When Governor Brown signed the End of Life Option Act on October 5th, California became the fifth state to allow physicians to assist terminally ill individuals to end their own lives.

Governor Brown issued a signing message acknowledging that physician assisted death — even though the aim is to allow terminally ill individuals to avoid great pain and suffering at the end of life — requires us to grapple with fundamental ethical and religious issues.  Disability rights advocates had raised concerns that individuals with disabilities could be vulnerable under the law.  Doctors had raised concerns that the law would change the ethical foundation of the practice of medicine.  Ultimately, Governor Brown, a former Jesuit seminarian, concluded that he would sign the bill into law to give Californians greater personal autonomy over the circumstances of their death when death is imminent:

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 End of Life Option Act will be added to California’s Health and Safety Code in 2016.  The new law will allow a terminally ill California resident, who is 18 years of age or older, and who has capacity to make medical decisions, to voluntarily request and obtain a prescription for a drug to self-administer to end the individual’s life.   There are detailed, formal requirements governing what the individual must do to request the prescription (including making two oral requests — 15 days apart — and a written request to his or her attending physician).

There are numerous actions the attending physician must take before prescribing the aid-in-dying drug.  Among these, the attending physician must:

  • determine the individual has an incurable and irreversible disease that will, within reasonable medical judgment, result in death within six months
  • determine the individual has capacity to make medical decisions, is voluntarily making the request, and has followed the proper procedures under the Act to request the prescription
  • inform the individual about relevant facts about the individual’s medical diagnosis and prognosis and the aid-in-dying drug and confirm the individual is making an informed decision to obtain the drug

Numerous sections of The End of Life Option Act underscore that a terminally ill individual is to act completely voluntarily, free from the undue influence of others.  At its most basic level, the individual must “self-administer” the drug.  But there are other safeguards:

A request for a prescription for an aid-in-dying drug under this part shall be made solely and directly by the individual diagnosed with the terminal disease and shall not be made on behalf of the patient, including, but not limited to, through a power of attorney, an advance health care directive, a conservator, health care agent, surrogate, or any other legally recognized health care decisionmaker.

A provision in a contract, will, or other agreement executed on or after January 1, 2016, whether written or oral, to the extent the provision would affect whether a person may make, withdraw, or rescind a request for an aid-in-dying drug is not valid.

Knowingly coercing or exerting undue influence on an individual to request or ingest an aid-in-dying drug . . . is punishable as a felony.

The Act does not authorize a physician or any other person to end an individual’s life by lethal injection, mercy killing or active euthanasia.  The Act specifically identifies these acts as suicide, assisted suicide, homicide or elder abuse.

The dialogue surrounding the legalization of physician assisted death is intense because it raises core ethical and religious issues and highlights the need for appropriate safeguards to protect the vulnerable.  At the same time, many individuals question why the State would deny them the choice to avoid weeks of physical and emotional suffering at the end of their lives if they are dying from an incurable and irreversible disease.

California’s End of Life Option Act will allow terminally ill individuals to make choices at the end of their lives that are grounded in their own values and beliefs.