California Senate Bill 128 – the End-of-Life Option Act – would allow a terminally ill, mentally competent adult to request a prescription for aid-in-dying medication, which the patient can self-administer when they choose. An individual has a “terminal illness” if he or she has a medical diagnosis that the illness is expected to result in death in the next six months. SB 128 is based on the “Death with Dignity” laws in Oregon (1994) and Washington (2008).
The bill does not require anyone to request or take such medication, nor does it require physicians or other health care providers to participate if they prefer to opt out. Nor does it affect insurance policies: a carrier cannot change the price or decline to issue a policy based on whether or not an individual requests medical aid in dying. This applies for life, health, accident insurance and annuity policies. Additionally, SB 128 imposes criminal penalties on anyone who tries to coerce another person into requesting the medication. A person who requests aid-in-dying medication may rescind his/her request at any time.
SB 128 was approved by the Senate Health Committee on March 25th and will be heard by the Senate Judiciary Committee on April 7th.
Safeguards Against Abuses
SB 128 includes numerous safeguards to protect vulnerable populations and to ensure that no one is unduly pressured into choosing this end-of-life option:
- First, an attending physician must determine that the individual is “competent” to make an “informed decision.” The physician must refer the patient for psychiatric or psychological counseling if the physician thinks the individual is or may be depressed or suffering from a psychological disorder.
- Second, individuals must make two oral requests (which must be at least 15 days apart) and a written request for the medication. (SB 128 provides a request form.) The written request must be signed by at least two adult witnesses, and at least one of them must be a “disinterested” party (i.e., not a relative by blood, marriage or adoption; not entitled to any portion of the patient’s estate upon death; and not an owner, operator or employee at a health care facility where the individual is a patient or resident.) The attending physician cannot be one of the witnesses.
- Third, the bill imposes extensive procedural requirements on physicians, including:
- Confirming the patient’s diagnosis, prognosis, and mental state;
- Referring the patient to another physician for a second opinion;
- Documenting the patient’s request for aid-in-dying medication;
- Advising the patient of his/her right to rescind the request;
- Complying with extensive “informed consent” provisions, including advising of alternative options such as hospice or palliative care;
- Referring the patient for psychological counseling if applicable;
- Complying with extensive record keeping and reporting requirements.
No Effect on Insurance Policies
All insurance policies would have to pay benefits the same as if the person died a natural death from the underlying cause. Whether a person makes or rescinds a request for aid-in-dying medication cannot affect the sale or issuance of –or the rate charged for — a life, health, accident insurance or annuity policy.
For all legal and reporting purposes, the cause of death is the underlying illness. Additionally, SB 128 does not authorize a physician or any other person to end an individual’s life by legal injection, mercy killing, or active euthanasia.
Immunity from Civil, Criminal and Disciplinary Sanctions
A person who in good faith provides aid in dying to a terminally ill patient shall not be subject to civil or criminal liability or professional disciplinary sanctions. Health care providers cannot be charged with medical malpractice, neglect or elder abuse, nor can they be subject to disciplinary sanctions such as loss of hospital privileges (by a hospital that opposes the practice) or suspension or revocation of the medical license by the State Medical board.
Information collected shall be confidential and shall be collected in a manner that protects the privacy of the patient, the patient’s family and any medical provider or pharmacist involved with the patient.
California Senate Bill 128 (End of Life Option Act) was introduced January 20, 2015, by Senators Bill Monning and Lois Wolk. Principal co-authors are senators Jackson and Leno and Assembly Member Talamantes Eggman.