Basic Overview

Hi there. My name is Bridget Mackay. I’m an attorney in Petaluma, California. I practice in the area of estate planning and elder law. You have joined me now for my first part in my four-part series about the End of Life Options Act that California will be implementing June 9th of 2016.

My first part is going to be covering the basics of this act. The act allows that if a qualified individual who is an adult with the capacity to make medical decisions and with a terminal disease they may make a request to receive a prescription for an aid-in-dying drug if all the following conditions are satisfied.

The first condition is, the individual’s attending physician, your regular doctor, has diagnosed you with a terminal disease with which you are likely to die within six months.

The second part, or the second requirement, is the individual has voluntarily expressed the wish to receive a prescription for an aid-in-dying drug. These requests can be made orally to your physician but they must be made 15 days apart.

The third requirement is, this individual has to establish that they’re a resident of California.

The fourth, the individual documents his or her request by two witnesses, only one of whom can be a family member. You have to ask twice, and then you have to make a written request. The state has developed a form for this. The state request form is titled “Request for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner.” That’s an actual form that they would need to fill out. It can be witnessed… It needs to be witnessed by two people, only one of whom can be a family member.

The fifth requirement of the act is that the individual has the physical and mental ability to self-administer the aid-in-dying drug. In the act, it defines a terminal disease as an incurable and irreversible disease that has been medically confirmed and will within reasonable medical judgment result in death within six months. That’s what terminal disease means for the act. What does medically confirmed mean? Well, in order for the disease to be medically confirmed, it needs to be diagnosed by both an attending physician and a consulting physician. You basically need two doctors to confirm. And medically confirmed means those two doctors need to give a medical diagnosis and prognosis and say that they’ve examined you and your relevant medical records to say that you satisfy terminal disease. It’s a terminal disease that will, reasonably you’ll die from within six months.

Those are the basics of the act. The next three series are going to be more about how is it implemented and what does it mean. So please stay tuned and find out what this earth-shattering law is going to mean to citizens in the State of California.

Prescription Requirements

Hi there, Bridget Mackay here. I’m an attorney in Petaluma, California, and I practice in the area of estate planning and elder law. You have joined me today for my second in a four-part series of video blogs regarding California’s End Of Life Option Act, which is going to be implemented June 9th, 2016.

In part two, I’m going to address what are the requirements to get a prescription to end your life. For those who qualify and who want to exercise their end-of-life option, they would need to first establish that they are California residents. If you saw my basics video blog, this is one of the requirements of the Act. Then you need to be diagnosed with an incurable and irreversible disease that will result in death within six months if gone untreated, which is important. If it goes untreated.

The determination they make will need to have come from your attending physician as well as a consult from another doctor. They have to agree on this diagnosis. Then once you have that, you need to request this option verbally to your doctor twice, with the request being made 15 days apart. Once that happens then you also have to request it in writing. Once you request it in writing you can do it with a form, ironically. The form is named, “The Request for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner.” You don’t have to figure out what you’re going to write to the doctor for this request, it’s done for you. The State of California has developed this form. This document needs to be signed by you, or whoever is doing this, and at least two witnesses, only one of which can be related to you.

Then your doctor then needs to do a second assessment, this is different than the terminal disease, to see if you have the physical and mental ability to administer the drugs to yourself. And then a second physician needs to confirm this assessment. As you can see, there’s a lot of doctor confirmations for this and sometimes different than Dr. Death. You know this isn’t a doctor administered prescription. You’re administering it to yourself and you need to have the physical and mental capacity to do so.

To find out more, please stay tuned for our part three in the series in which we’re going to cover the topic of, how is the prescription administered, so we know that you have to administer it, but are there some requirements around it?

Law For Administering Prescription Drug

Hi there. My name is Bridget Mackay, I’m an attorney in Petaluma, California, and I practice in the area of estate planning and elder law. You are joining me for part three of a four-part series on the End of Life Option Act, which California is implementing on June 9th, 2016.

We’ve covered the basics, we’ve covered about how you get the right-to-die prescription, and now we’re going to talk about how this prescription is administered. If you have reached all of the other requirements needed in the act, your doctor then can prescribe the end-of-life option drugs. Your doctor must assess whether you, the person requesting it, has the physical and mental ability to self-administer the lethal drug.

Then a second physician must confirm that same diagnosis, and that the patient’s capacity to make these medical decisions before a prescription can be filled. So the law makes clear in the act that we’re not legalizing euthanasia. Patients must be able to take the life-ending drugs themselves. A final attestation is required within 48 hours before the medication is used, confirming that the patient is choosing to do this to themselves. Then following the application of the drugs and the death of the patient, that form must be given to the prescribing physician who prescribes the drugs, or if it didn’t take place, the drugs must be returned.

Family and friends who are present for the administering, self-administration of the drugs by the patient for the death are cleared of liability, and someone can prepare the medication but they are not allowed to help the patient ingest it. That’s a clear distinction in the law. A family member or caregiver can prepare the drugs but the patient has to be able to self-administer it or ingest it themselves. That is, how is the prescription administered.

Part four is next. We’re going to talk about what are some of the protections under this act for the patient and others, and what’s been built into this law. Stay tuned because June 9th is coming up and it brings up a lot of ethical, medical, and social issues with the Right-to-Die Options Act.

Built In Protections

Hi there, Bridget Mackay here, and I’m an attorney in Petaluma. I work in the area of estate planning and elder law. You are joining me for my final part in a four-part series on the End of Life Options Act, which California is implementing on June 9th of this year. The final series, we’re going to talk about what protections are in this law. The authors of the law assert that the system includes enough steps and safeguards to prevent abuse such as inheritors trying to expedite the death of an elderly relative. They point to the example of Oregon, where assisted death has been legal for nearly 20 years with no recorded cases of misuse. In the law, physicians must inform the patient that he or she may rescind the request for an aid in dying drug at anytime and in any manner so at any point, the patient can stop this process from happening.

Furthermore, as you’ve learned from our earlier video blogs, the request for a prescription cannot be made on behalf of a patient through an agent under a power of attorney, or an agent under an advanced healthcare directive, or a conservator, or any other person. The request for the prescription needs to be made by the patient themselves, and the law does make it a felony to forge requests for a prescription, coerce someone into requesting the life-ending medication, or administer it without their consent. Those are all huge violations of the act, and whoever does it is exposed to a felony criminal charge.

Also, at any moment, a patient can also withdraw their request, and health insurance carriers are not allowed to provide any information about assisted-death options unless someone asks for it. It’s really a law that’s based on everything coming from the patient, all the decision making, even administering the drug. Furthermore, California Medical Association has come onboard and issued guidelines to physicians on writing prescriptions of lethal doses of drugs for terminally ill patients. There is some comfort in knowing that physicians throughout the state are getting some guidance through the California Medical Association, although the new law does leave some questions unanswered for physicians including what the physician writes on the death certificate, and the law is silent as to what the cause of death should be identified on the death certificate.

It does say, taking an aid in dying drug shall not constitute suicide. If suicide is not the reason of death on the death certificate, a lot of discussion among physicians would be the underlying diagnosis that led this patient to a decision to end their life early because of a terminally ill diagnosis. The discussion is that what is on the death certificate will be whatever that terminally ill diagnosis was. The guide also says physicians can list the cause of death as they feel what is most accurate, including the underlying terminal illness, like I said, or just write, “pursuant to the End of Life Options Act.” This is all something that’s going to be figured out as we implement the law, and there have been people who have done it and precedence. All of you who maybe are just tuning in now, please look at earlier video blogs, where I discuss the basics of the act, who does it cover and how, the second is on the requirements to get a prescription, and the third is how the prescription is administered. Thank you.