Gov. Jerry Brown signed a measure this week that makes it legal for physicians to prescribe lethal doses of drugs to terminally ill patients.
The End of Life Option Act makes California the fifth right-to-die state in the nation, after Oregon, Washington, Vermont, and Montana, where it was allowed by court decision. California’s right-to-die law was modeled after landmark legislation passed in Oregon in 1997.
Here is how California’s law is expected to work:
Q. What is allowed under the End of Life Option Act?
A. The law will give terminally ill adults in California the option to end their lives by swallowing lethal doses of physican-prescribed drugs. For a patient to receive the drug, two doctors must confirm the patient’s prognosis of six months or less to live and determine that the patient is mentally competent to make informed health care decisions. The patient must then make two oral requests 15 days apart, and one written request, to a physician for assisted death, with witnesses to all requests.
Patients must be able to self-administer the drugs. Under this law, it is a felony to coerce a patient into making a request or to forge such a request. A request can only come from the patient and cannot be made on the patient’s behalf through any means, including power of attorney, advance health care directive, conservator, health care agent, surrogate or any other legally recognized health care decision maker.
Q. When will this law go into effect?
A. The exact date is unclear. It is set to become effective 90 days after the Legislature adjourns its special session on health care, but that might not be until next year. At the earliest, the special session, which began in June, will be adjourned in January. But, it might extend late into 2016.
Q. Is a physician, hospital or pharmacist required to participate?
A. No. Participation is voluntary. Hospitals and health care providers are not required to provide prescriptions for the lethal drugs to qualified patients. Physicians also are not required to provide patients with referrals. The act states that a health care provider or professional organization shall not subject a physician to any type of action or penalty for participating in good faith or for refusing to participate.
Q. Are doctors penalized for being present when the drug is administered?
A. The law only requires that a patient self-administer and ingest – swallow – the drug. It does not require a doctor to be present when the patient self-administers the drug. But it does not prohibit a doctor from doing so. A physician cannot, however, administer the drug to the patient.
Q. Does this law allow euthanasia?
A. No. The law does not authorize a physician or any other person to end an individual’s life by lethal injection, mercy killing, or active euthanasia. Under this law, the patient would self-administer the drug.
Q. Who monitors and enforces this law?
A. The California Public Health Department is required to review a sample of records annually and adopt regulations establishing reporting requirements for physicians and pharmacists. The reporting requirements will be designed to collect information about how this law is used while protecting the privacy of patients and their families and medical providers.
Q. How is “mental capacity” determined?
A. Under this law, mental capacity is defined as the ability to make decisions about your own health care as determined by your doctor. Essentially, if the physician believes that the patient understands the nature and consequences of a health care decision, then that patient is deemed competent. He or she must be able to comprehend the benefits, risks and alternatives, and have the ability to make an informed decision, and communicate that decision, to health care providers.
Q. Can the patient change his or her mind?
A. Yes, a patient can rescind a request at any time and in any manner. The physician also will offer the patient an opportunity to rescind his or her request at the end of the 15-day waiting period following the patient’s initial oral request to participate.
Q. How will the law be evaluated or changed?
A. The law was passed after its authors added a sunset provision, meaning lawmakers must vote to renew the bill in 10 years. As with any other law, it can be amended and could go through changes in the next decade. If not renewed, the bill would be repealed Jan. 1, 2026.
Q. Does this law change the nature of medicine?
A. Dr. Sudeep Kukreja, past president of the Orange County Medical Association, said The End of Life Option Act doesn’t change the practice of medicine in a significant way. It may affect palliative care doctors – who focus on relieving pain and reducing stress for critically ill patients – more than others, simply because they may encounter more patients seeking this option, he said. For physicians in general, there is nothing more to do other than understanding the procedures involved, Kukreja said.