California Board of Registered Nursing

On October 5, 2015, Governor Jerry Brown signed the End of Life Option Act (Act) into law. The provisions [took] effect on June 9, 2016.

The law allows a California resident with a terminal illness and who complies with specified criteria to end his or life through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose. The law is very specific and contains procedures that physicians, pharmacists, and patients need to follow.



     What does the new California law do?


The law authorizes a resident of California

who is 18 years of age or older,

who has been determined to be terminally-ill

and mentally-competent, [sic: has capacity; competence is nowhere mentioned in act]

to make a request for a drug prescribed for the purpose of ending his or her life.



     What safeguards are included in the law?


The Act includes several safeguards, which are aimed at restricting access to patients who are terminally-ill and mentally-competent:

·                                 Two physician assessments are required. The attending and consulting physicians must each independently determine that the individual has a terminal disease with a prognosis of six months or less, and is able to provide informed consent. Elements of informed consent, including disclosure of relevant information, assessment of decisional capacity and assurance of voluntariness, are stipulated in the law.

·                                 If either physician is aware of any indications of a mental disorder, a mental health specialist assessment must be arranged to determine that the individual has the capacity to make medical decisions and is not suffering from impaired judgment due to a mental disorder.

·                                 The attending physician must provide counseling about the importance of the following: having another present when he or she ingests the aid-in-dying drug, not ingesting the aid-in-dying drug in a public place, notifying the next-of-kin of his or her request for the aid-in-dying drug, participating in a hospice program and maintaining the aid-in-dying drug in a safe and secure location.

·                                 The attending physician must offer the individual the opportunity to withdraw his or her request for the aid-in-dying drug at any time.

·                                 The individual must make two oral requests, separated by a minimum of fifteen days, and one written request for the aid-in-dying drug.

·                                 The written request must be observed by two adult witnesses, who attest that the patient is of sound mind and not under duress, fraud or undue influence.

·                                 The patient must make a final attestation, forty-eight hours before he or she intends to ingest the medication.

·                                 Only the person diagnosed with the terminal disease may request a prescription for the aid-in-dying drug (i.e., surrogate requests are not permitted).

·                                 The individual must be able to self-administer the medication.



     What are the documentation and reporting requirements?


The law explicitly stipulates a number of requirements for documentation in the patient’s medical record, largely corresponding to the safeguards above. In addition, the law creates two reporting obligations:

1.   Within 30 days of writing a prescription for an aid-in-dying drug, the attending physician must submit to the California Department of Public Health (CDPH) a copy of the qualifying patient’s written request, an attending physician checklist and compliance form, and a consulting physician’s compliance form.

2.   Within 30 days following the individual’s death, the attending physician must submit a follow-up form to CDPH. All forms will be posted on the CDPH and Medical Board websites.



     Is participation required?


No. Participation in the law is voluntary for all parties. Individual providers -- and institutions as well -- may make personal, conscience-based decisions about whether or not to participate.