Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
This part shall be known and may be cited as the End of Life Option Act.
Part 1.85 - End of Life Option Act
California Health and Safety Code — §§ 443-443.22
Sections (16)
Amended by Stats. 2021, Ch. 542, Sec. 1. (SB 380) Effective January 1, 2022.
As used in this part, the following definitions shall apply:
(a)“Adult” means an individual 18 years of age or older.
(b)“Aid-in-dying drug” means a drug determined and prescribed by a physician for a qualified individual, which the qualified individual may choose to self-administer to bring about their death due to a terminal disease.
(c)“Attending physician” means the physician who has primary responsibility for the health care of an individual and treatment of the individual’s terminal disease.
(d)“Attending physician checklist and compliance form” means a form, as described in Section
443.22, identifying each and every requirement that must be fulfilled by an attending physician to be in good faith compliance with this part should the attending physician choose to participate.
(e)“Capacity to make medical decisions” means that, in the opinion of an individual’s attending physician, consulting physician, psychiatrist, or psychologist, pursuant to Section 4609 of the Probate Code, the individual has the ability to understand the nature and consequences of a health care decision, the ability to understand its significant benefits, risks, and alternatives, and the ability to make and communicate an informed decision to health care providers.
(f)“Consulting physician” means a physician who is independent from the attending physician and who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding an individual’s terminal
disease.
(g)“Department” means the State Department of Public Health.
(h)“Health care provider” or “provider of health care” means any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code; any person licensed pursuant to the Osteopathic Initiative Act or the Chiropractic Initiative Act; and any person certified pursuant to Division 2.5 (commencing with Section 1797) of this code.
(i)“Health care entity” means any clinic, health dispensary, or health facility licensed pursuant to Division 2 (commencing with Section 1200), including a general hospital, medical clinic, nursing home or hospice facility. A health care entity does not include individuals described in subdivision (h).
(j)“Informed decision” means a decision by an individual with a terminal disease to request and obtain a prescription for a drug that the individual may self-administer to end the individual’s life, that is based on an understanding and acknowledgment of the relevant facts, and that is made after being fully informed by the attending physician of all of the following:
(1)The individual’s medical diagnosis and prognosis.
(2)The potential risks associated with taking the drug to be prescribed.
(3)The probable result of taking the drug to be prescribed.
(4)The possibility that the individual may choose not to obtain the drug or may obtain the drug but may decide not to ingest it.
(5)The feasible alternatives or additional treatment opportunities, including, but not limited to, comfort care, hospice care, palliative care, and pain control.
(k)“Medically confirmed” means the medical diagnosis and prognosis of the attending physician has been confirmed by a consulting physician who has examined the individual and the individual’s relevant medical records.
(l)“Mental health specialist assessment” means one or more consultations between an individual and a mental health specialist for the purpose of determining that the individual has the capacity to make medical decisions and is not suffering from impaired judgment due to a mental disorder.
(m)“Mental health specialist” means a psychiatrist or a licensed psychologist.
(n)“Physician” means a doctor of medicine or osteopathy currently licensed to practice medicine in this state.
(o)“Public place” means any street, alley, park, public building, any place of business or assembly open to or frequented by the public, and any other place that is open to the public view, or to which the public has access. “Public place” does not include a health care entity.
(p)“Qualified individual” means an adult who has the capacity to make medical decisions, is a resident of California, and has satisfied the requirements of this part in order to obtain a prescription for a drug to end their life.
(q)“Self-administer” means a qualified individual’s affirmative, conscious, and physical act of administering and ingesting the aid-in-dying drug to bring about their own death.
(r)“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months.
Amended by Stats. 2017, Ch. 561, Sec. 99. (AB 1516) Effective January 1, 2018.
(a)An individual who is an adult with the capacity to make medical decisions and with a terminal disease may make a request to receive a prescription for an aid-in-dying drug if all of the following conditions are satisfied:
(1)The individual’s attending physician has diagnosed the individual with a terminal disease.
(2)The individual has voluntarily expressed the wish to receive a prescription for an aid-in-dying drug.
(3)The individual is a resident of California and is able to establish residency through any of the following means:
(A)Possession of a California
driver’s license or other identification issued by the State of California.
(B)Registration to vote in California.
(C)Evidence that the person owns or leases property in California.
(D)Filing of a California tax return for the most recent tax year.
(4)The individual documents his or her request pursuant to the requirements set forth in Section 443.3.
(5)The individual has the physical and mental ability to self-administer the aid-in-dying drug.
(b)A person shall not be considered a “qualified individual” under the provisions of this part solely because of age or disability.
(c)A request for a prescription for an aid-in-dying drug under this part shall be made solely and directly by the individual diagnosed with the terminal disease and shall not be made on behalf of the patient, including, but not limited to, through a power of attorney, an advance health care directive, a conservator, health care agent, surrogate, or any other legally recognized health care decisionmaker.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
A qualified individual may not receive a prescription for an aid-in-dying drug pursuant to this part unless he or she has made an informed decision. Immediately before writing a prescription for an aid-in-dying drug under this part, the attending physician shall verify that the individual is making an informed decision.
Amended by Stats. 2021, Ch. 542, Sec. 5. (SB 380) Effective January 1, 2022.
(a)A request for an aid-in-dying drug as authorized by this part shall be in the following form:
(b)(1) The written language of the request shall be
written in the same translated language as any conversations, consultations, or interpreted conversations or consultations between a patient and their attending or consulting physicians.
(2)Notwithstanding paragraph (1), the written request may be prepared in English even when the conversations or consultations or interpreted conversations or consultations were conducted in a language other than English if the English language form includes an attached interpreter’s declaration that is signed under penalty of perjury. The interpreter’s declaration shall state words to the effect that:
(3)An interpreter whose services are provided pursuant to paragraph (2) shall not be related to the qualified individual by blood, marriage, registered domestic partnership, or adoption or be entitled to a portion of the person’s estate upon death. An interpreter whose services are provided pursuant to paragraph (2) shall meet the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care or other standards deemed acceptable by the department for health care providers in California.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
(a)A provision in a contract, will, or other agreement executed on or after January 1, 2016, whether written or oral, to the extent the provision would affect whether a person may make, withdraw, or rescind a request for an aid-in-dying drug is not valid.
(b)An obligation owing under any contract executed on or after January 1, 2016, may not be conditioned or affected by a
qualified individual making, withdrawing, or rescinding a request for an aid-in-dying drug.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
(a)(1) The sale, procurement, or issuance of a life, health, or annuity policy, health care service plan contract, or health benefit plan, or the rate charged for a policy or plan contract may not be conditioned upon or affected by a person making or rescinding a request for an aid-in-dying drug.
(2)Pursuant to Section 443.18, death resulting from the
self-administration of an aid-in-dying drug is not suicide, and therefore health and insurance coverage shall not be exempted on that basis.
(b)Notwithstanding any other law, a qualified individual’s act of self-administering an aid-in-dying drug shall not have an effect upon a life, health, or annuity policy other than that of a natural death from the underlying disease.
(c)An insurance carrier shall not provide any information in communications made to an individual about the availability of an aid-in-dying drug absent a request by the individual or his or her attending physician at the behest of the individual. Any communication shall not include both the denial of treatment and information as to the availability of aid-in-dying drug coverage. For the purposes of this subdivision, “insurance carrier” means a health care service plan as defined in Section 1345 of this code or
a carrier of health insurance as defined in Section 106 of the Insurance Code.
Amended by Stats. 2021, Ch. 542, Sec. 6. (SB 380) Effective January 1, 2022.
(a)Notwithstanding any other law, a person shall not be subject to civil or criminal liability solely because the person was present when the qualified individual self-administers the prescribed aid-in-dying drug. A person who is present may, without civil or criminal liability, assist the qualified individual by preparing the aid-in-dying drug so long as the person does not assist the qualified person in ingesting the aid-in-dying drug.
(b)A health care provider, health care entity, or professional organization or association shall not subject an individual to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating in good faith compliance with this part or for refusing to participate in
accordance with subdivision (e).
(c)Notwithstanding any other law, a health care provider or a health care entity shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for participating in this part. This subdivision does not limit the application of, or provide immunity from, Section 443.15, 443.16, or 443.17.
(d)(1) A request by a qualified individual to an attending physician to provide an aid-in-dying drug in good faith compliance with the provisions of this part shall not provide the sole basis for the appointment of a guardian or conservator.
(2)Actions taken in compliance with the provisions of this part shall not constitute or provide the basis for any claim of neglect or elder abuse for any purpose of law.
(e)(1) Participation under this part shall be voluntary. Notwithstanding Sections 442 to 442.7, inclusive, a person or entity that elects, for reasons of conscience, morality, or ethics, not to participate is not required to participate under this part. This subdivision does not limit the application of, or excuse noncompliance with, paragraphs (2), (4), and (5) of this subdivision or subdivision (b), (i), or (j) of Section 443.15, as applicable.
(2)A health care provider who objects for reasons of conscience, morality, or ethics to participate under this part shall not be required to participate. If a health care provider is unable or unwilling to participate under this part, as defined in subdivision (f) of Section 443.15, the provider shall, at a minimum, inform the individual that they do not participate in the End of Life Option Act,
document the individual’s date of request and provider’s notice to the individual of their objection in the medical record, and transfer the individual’s relevant medical record upon request.
(3)A health care provider or health care entity is not subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for refusing to participate under this part, as defined in paragraph (2) of subdivision (f) of Section 443.15.
(4)If a health care provider is unable or unwilling to carry out a qualified individual’s request under this part and the qualified individual transfers care to a new health care provider or health care entity, the individual’s relevant medical records shall be provided to the individual and, upon the individual’s request, timely
transferred with documentation of the date of the individual’s request for a prescription for aid-in-dying drug in the medical record, pursuant to law.
(5)A health care provider or a health care entity shall not engage in false, misleading, or deceptive practices relating to a willingness to qualify an individual or provide a prescription to a qualified individual under this part.
Amended by Stats. 2021, Ch. 542, Sec. 7. (SB 380) Effective January 1, 2022.
(a)Subject to subdivision (b), notwithstanding any other law, a health care entity may prohibit its employees, independent contractors, or other persons or entities, including health care providers, from participating under this part while on premises owned or under the management or direct control of that health care entity or while acting within the course and scope of any employment by, or contract with, the entity.
(b)A health care entity shall first give notice upon employment or other affiliation and thereafter annual notice of the policy concerning this part to the individual or entity. An entity that fails to provide notice to an individual or entity in compliance with this subdivision shall not be entitled to enforce such a policy against that individual
or entity. For purposes of this subdivision, posting on the entity’s public internet website the entity’s current policy governing medical aid in dying shall satisfy the annual notice requirement.
(c)Subject to compliance with subdivision (b), the health care entity may take action, including, but not limited to, the following, as applicable, against any individual or entity that violates this policy:
(1)Loss of privileges, loss of membership, or other action authorized by the bylaws or rules and regulations of the medical staff.
(2)Suspension, loss of employment, or other action authorized by the policies and practices of the health care entity.
(3)Termination of any lease or other contract between the health care entity and the individual or
entity that violates the policy.
(4)Imposition of any other nonmonetary remedy provided for in any lease or contract between the health care entity and the individual or entity in violation of the policy.
(d)This section does not prevent, or allow a health care entity to prohibit, any health care provider, employee, independent contractor, or other person or entity from any of the following:
(1)Participating, or entering into an agreement to participate, under this part, while on premises that are not owned or under the management or direct control of the health care entity or while acting outside the course and scope of the participant’s duties as an employee of, or an independent contractor for, the health care entity.
(2)Participating, or
entering into an agreement to participate, under this part as an attending physician or consulting physician while on premises that are not owned or under the management or direct control of the health care entity.
(e)In taking actions pursuant to subdivision (c), a health care entity shall comply with all procedures required by law, its own policies or procedures, and any contract with the individual or entity in violation of the policy, as applicable.
(f)For purposes of this part:
(1)“Notice” means a separate statement in writing advising of the health care entity policy with respect to participating under this part.
(2)“Participating, or entering into an agreement to participate, under this part” means doing or entering into an agreement to do
any one or more of the following:
(A)Performing the duties of an attending physician as specified in Section 443.5.
(B)Performing the duties of a consulting physician as specified in Section 443.6.
(C)Performing the duties of a mental health specialist, in the circumstance that a referral to one is made.
(D)Delivering the prescription for, dispensing, or delivering the dispensed aid-in-dying drug pursuant to paragraph (2) of subdivision (b) of, and subdivision (c) of, Section 443.5.
(E)Being present when the qualified individual takes the aid-in-dying drug prescribed pursuant to this part.
(3)“Participating, or entering
into an agreement to participate, under this part” does not include doing, or entering into an agreement to do, any of the following:
(A)Diagnosing whether a patient has a terminal disease, informing the patient of the medical prognosis, or determining whether a patient has the capacity to make decisions.
(B)Providing information to a patient about this part.
(C)Providing a patient, upon the patient’s request, with a referral to another health care provider for the purposes of participating under this part.
(g)Any action taken by a health care entity pursuant to this section shall not be reportable under Sections 800 to 809.9, inclusive, of the Business and Professions Code. The fact that a health care provider participates under this part shall not
be the sole basis for a complaint or report of unprofessional or dishonorable conduct under Sections 800 to 809.9, inclusive, of the Business and Professions Code.
(h)This part does not prevent a health care provider from providing an individual with health care services that do not constitute participation in this part.
(i)Each health care entity shall post on the entity’s public internet website the entity’s current policy governing medical aid in dying.
(j)A health care entity shall not engage in false, misleading, or deceptive practices relating to its policy concerning end-of-life care services nor engage in coercion or undue influence under this part.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
(a)A health care provider may not be sanctioned for any of the following:
(1)Making an initial determination pursuant to the standard of care that an individual has a terminal disease and informing him or her of the medical prognosis.
(2)Providing information about the End of Life Option Act to a patient upon the
request of the individual.
(3)Providing an individual, upon request, with a referral to another physician.
(b)A health care provider that prohibits activities under this part in accordance with Section 443.15 shall not sanction an individual health care provider for contracting with a qualified individual to engage in activities authorized by this part if the individual health care provider is acting outside of the course and scope of his or her capacity as an employee or independent contractor of the prohibiting health care provider.
(c)Notwithstanding any contrary provision in this section, the immunities and prohibitions on sanctions of a health care provider are solely reserved for actions of a health care provider taken pursuant to this part. Notwithstanding any contrary provision in this part, health care
providers may be sanctioned by their licensing board or agency for conduct and actions constituting unprofessional conduct, including failure to comply in good faith with this part.
Amended by Stats. 2021, Ch. 542, Sec. 8. (SB 380) Effective January 1, 2022.
(a)Knowingly altering or forging a request for an aid-in-dying drug to end an individual’s life without their authorization or concealing or destroying a withdrawal or rescission of a request for an aid-in-dying drug is punishable as a felony if the act is done with the intent or effect of causing the individual’s death.
(b)Knowingly coercing or exerting undue influence on an individual to request or ingest an aid-in-dying drug for the purpose of ending their life or to destroy a withdrawal or rescission of a request, or to administer an aid-in-dying drug to an individual without their knowledge or consent, is punishable as a felony.
(c)For purposes of this section, “knowingly” has the meaning
provided in Section 7 of the Penal Code.
(d)The attending physician, consulting physician, or mental health specialist shall not be related to the individual by blood, marriage, registered domestic partnership, or adoption, or be entitled to a portion of the individual’s estate upon death.
(e)This section does not limit civil liability or damages arising from negligent conduct or intentional misconduct in carrying out actions otherwise authorized by this part by any person, health care provider, or health care entity.
(f)The penalties in this section do not preclude criminal penalties applicable under any law for conduct inconsistent with the provisions of this part.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
Nothing in this part may be construed to authorize a physician or any other person to end an individual’s life by lethal injection, mercy killing, or active euthanasia. Actions taken in accordance with this part shall not, for any purposes, constitute suicide, assisted suicide, homicide, or elder abuse under the law.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
(a)The State Department of Public Health shall collect and review the information submitted pursuant to Section 443.9. The 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 under the provisions of this part. The information shall not be disclosed, discoverable, or compelled to be produced
in any civil, criminal, administrative, or other proceeding.
(b)On or before July 1, 2017, and each year thereafter, based on the information collected in the previous year, the department shall create a report with the information collected from the attending physician followup form and post that report to its Internet Web site. The report shall include, but not be limited to, all of the following based on the information that is provided to the department and on the department’s access to vital statistics:
(1)The number of people for whom an aid-in-dying prescription was written.
(2)The number of known individuals who died each year for whom aid-in-dying prescriptions were written, and the cause of death of those individuals.
(3)For the period
commencing January 1, 2016, to and including the previous year, cumulatively, the total number of aid-in-dying prescriptions written, the number of people who died due to use of aid-in-dying drugs, and the number of those people who died who were enrolled in hospice or other palliative care programs at the time of death.
(4)The number of known deaths in California from using aid-in-dying drugs per 10,000 deaths in California.
(5)The number of physicians who wrote prescriptions for aid-in-dying drugs.
(6)Of people who died due to using an aid-in-dying drug, demographic percentages organized by the following characteristics:
(A)Age at death.
(B)Education level.
(C)Race.
(D)Sex.
(E)Type of insurance, including whether or not they had insurance.
(F)Underlying illness.
(c)The State Department of Public Health shall make available the attending physician checklist and compliance form, the consulting physician compliance form, and the attending physician followup form, as described in Section 443.22, by posting them on its Internet Web site.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
A person who has custody or control of any unused aid-in-dying drugs prescribed pursuant to this part after the death of the patient shall personally deliver the unused aid-in-dying drugs for disposal by delivering it to the nearest qualified facility that properly disposes of controlled substances, or if none is available, shall dispose of it by lawful means in accordance with guidelines promulgated by the California State Board of Pharmacy or a federal Drug
Enforcement Administration approved take-back program.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016.
Any governmental entity that incurs costs resulting from a qualified individual terminating his or her life pursuant to the provisions of this part in a public place shall have a claim against the estate of the qualified individual to recover those costs and reasonable attorney fees related to enforcing the claim.
Added by Stats. 2015, 2nd Ex. Sess., Ch. 1, Sec. 1. (AB 15 2x) Effective June 9, 2016. Note: See published bill for complete section text. The physician compliance forms appear on pages 18 to 25 of Ch. 1 (2nd Ex.).
(a)The Medical Board of California may update the attending physician checklist and compliance form, the consulting physician compliance form, and the attending physician followup form, based on those provided in subdivision (b). Upon completion, the State Department of Public Health shall publish the updated forms on its Internet Web site.
(b)Unless and until updated by the Medical Board of California pursuant to this section, the attending physician checklist and compliance form, the consulting physician compliance form, and the attending physician followup form shall be in the following form:
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NOTICE OF INCOMPLETE TEXT: The physician compliance andfollow-up forms appear in the published chaptered bill. See Sec. 1of Chapter 1 (pp. 18–25), 2nd Ex. Session, Statutes of 2015.
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