The California End of Life Option Act and Death with Dignity

As we reported earlier this month, the opponents of Death with Dignity in California failed to collect enough signatures to qualify a measure overturning the newly-passed ABX2-15, End of Life Option Act, for the November ballot. The law will, therefore, go into effect three months after the legislative session on healthcare, in which it was passed, concludes. There are no indications that the special legislative session has completed its work and that the closing of the session is imminent. Only Governor Brown has the authority to close the special session, though he must do this by November 2016. This means the law could be available to individuals this summer but no later than February 2017.

About the California End of Life Option Act

The California End of Life Option Act is closely modeled on the Oregon Death with Dignity Act, which has been working flawlessly since 1998. Like the Oregon law, California’s allows mentally competent adult residents of the state who have been diagnosed with a terminal illness with a 6 months or less prognosis to voluntarily request and obtain from a prescription medication to hasten their inevitable, imminent death. The patient must also be able to self-administer and ingest the prescribed medication.

Two physicians must confirm all the eligibility criteria are met before writing the prescription. Two waiting periods, the first between oral requests, the second between receiving and filling the prescription, are required. Participation in the law is voluntary.

In the end, I was left to reflect on what I would want in the face of my own death. I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.

The law will work just like Oregon’s or Washington’s, with the exceptions outlined below. Learn more about accessing Death with Dignity laws →

Differences Between the Oregon and California Laws

While California’s new End of Life Option Act is closely modeled on the Oregon Death with Dignity Act, it differs from the Oregon law in a few areas:

1. People who do not speak English can use a language interpreter.
2. The attending physician must discuss the request for medications with the patient (and their interpreter, if applicable) alone (patients in Oregon are free to bring anyone along).
3. There is no waiting period between the written request and the writing of the prescription.
4. The attending physician must provide a separate form for the patient to complete within 48 hours prior to taking the medications.
5. Unused medications must be delivered for disposal to the nearest qualified facility that properly disposes of controlled substances, or if none is available, disposed of by lawful means in accordance with the Board of Pharmacy or Drug Enforcement Administration guidelines.
6. Forms for physicians are codified in the statute (Oregon’s forms are created by the Oregon Health Authority through separate administrative rules).
7. The End of Life Option Act expires on January 1, 2026, if not renewed (Oregon’s law is permanent unless repealed by the legislature or voters).

The Future of End of Life Options in California

California will have at least ten years to prove the efficacy and demonstrate the benefits of its End of Life Option Act. If Oregon’s 18-year experience and Washington’s 6-year experience are any indication, Californians may expect to see

• Improvements end-of-life care. In Oregon, the law has dramatically improved end-of-life care, particularly in pain management, hospice care, and support services for family members; Oregon consistently ranks as a top state in end-of-life care. Reports show that up to 97% of people using Oregon’s Death with Dignity law are on hospice at the time of death, as compared to 45% in the US overall, according to the National Hospice and Palliative Care Organization. The most significant impact of the death with dignity law in Oregon has been to improve the care for all dying patients, by increasing awareness among doctors, allowing an open and honest conversation, improving pain management and palliative care, and providing patients with a sense of control and peace of mind.
• Greater fluency in end-of-life care issues. Residents of states with Death with Dignity laws are better-versed in end-of-life care issues. Oregon and Washington residents are more knowledgeable and supportive of a variety of end-of-life options, including hospice and palliative care, than most Americans.
• More autonomy in end-of-life decisions. Many healthy Oregonians and Washingtonians today discuss end-of-life issues with their doctors and increasingly demand active participation and decision making in their own end-of-life care. Oregon and Washington doctors, as a result, today work harder to prolong patients’ lives and enhance quality of life, while respecting patients’ final wishes when their suffering becomes intolerable. Because of the law’s protections, most people know they won’t face abandonment by their doctors when the suffering becomes unbearable and use of the law is requested.
• Increase in support for Death with Dignity. Whereas the Oregon law was passed in 1994 by 51% of voters and affirmed in 1997 by 60%, today support for the option hovers around 80%. And, the law is uncontroversial.

Featured image by Wolfgang Staudt.