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Physician Aid in Dying

The following information about California's End of Life Option Act (EOLA) and the physician aid in dying (AID) process is provided to help UC San Diego Health patients and their loved ones understand how this law works.

End of Life Option Act

The End of Life Options Act (SB 128) went into effect on June 9, 2016. It allows California residents who are at least 18 years old and have a terminal illness with life expectancy of 6 months or less to request a medication that will hasten their death.

This practice is also known as "death with dignity" or "physician (doctor) aid in dying." It is not the same as euthanasia, which involves a doctor actually administering drugs to end a patient's life. Euthanasia is not legal in the U.S.

People who wish to exercise this aid in dying option must maintain their decision-making capacity and must independently make this request to a physician. They also must be able to ingest the medication on their own.

Under this law, physician aid in dying (AID) is not considered suicide. Participation in this end-of-life option is voluntary for patients, doctors and staff.

Physician Aid in Dying (AID) Process at UC San Diego Health

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How to Begin the Process

If you are a UC San Diego Health patient, ask your physician about your treatment options. Your physician is dedicated to making sure that your treatment matches your goals.

When it has become clear that you are in the final months of life, there are several options to consider. Pain and discomfort can, in most cases, be managed by a palliative care team, or hospice care can bring services into your home that enhance comfort and quality of life.

Only the individual can decide if and when their own quality of life has become so poor that physician aid in dying seems to be the best option to end one's own life in a humane and dignified manner.

When you're ready, you should begin with a frank discussion with the physicians who knows you best. Physicians who do not participate in the AID program are not obligated by law to act on your request.

If your physician does not prescribe the aid-in-dying drug, you can ask members of your medical team to connect you with an AID consultant who will give you more information. No member of our medical team is obligated by law to participate, so only medical professionals and staff who are voluntarily participating will assist you.

Working With an AID Consultant

Once you make a request for the aid-in-dying drug, your physician or other health care provider will refer you to an AID consultant — a specially trained social worker — for a collaborative consultation.

The AID consultant will help you understand what you need to do to obtain the aid-in-dying medication. The consultant will also ensure that all the appropriate requests, notes and paperwork are completed and filed in your medical record prior to drug prescription.

AID consultants want to make this process as easy as possible for you. If you choose to include your family, the consultant will also support them. You are invited to include one or more of your family members, a caregiver, or a close friend in the process.

The law also permits physicians and other members of the health care team to decline to participate. If this is the case at UC San Diego Health, an AID consultant will help you find a doctor to help you go through this process. 

Making the Request

An attending physician will see you twice at least 48 hours apart and verify that you continue to meet the aid-in-dying requirements under the law. You must make a verbal request at each visit that you want the life-ending drug.

Your attending physician is also required to have at least one conversation with you alone, with no other friends or family members present. This is to ensure you are making the request independently and voluntarily. The attending physician is the one who writes the prescription once the process has been completed.

At one of these appointments, you must submit a form titled "Written Request for An Aid-In-Dying Drug to End My Life in a Humane and Dignified Manner."  This form must be signed by two witnesses who know you and are attesting to the fact that you are making this request on your own. Only one of these witnesses can be a family member. Your physician or the AID consultant can give you this form.

The law also requires that you make a verbal request to a second physician, called the "consulting physician," who is independently assessing that you qualify for the End of Life Option Act (EOLA), including your diagnosis, prognosis, mental state and independence.

If for any reason you are not eligible for the EOLA at the time you initially ask about it, your physician can help you obtain other services to address your needs, and may re-evaluate you at a later date if your condition changes.

The above process can take up to several weeks depending on appointment availability and the time it takes to get the medications.

About the Medications

The following information is subject to change.

Most private insurances do not cover the cost of aid-in-dying medications. However, Medi-Cal usually will. The pharmacist will always check to see if your insurance plan covers the cost. The prescription will be sent directly to the pharmacy, not given to you.

  • You must be able to ingest the medication independently.
  • You must be able to ingest about 4 to 6 ounces of liquid by mouth or feeding tube. The medication results in sleep, usually within a few minutes, followed by death within a few hours.
  • It can take 2 to 4 days to get the medication once the prescription has been written.
  • Remember, you have the right change your mind about taking the medications at any time, even after obtaining them. You always have the right to stop the process at any time.
  • No one should administer these drugs to you. Another person may assist in preparing the medication for you to take. However, if you decide to take them, you must ingest them on your own.

If you obtain the medications, the pharmacist will review proper storage and handling of them.  Be sure to keep them in a safe place in your home, preferably locked up, and arrange for them to be safely disposed of if unused.

The law does not allow taking these drugs in a public place, and they may not be taken on any UC San Diego Health premises. You are allowed to take them at home or in your yard. If you are at a nursing facility or out-of-home placement, check with your agency if ingestion is allowed on their property.

Other Considerations

The impending death of a loved one is often a time of high and conflicting emotions and values. Most people understand the desire to limit or end suffering, but the loss of a loved one is still a very difficult reality to cope with. Some things to consider are:

  • Who do you want to know about your interest in aid in dying?
  • Have you shared your thoughts with anyone in your family, or with friends?
  • Do you want to have family or friends present at the time of your death?
  • Are you feeling pressured to pursue aid in dying so as not to burden your loved ones?
  • Is there a conflict with family members about your interest in aid in dying?
  • Your AID consultant is a trained clinical social worker who can help you address these issues so you don't face them alone.

Completing the Process

For the process to move along in as smooth and timely a manner as possible, your AID consultant must be able to keep in regular contact with you.

If you change your mind and decide not to pursue aid in dying, please inform your AID consultant. It is your right to change your mind and stop the process at any time.

Checklist of Steps to Complete the Process

  1. Initial appointment with an "attending physician" for aid in dying, at which you make your first formal verbal request for the life-ending drug
  2. Consulting physician visit to verify that you qualify
  3. Second visit with the attending physician (at least 48 hours after your first appointment)
  4. Submittal of your signed witnessed written request for aid in dying on form provided to you
  5. Appointment with a mental health specialist if requested by either the attending physician or consulting physician to determine if you have the ability to make this decision for yourself
  6. Attending physician sends the prescription to a pharmacy. You can leave the prescription at the pharmacy if you are not ready to fill it yet, but want the option of filling it at a later date. 
  7. Enrollment in hospice care prior to ingesting the medication is strongly recommended
  8. Before ingesting the medication, think about personal considerations and your desires of how you want the day to go and communicate with your caregivers/loved ones
  9. Having someone in attendance with experience to help you on the day of ingesting the medication is strongly recommended