patient’s attending physician (the physician primarily responsible for managing their illness) must decide that the patient is terminal and has the capacity to make medical decisions. The patient must see a second (consulting) physician, who will confirm the patient’s prognosis, diagnosis, and capacity to make medical decisions
  • Must the doctor counsel patients about alternate options?

    • full discussion of the patient’s end of life options and the details of the aid-in-dying process is required.The physician must counsel the patient about alternatives to PAD (like pain management, comfort care, hospice referral and voluntary stoping of eating and drinking). A In many cases, patients will choose and greatly benefit from the alternate options and may not pursue aid in dying.
  • What about patients who do not speak English?

    • The physician must communicate with patients with Limited English Proficiency through a Medical Interpreter.  The family members cannot serve as interpreters. A professional medical interpreter must do the interpretation during the clinical encounter. Family members cannot be present when the patient is making the request for assisted death through the interpreter to the physician. The written request for physician assisted death may be prepared in English even when the conversations with the patient are in the patient’s preferred language through a medical interpreter. The interpreter must sign a declaration ( under penalty of perjury) that the patient’s request is voluntary and coercion and that the patient understood the content in the written in the official form requesting aid in dying.
  • Can patients with dementia or other illness with cognitive impairment ask for physician assisted death?

    • No. Dementia patients or patients with cognitive impairment are not eligible for aid in dying. Patients have to have decision making capacity and be able to voluntarily ask for aid in dying.
  • If a patient cannot speak, can they ask for physician assisted death?

    • The law states that the patient must make two verbal requests and one written requests. Some patients may not be able to speak. The current statement of the law leads us to believe that these patients are not eligible for PAD.
  • Can the family be present when the patient is asking for aid in dying?

    • The patient must directly ask the physician for physician assisted death. To protect them from undue influence and coercion, the family members are not allowed to be present when the patient is making the two verbal requests about aid in dying. The two verbal requests should be made at least 15 days apart.
  • Must all patients requesting aid in dying see a psychiatrist?

    • Patients at risk of impaired decision-making due to depression or other mental illnesses will be referred to a mental health expert.There is no mandate for a psychiatry referral.
  • What happens during the second visit with the attending physician?

    • During the second visit, the patient must once again directly ask the attending physician for aid in dying. During this visit, the attending physician must re-confirm the patient’s prognosis is anticipated to be six months or less. The doctor must also confirm that the patient has the mental capacity to make health decisions. Additionally, the doctor must also counsel the patient (i) that it is best to have someone they trust be present when they swallow the lethal medication, (ii) to take the medication in a safe and private place and not in a public place, (iii) to notify their proxy decision maker(s) and next of kin of their plan, and (iv) to maintain the lethal medication in a safe and secure place. The attending physician must also inform the patient that they change their mind at any time. They should also remind the patient of using options like hospice care. Once these components have been fulfilled, the physician can write the prescription for the lethal medication.
  • What is the lethal medication given?

    • The lethal prescription is barbiturate which the patient has to swallow.The Oregon experience has shown that the typical prescription is nine grams of secobarbital in capsules (or) ten grams of pentobarbital liquid consumed at one time.

How is the lethal medication given?

  • The medication is best taken on an empty stomach to increase rate of absorption. The contents of the secobarbital capsules or the pentobarbital liquid should be mixed with a sweet substance to mask the bitter taste. Some pharmacies may prepare a slurry for the patient to consume. As some patients may get nausea or may vomit the lethal medications after taking them, anti-nausea pills are taken first and then the lethal medications are ingested one hour later ( to allow maximal effect of the anti-nausea pills).
  • Can someone help the patient ingest the lethal medications?

    • By law, the patient has to self-administer the lethal medication.No one should help the patient take the lethal pills. This is an effort to protect the patient and prevent coercion.Thus, a patient who is not able to use their arms due to a stroke or other diseases like Multiple Sclerosis or Lou Gehrig’s disease will not be eligible for physician assisted death at the present time.
  • If I am present when the patient is ingesting the lethal medication, will I be breaking the law?

    • The law provides immunity from civil or criminal liability when a person is  (a) present when the seriously ill patient is self-administering the lethal medications, or (b) or helps the patient with  preparing the aid-in-dying drug. No one should administer the lethal medication to the patient or help with with ingesting the medication ( e.g. put the medication in their mouth)
  • What about intravenous (IV) lethal medications?

    • The law allows only oral formulations of lethal medications for physician assisted death.IV lethal medicines are not legally allowed i.e. a patient cannot be injected with lethal medications.
  • Must all doctors participate?

    • Physicians participation is voluntary, provided they work in a health system that has opted in for PAD. Catholic hospitals and federal facilities prohibit participation in PAD: Doctors who are employees must abide by the organizational rules.
  • What if my doctor does not participate?

    • The patient must find another doctor who is willing and able to assist them. Federal law prohibits participation and thus federal employees are not allowed to make official referrals.
  • What about out of state doctors?

    • Doctor must be a licensed to practice in the State of California.
  • Who will pay for the lethal medication?

    • Some insurances will pay the cost of the lethal prescription.Federal funds cannot be used to provide aid in dying.MediCal is funded by state and federal funds. MediCal can use only state funds to pay for the lethal medication. The insurance company cannot contact the patient or inform them that they will provide coverage for lethal medications.
  • What rights does a proxy have?

    • Proxy cannot request on behalf of the patient. The patient has to make a direct request to the attending physician for aid in dying. The proxy can be present when the patient is self-administering the lethal medication.Proxy cannot administer the oral dosage to the patient. The patient has to self-administer the oral medication.
  • Is PAD Euthanasia?

    • Euthanasia is the act of hastening death by which a doctor injects a patient with lethal medication. Euthanasia is illegal in the United States. PAD is legal in some states including California. PAD, as defined and described by the law, is not euthanasia.
  • Is hospice mandated for PAD?

    • No. Hospice is not mandated. However, hospice can help the patient and provide support to their family and counsel them about what to expect during the dying process. The hospice team can provide expert management of pain and other distressing symptoms.The hospice nurse cannot administer the lethal medications.
  • How long does it take for the medication to work?

    • Based on past experiences in Oregon, a patient who swallows the lethal prescription will lose consciousness in about 5 minutes and will likely die in about 25 minutes.
  • Can the patient change her/his mind?

    • Yes. At any time.There is no penalty for changing your mind. If the patient changes her/his mind after ingesting some or all of the the lethal medications the family should call 911. If a patient changes her/his mind after taking the lethal medications, that may not work. The medications take effect within 5 minutes and even the emergency medical technicians may not be able to reverse the effect of the lethal medications.
  • What will the death certificate say?

    • The death certificate will list the underlying terminal illness as the cause of death, as long as the patient followed all the steps indicated in the End of Life Option Act i.e. the death certificate will not list suicide as the cause of death. Life insurance will not be affected if the underlying serious illness is listed as the cause of death.
  • Is an autopsy mandated?

    • No. An autopsy is not mandated for patients who die after consuming lethal medications. The family can decide whether or not they want an autopsy.

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