California End of Life Option Act
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California End of Life Option Act is a law enacted in June 2016 by the California State Legislature which allows terminally ill adult residents in the state of California to access medical aid in dying by self-administering lethal drugs, provided specific circumstances are met. The law was signed in by California governor
Jerry Brown Edmund Gerald Brown Jr. (born April 7, 1938) is an American lawyer, author, and politician who served as the 34th and 39th governor of California from 1975 to 1983 and 2011 to 2019. A member of the Democratic Party, he was elected Secretary of ...
in October 2015, making California the fifth state to allow physicians to prescribe drugs to end the life of a terminally ill patient, often referred to as
physician-assisted suicide Assisted suicide is suicide undertaken with the aid of another person. The term usually refers to physician-assisted suicide (PAS), which is suicide that is assisted by a physician or other healthcare provider. Once it is determined that the p ...
. In May 2018, a state trial court ruled that the law was unconstitutionally enacted, but the following month, the law was reinstated by a state appeals court; the law was affirmed by the
California Supreme Court The Supreme Court of California is the highest and final court of appeals in the courts of the U.S. state of California. It is headquartered in San Francisco at the Earl Warren Building, but it regularly holds sessions in Los Angeles and Sac ...
.


History

Previous similar bills have been rejected on at least four other occasions in the state of California and residents voted against a proposal in a ballot in 1992, however a report published by Compassion and Choices collating more recent regional and national independent opinion polls on the right to die issue shows that the US public consistently supports or strongly supports medical aid in dying. Criticism has also come from Life Legal Defense Foundation who have stated that there is no way to tell whether the process is voluntary or whether some degree of persuasion may be involved. In January 2015, Senate
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128 was introduced by Democratic Senators
Lois Wolk Lois Wolk (born May 12, 1946) is an American politician and former member of the California State Senate. A Democrat, she represented the 3rd Senate District, which encompasses the Sacramento–San Joaquin River Delta region and portions of th ...
and
Bill Monning William Wheeler Monning (born April 2, 1951) is an American politician who was elected to the California State Senate in 2012. A Democrat, he served in the 17th Senate District which encompasses the Central Coast. Monning was reelected to the ...
, eventually becoming ''PART 1.85. End of Life Option Act'' added to Division 1 of the California Health and Safety Code. The act includes definitions and procedures which must be fulfilled, a statement of request for aid-in-dying drugs which must be signed and witnessed and a final attestation of intent signed 48 hours before self-administering the drug. The bill was initially revealed by the family of
right to die The right to die is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Possession of this right is often understood that a person with a terminal illness, incurable pain, or without ...
advocate Brittany Maynard, the 29-year-old
terminally ill Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient. This term is more commonly used for progressive diseases such as cancer, dementia or advanced h ...
campaigner who had exercised her right to die in the state of
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in November of the previous year, and who had partnered with Compassion and Choices to become the public face of the right to die campaign. Maynard had been a resident of California, her family pointing out she would have preferred to die at home. The bill was modeled on
Oregon Oregon () is a state in the Pacific Northwest region of the Western United States. The Columbia River delineates much of Oregon's northern boundary with Washington, while the Snake River delineates much of its eastern boundary with Idaho. T ...
's Ballot Measure 16 Death with Dignity Act which has been in force since 1994, after the
California Medical Association The California Medical Association (CMA) is a professional organization based in California that advocates on behalf of nearly 50,000 physicians in legislative, legal, regulatory, economic, and social issues. The organization was founded in 1856 ...
, which represents physicians in the state, withdrew its longstanding opposition on May 20, 2015, by the recommendation of its Council of Ethical Affairs. In the run up to its enactment the bill received considerable opposition from religious organizations including the Catholic archdiocese and in July 2015 the bill was held up as it did not receive the required number of votes to proceed to the assembly health committee. The California End of Life Option Act was signed into law by Governor
Jerry Brown Edmund Gerald Brown Jr. (born April 7, 1938) is an American lawyer, author, and politician who served as the 34th and 39th governor of California from 1975 to 1983 and 2011 to 2019. A member of the Democratic Party, he was elected Secretary of ...
on October 5, 2015, with Brown taking the unusual step of releasing a personal statement in which he indicated his dilemma regarding the consideration of the ethical issues involved and that he felt unable to deny the right of choice to others. The law went into effect on June 9, 2016, making California the fifth state to have a law enabling some of its residents to die of their own volition at a time of their choosing, after Oregon, Washington, Montana, and Vermont. Because the bill was passed during a special session, it did not take effect until June 2016. By the end of 2016, 250 people had exercised the right to begin the process, 191 received a prescription for the medication, of whom it is known 111 took their own lives, 21 dying of natural causes.


Procedure

The law requires that an individual must be over the age of 18 and possessing full capacity to make an independent decision to end their own life, as well as be able to administer the drugs themself. Participation in all aspects of the bill is voluntary for all involved and the application must be made to both an attending and consulting physician with a gap of no fewer than 15 days, and should either physician request one, a mental health specialist such as psychiatrist or licensed psychologist. The patient must also be certified by the physician as having a life limiting illness with estimated less than 6 months to live and other
palliative care Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wit ...
options must have been previously discussed and considered. The law does not specify which drugs must be prescribed. Under the provisions of the law, if a person chooses to die in this manner, their
death certificate A death certificate is either a legal document issued by a medical practitioner which states when a person died, or a document issued by a government civil registration office, that declares the date, location and cause of a person's death, as ...
only lists their underlying illness as the cause of death; no mention is made of the act or of suicide. According to CNN, this is done to protect
patient confidentiality A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health ...
, in addition to avoiding potential legal complications regarding the decedent's estate and life insurance that may arise when a death is registered as a suicide.


Reception

California residents who have spoken to the media to publicize the law and are known to have exercised their right to die include: ex-
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and homeless charity worker Robert Stone, former Marine and insurance broker Tom House, right-to-die campaigner Brittany Maynard who moved to Oregon to be able to fulfill her right to die, retired psychologist Tom Minor who initially failed to find a doctor to support him and Democratic politician Warren Church. It has been suggested that the bill may exclude Californians based on income and medical care coverage, with Medicare and other insurers not covering the cost of barbiturates to end life. Death With Dignity estimates the cost can reach $5,000 as of 2017. Given that the cost for such drugs per individual runs between $1.50 and $50 compared to the inordinate cost of treatment for complex, life-threatening diseases like cancer, other critics express concern about disenfranchised Californians choosing assisted death because other options are too expensive. The law nevertheless makes overt coercion or deception of patients a
felony A felony is traditionally considered a crime of high seriousness, whereas a misdemeanor is regarded as less serious. The term "felony" originated from English common law (from the French medieval word "félonie") to describe an offense that resu ...
.


See also

*
Act 39 Act 39 of 2013 established the U.S. state of Vermont's Patient Choice and Control at End of Life Act ( Vermont Statutes Annotated Sec. 1. 18 V.S.A. chapter 113), which legalizes medical aid in dying (commonly referred to as physician-assisted suici ...
in
Vermont Vermont () is a state in the northeast New England region of the United States. Vermont is bordered by the states of Massachusetts to the south, New Hampshire to the east, and New York to the west, and the Canadian province of Quebec to ...
*
Assisted suicide in the United States Assisted suicide is suicide with the aid of another person. In the United States, the term "assisted suicide" is typically used to describe what proponents refer to as medical aid in dying, in which terminally ill adults are prescribed and self- ...
* ''
Baxter v. Montana ''Baxter v. Montana'', is a Montana Supreme Court case, argued on September 2, 2009, and decided on December 31, 2009, that addressed the question of whether the state's constitution guaranteed terminally ill patients a right to lethal prescript ...
'' * Compassion and Choices *
Death with Dignity National Center Death with Dignity National Center is a 501(c)(3) nonpartisan nonprofit organization, headquartered in Portland, Oregon, that has led the legal defense of and education about Death with Dignity laws throughout the United States for more than ...
*
Final Exit Network Final Exit Network, Inc. (FEN) is an American 501(c)(3) nonprofit right to die advocacy group incorporated under Florida law. It holds that mentally competent adults who suffer from terminal illnesses, intractable pain, or irreversible phys ...
*
Medical aid in dying in the United States Assisted suicide is suicide with the aid of another person. In the United States, the term "assisted suicide" is typically used to describe what proponents refer to as medical aid in dying, in which terminally ill adults are prescribed and self- ...
*
Oregon Death with Dignity Act Measure 16 of 1994 established the U.S. state of Oregon's Death with Dignity Act (ORS 127.800–995), which legalizes medical aid in dying (commonly referred to as physician-assisted suicide) with certain restrictions. Passage of this initiativ ...
*
Washington Death with Dignity Act Initiative 1000 (I-1000) of 2008 established the U.S. state of Washington's Death with Dignity Act ( RCW 70.245), which legalizes medical aid in dying with certain restrictions. Passage of this initiative made Washington the second U.S. state to ...
* Euthanasia in Australia *
Voluntary Assisted Dying Act 2017 (Victoria) {{use Australian English, date=December 2017 {{Use dmy dates, date=August 2017 {{Infobox legislation , short_title = Voluntary Assisted Dying , legislature = Parliament of Victoria , image = , imagesize = , ...


References


External links


Information on the End of Life Option ActDeath With Dignity explanation of the law for patientsEnd of life information in California
{{suicide navbox 2016 in California Assisted suicide in the United States United States state health legislation California law Euthanasia legislation