On a warm night in July in Mission Valley, the Daughterhood San Diego chapter held a Circle to learn more about California’s End Of Life Option Act, the medical aid in dying law that went into effect on June 9, 2016. This law allows terminally ill adults with fewer than six months to live to make the choice to end their own life, provided certain conditions are met. Daughterhood San Diego welcomed guests who have already witnessed this law in use in order to expand the Circle’s knowledge as daughters, family members and caregivers.
The California End Of Life Option Act, the fifth such law in the country, went into effect on June 9th. A terminally ill adult, with a diagnosis of fewer than six months to live, can invoke this law to obtain aid-in-dying medication from a physician who is eligible and willing to prescribe it. Naturally, there are many conditions and caveats that must be met by the patient, and the process itself is not a simple one. In order to request the prescription for the aid-in-dying drugs, a person must be:
- An adult
- A California resident
- Terminally ill with a prognosis of less than six months to live
- Competent to make their own medical decisions
- Able to voluntarily and without influence or coercion request the prescription
- Able to administer the aid-in-dying drug to themselves, whether they eat, drink, or inject it
- Making a decision informed by a review of all the other options available
Assuming all these conditions are met, the process to request the prescription isn’t simple, either. On their own, the patient must:
- Make two verbal requests directly to his or her doctor – no sooner than 15 days apart
- Also make one written request, using the Patient’s Request for Aid-in-Dying Drug form (PDF), signed by the patient and two witnesses. This form must be given directly to the attending physician, and neither of the witnesses can be beneficiaries of any of the patient’s estate or legacies.
- Discuss the request with the attending physician alone so the physician can be sure the decision is voluntary.
- Then see a second physician known as the “consulting physician” so he or she can confirm the patient’s diagnosis, prognosis, and competence to make medical decisions.
- Discuss one more time with his/her doctor: the other treatment options available, the palliative options available (such as hospice care), whether the patient really wants to proceed, and how the patient plans to carry out the next and final steps
Once the patient obtains the prescription, they must sign one final form right before taking the medication that ensures the entire process was voluntary and fully informed.
One of the guests in attendance at the Daughterhood San Diego circle on July 19, 2016 was Dr. Bob Uslander, a concierge physician based in Del Mar who specializes in hospice, palliative, and integrated end of life care for the elderly. Dr. Bob shared his experiences with the California End Of Life Option Act, and his realization that the overwhelming majority of physicians have opted out of making themselves available to be the second, consulting physician without whom patients can’t enjoy their rights under this law. One aspect of the law is that physicians are not required to participate, if they choose, for reasons of conscience. Some physicians who endorse the law as individuals belong to hospitals or practices whose legal teams are unwilling to let any members take part in a process so new and untested in court. This scarcity makes physicians like Dr. Bob, as he prefers to be called, a valuable resource to the terminally ill community. He also told the Circle that the cost of the aid-in-dying drug was prohibitive, currently $3500 to $4200 in his recent experience, and that insurance will not cover this expense.
The process is deliberately complicated, and that can present difficulties for patients who meet all the criteria but don’t have a support network to help them jump through all the hoops. That’s where Compassion & Choices CA and volunteers like Lynne Calkins come in. The Circle’s other welcome guest and a longtime nurse, Lynne shared her own experience with the law, and how Compassion & Choices can help patients meet the requirements. Compassion & Choices provides information, videos and resources to doctors and patients, including a list of doctors offering end of life care. Lynne mentioned several useful websites including endoflifeoption.org, the California Department of Public Health website, and Death Café.
Daughterhood San Diego offers connection, information, and encouragement to the daughters and family caregivers in its Circle. We welcome you to learn more about us, join our mailing list, and put our next meeting on your calendar at Daughterhood San Diego’s Facebook page.