CALIFORNIA
END OF LIFE OPTION ACT
SAFEGUARDS
TO FULFILL TO QUALIFY FOR HELP IN DYING
In its
first six months of operation, beginning
in June 2016,
about 100 dying patients used
California's new
right-to-die law.
https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CDPH%20End%20of%20Life%20Option%20Act%20Report%20-ADA.pdf
The link just above
gives full details for that first 6-1/2 months of operation.
Less than 1 dying patient out of 1,000 used this method of managing
dying.
The law itself does contain an
application form.
And all of the safeguards
listed below
are found in various sections
of the law.
Here is the text
of the
original bill, as proposed in 2015.
This presentation shows the safeguards in their original locations.
And it does link to the revised version of the bill,
which became the End of Life Option Act in 2016.
The
following list of California's
safeguards
begins with the most
important.
Patients considering using
California's End of Life
Option Act
can begin the application
process at any time
by gathering written
documentation
that the following 11 safeguards have been fulfilled.
The general
explanation of each safeguard (on the
Internet) is linked first.
Then there are some specific
ideas for creating that document for California.
Suggestions
for improving this
presentation are welcome.
Readers of other presentations of California's
safeguards
will note that this account goes beyond the minimum requirements.
Safeguards can be used as a creative exercise
in making the wisest possible end-of-life decisions.
B. REQUESTS
FOR
DEATH FROM THE
PATIENT
The dying patient makes explicit, written requests
for death.
In California there must be oral and written requests,
separated by meaningful periods of time for further reflection.
These requests must come from the patient
---not any proxies or family members.
The requests for death should refer to the doctors' statements below,
which will include the medical details of the illness or condition.
D.
PHYSICIAN'S
STATEMENT
OF CONDITION AND PROGNOSIS
The doctor most in charge of the terminal care for
the patient
issues a written summary of the medical condition of the patient.
This doctor should also indicate how long the patient has been sick,
what treatments have been tried, their results, etc.
When the terminal-care physician
is different from the primary-care
physician,
they should coordinate their statements
of the patient's condition and
prognosis.
E. INDEPENDENT
PHYSICIAN REVIEWS THE CONDITION AND PROGNOSIS
A second doctor, perhaps a specialist in the major
problem of the patient,
also examines the patient and issues a summary statement.
The second doctor should also read all relevant parts of the medical
record.
If this second analysis differs from the first,
such professional differences should be resolved
before any plans for death go forward.
F.
CERTIFICATION
OF TERMINAL ILLNESS OR INCURABLE CONDITION
The End of Life Option Act requires the patient
to
have a disease or condition likely to cause death within 6 months.
This life-expectancy is projected by the doctors involved in the
patient's care.
J.
INFORMED
CONSENT FROM THE PATIENT
The patient must be able to understand the medical
problems
and the likely outcomes of various treatments still possible.
The patient might show informed consent for the life-ending decision
by creating a written statement explaining the medical background
in the patient's own words
and affirming that a voluntary death is now the best option.
U. WAITING
PERIODS FOR REFLECTION
The California End of Life Option Act has built-in
waiting periods.
Their purpose is encourage re-thinking of the life-ending
decisions.
The process of deciding to end the patient's life
must be spread over meaningful periods of time.
Fulfilling the other safeguards will also add to the length of time
for everyone involved to consider and re-consider the plans for death.
V.
OPPORTUNITIES
FOR THE PATIENT TO RESCIND
OR
POSTPONE
ANY LIFE-ENDING DECISIONS
And there must be documented opportunities
or the
patient to change course
or to give up the life-ending decisions entirely.
Does the patient continue to affirm the plans for death
at each opportunity to postpone or abandon the decision to die?
X.
COMPLETE
RECORDING AND SHARING
OF
ALL
MATERIAL FACTS AND OPINIONS
The process of planning this patient's death
should be recorded in each of its documents.
Careful attention should be paid to distributing the documents
to everyone who has legitimate right
to take part in the end-of-life
deliberations.
Y.
THE
PATIENT MUST BE CONSCIOUS AND ABLE TO ACHIEVE DEATH
Because the California End of Life Option Act
depends on the inherent right of the patient to give up his or her
life,
no one else may perform the
final act that brings death.
The "aid-in-dying drug" must be taken by the patient.
This means that the patient must be conscious and capable
up to the last moment of life.
AA
Information
about
Palliative Care and other Alternatives to Death
In order to make a reasonable life-ending decision,
the patient should have considered in advance
all of the other ways of responding to the disease or condition.
Were other forms of medical care and treatment offered?
What forms of palliative care were actually tried?
A separate document about such efforts
and all such information might be
created.
DD
The
Patient
Must be an Adult Resident of the State
California, like most other right-to-die states and
countries,
does not want to become a death-destination for non-residents.
There are various ways to prove that the patient is a resident of
California.
And the candidate-for-death must also be at least 18 years of age.
By this
count, there are 11
safeguards
embedded in California's right-to-die law.
The letters for each safeguard
come from the complete list of 26
recommended
safeguards.
And they retain their letters from
that comprehensive list of
safeguards.
In especially difficult cases, it
might be wise
to use some additional safeguards from these 26
as ways of making certain that a voluntary death
is the best pathway towards death for this dying patient.
If you would like
to see these safeguards in their original context,
here they are highlighted
in
the original bill in 2015.
This presentation also organizes the safeguards (as listed above)
and makes some suggestions for improving the California law.
Suggestions for
improving the above explanations are
welcome,
both concerning the general explanations on the Internet
and the specific procedures for applying for the right-to-die in
California.
Send responses and questions to James Park by e-mail:
parkx032(CAPS2)umn.edu.
Created
October 14, 2015; Revised 10-15-2015; 11-13-2015; 8-20-2016; 8-22-2016;
4-3-2018;
FURTHER READING AND MORE SAFEGUARDS
If
added to California's law,
this
safeguard would make the law even stronger and more careful.