This part shall be known and may be cited as the End of Life Option Act.
Part 1.85End of Life Option Act
Section § 443
This section is the title of the End of Life Option Act. It specifies that people in California can refer to this section as such when discussing or using this law.
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Section § 443.1
This section provides definitions for terms used in the context of California's aid-in-dying laws. It clarifies who qualifies as an 'adult,' 'qualified individual,' and defines an 'aid-in-dying drug' as one prescribed to these individuals to end their life due to a terminal disease. An 'attending physician' is the main doctor responsible for treating the terminal disease, while a 'consulting physician' provides a second opinion. To make an 'informed decision,' individuals must understand their diagnosis, risks and outcomes of the drug, and alternative treatments. 'Capacity to make medical decisions' means understanding and communicating about these choices. 'Medically confirmed' means a second physician verifies the incurability and prognosis of the disease.
The law spells out additional roles, such as 'mental health specialists' who ensure that individuals can decide without impairment. 'Self-administer' refers to the act of voluntarily taking the prescribed medication. A 'terminal disease' is one expected to lead to death within six months. The law distinguishes 'health care providers,' 'entities,' and 'public places' related to administering this process.
As used in this part, the following definitions shall apply:
(a)CA Health and Safety Code § 443.1(a) “Adult” means an individual 18 years of age or older.
(b)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(g) “Department” means the State Department of Public Health.
(h)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(j)(1) The individual’s medical diagnosis and prognosis.
(2)CA Health and Safety Code § 443.1(j)(2) The potential risks associated with taking the drug to be prescribed.
(3)CA Health and Safety Code § 443.1(j)(3) The probable result of taking the drug to be prescribed.
(4)CA Health and Safety Code § 443.1(j)(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)CA Health and Safety Code § 443.1(j)(5) The feasible alternatives or additional treatment opportunities, including, but not limited to, comfort care, hospice care, palliative care, and pain control.
(k)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(m) “Mental health specialist” means a psychiatrist or a licensed psychologist.
(n)CA Health and Safety Code § 443.1(n) “Physician” means a doctor of medicine or osteopathy currently licensed to practice medicine in this state.
(o)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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)CA Health and Safety Code § 443.1(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.
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Section § 443.10
Before a doctor can prescribe a drug to help someone end their life under this law, they must first make sure the person knows what they're doing and chooses it on their own, called making an informed decision.
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.
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Section § 443.11
This law explains the process for requesting a prescription for a life-ending aid-in-dying drug in California. To make this request, the individual must be an adult of sound mind, confirmed by medical professionals to be terminally ill, and a resident of the state. They must confirm understanding of their medical condition, the risks of the drug, and available care alternatives, such as hospice. The request must be voluntary and can be withdrawn at any time.
The individual must acknowledge their family's awareness of the decision, or state that they have no family to inform. Two witnesses must sign the declaration, ensuring the individual is of sound mind and acting without coercion. Only one witness can be a relative or involved with the individual's health care facility.
If the request is verbalized in another language, the written request can be in English with a declaration from an interpreter. The interpreter must confirm the individual's understanding and intentions, and must not be a family member or have a financial interest in the person's estate. Interpreters must adhere to certain professional standards.
(a)CA Health and Safety Code § 443.11(a) A request for an aid-in-dying drug as authorized by this part shall be in the following form:
(b)Copy CA Health and Safety Code § 443.11(b)
(1)Copy CA Health and Safety Code § 443.11(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)CA Health and Safety Code § 443.11(b)(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:
On (insert date) at approximately (insert time), I read the “Request for an
Aid-In-Dying Drug to End My Life” to (insert name of individual/patient) in (insert target language).
Mr./Ms./Mx. (insert name of patient/qualified individual) affirmed to me that they understood the content of this form and affirmed their desire to sign this form under their own power and volition and that the request to sign the form followed consultations with an attending and consulting physician.
I declare that I am fluent in English and (insert target language) and further declare under penalty of perjury that the foregoing is true and correct.
Executed at (insert city, county, and state) on this (insert day of month) of (insert month), (insert year).
X______Interpreter signature
X______Interpreter printed name
X______Interpreter address
(3)CA Health and Safety Code § 443.11(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.
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Section § 443.12
This law states that any agreement made after January 1, 2016, whether it's a contract, will, or other types, can't include terms that impact someone's choice to make, cancel, or take back a request for an aid-in-dying drug. This means you can't have conditions in contracts that depend on whether a person decides to ask for or withdraw an aid-in-dying drug.
In simple terms, if you sign a contract after this date, it can't legally affect your rights to choose an aid-in-dying drug.
(a)CA Health and Safety Code § 443.12(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)CA Health and Safety Code § 443.12(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.
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Section § 443.13
This law ensures that a request for an aid-in-dying drug does not impact the sale, price, or terms of life, health, or annuity insurance policies. It clarifies that self-administering such a drug is not considered suicide, so insurance coverage remains unaffected. Furthermore, the law prohibits insurance carriers from discussing the availability of aid-in-dying drugs unless explicitly asked by the individual or their doctor. Communications from insurers must not mix treatment denials with aid-in-dying information.
(a)Copy CA Health and Safety Code § 443.13(a)
(1)Copy CA Health and Safety Code § 443.13(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)CA Health and Safety Code § 443.13(a)(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)CA Health and Safety Code § 443.13(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)CA Health and Safety Code § 443.13(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.
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Section § 443.14
This law provides protections and outlines responsibilities for those involved in the aid-in-dying process. If you're present when someone self-administers the aid-in-dying drug, you won't face civil or criminal liability just for being there. You can help prepare the drug, but can't help them take it. Healthcare providers and organizations can't punish someone for following or choosing not to follow this law. Participating in aid-in-dying is voluntary, and no one is forced to be involved if it conflicts with their conscience or ethics. If healthcare providers object, they must inform the individual and transfer medical records if the person switches care. Also, they must avoid misleading claims about their willingness to provide aid-in-dying prescriptions. The act emphasizes non-interference with anyone's professional standing or medical licenses for participation or refusal to participate in aid-in-dying practices.
(a)CA Health and Safety Code § 443.14(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)CA Health and Safety Code § 443.14(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)CA Health and Safety Code § 443.14(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)Copy CA Health and Safety Code § 443.14(d)
(1)Copy CA Health and Safety Code § 443.14(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)CA Health and Safety Code § 443.14(d)(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)Copy CA Health and Safety Code § 443.14(e)
(1)Copy CA Health and Safety Code § 443.14(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)CA Health and Safety Code § 443.14(e)(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)CA Health and Safety Code § 443.14(e)(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)CA Health and Safety Code § 443.14(e)(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)CA Health and Safety Code § 443.14(e)(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.
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Section § 443.15
This section allows a health care entity, like a hospital, to ban its staff and contractors from participating in medical aid-in-dying activities on its premises or during their work duties. However, the entity must inform these individuals about the policy when they start and remind them annually, typically by posting the policy online.
If someone breaks this rule, the entity can take non-monetary actions such as suspending employment or terminating contracts. However, this restriction doesn’t apply if the person is off-site or acting outside their work roles.
Participation includes roles like being an attending or consulting physician in aid-in-dying situations, but doesn’t include diagnosing or providing general end-of-life care information. The healthcare provider’s participation in such activities shouldn’t lead to claims of unprofessional conduct unless otherwise warranted.
Entities must publicly post their policy online and avoid misleading or coercive communication about their end-of-life care policies.
(a)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(c)(1) Loss of privileges, loss of membership, or other action authorized by the bylaws or rules and regulations of the medical staff.
(2)CA Health and Safety Code § 443.15(c)(2) Suspension, loss of employment, or other action authorized by the policies and practices of the health care entity.
(3)CA Health and Safety Code § 443.15(c)(3) Termination of any lease or other contract between the health care entity and the individual or
entity that violates the policy.
(4)CA Health and Safety Code § 443.15(c)(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)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(d)(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)CA Health and Safety Code § 443.15(d)(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)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(f) For purposes of this part:
(1)CA Health and Safety Code § 443.15(f)(1) “Notice” means a separate statement in writing advising of the health care entity policy with respect to participating under this part.
(2)CA Health and Safety Code § 443.15(f)(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)CA Health and Safety Code § 443.15(f)(2)(A) Performing the duties of an attending physician as specified in Section 443.5.
(B)CA Health and Safety Code § 443.15(f)(2)(B) Performing the duties of a consulting physician as specified in Section 443.6.
(C)CA Health and Safety Code § 443.15(f)(2)(C) Performing the duties of a mental health specialist, in the circumstance that a referral to one is made.
(D)CA Health and Safety Code § 443.15(f)(2)(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)CA Health and Safety Code § 443.15(f)(2)(E) Being present when the qualified individual takes the aid-in-dying drug prescribed pursuant to this part.
(3)CA Health and Safety Code § 443.15(f)(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)CA Health and Safety Code § 443.15(f)(3)(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)CA Health and Safety Code § 443.15(f)(3)(B) Providing information to a patient about this part.
(C)CA Health and Safety Code § 443.15(f)(3)(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)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(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)CA Health and Safety Code § 443.15(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.
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Section § 443.16
This section of the law states that healthcare providers cannot be punished for informing a patient that they have a terminal illness, giving information about the End of Life Option Act, or referring a patient to another doctor if asked.
Healthcare providers are also protected if they work with a terminal patient outside their official role in facilities that don't allow such activities, as long as they act independently. However, providers can face disciplinary action from their professional boards if they engage in unprofessional behavior or don't follow the rules set in this part thoroughly.
(a)CA Health and Safety Code § 443.16(a) A health care provider may not be sanctioned for any of the following:
(1)CA Health and Safety Code § 443.16(a)(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)CA Health and Safety Code § 443.16(a)(2) Providing information about the End of Life Option Act to a patient upon the
request of the individual.
(3)CA Health and Safety Code § 443.16(a)(3) Providing an individual, upon request, with a referral to another physician.
(b)CA Health and Safety Code § 443.16(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)CA Health and Safety Code § 443.16(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.
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Section § 443.17
This law makes it a felony to tamper with someone's request for an aid-in-dying drug, such as altering, forging, or destroying their request without permission, especially if it leads to their death. It's also a felony to force someone to take the drug or to give it to them without consent. The term 'knowingly' is defined by the state penal code. Physicians and mental health specialists involved cannot be related to the patient or benefit from their estate. This doesn't limit civil lawsuits for negligence or intentional harm, nor does it affect other criminal penalties for related misconduct.
(a)CA Health and Safety Code § 443.17(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)CA Health and Safety Code § 443.17(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)CA Health and Safety Code § 443.17(c) For purposes of this section, “knowingly” has the meaning
provided in Section 7 of the Penal Code.
(d)CA Health and Safety Code § 443.17(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)CA Health and Safety Code § 443.17(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)CA Health and Safety Code § 443.17(f) The penalties in this section do not preclude criminal penalties applicable under any law for conduct inconsistent with the provisions of this part.
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Section § 443.18
This section ensures that no one, including doctors, is allowed to intentionally end someone's life through methods like lethal injection or mercy killing. Anything done according to this part of the law won't be considered acts like suicide, assisted suicide, murder, or elder abuse.
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.
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Section § 443.19
This section mandates that the State Department of Public Health confidentially collects and reviews information related to aid-in-dying prescriptions. The collected data, which is protected to ensure patient and provider privacy, is not to be disclosed in legal proceedings.
Every year from July 1, 2017, the department must publish a report on their website with statistics and data about the use of aid-in-dying prescriptions. This includes details like the number of people receiving prescriptions, deaths from these prescriptions, and demographic details of those who died using aid-in-dying drugs.
Additionally, the department needs to make certain physician compliance forms available online, as outlined in another section of the law.
(a)CA Health and Safety Code § 443.19(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)CA Health and Safety Code § 443.19(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)CA Health and Safety Code § 443.19(b)(1) The number of people for whom an aid-in-dying prescription was written.
(2)CA Health and Safety Code § 443.19(b)(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)CA Health and Safety Code § 443.19(b)(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)CA Health and Safety Code § 443.19(b)(4) The number of known deaths in California from using aid-in-dying drugs per 10,000 deaths in California.
(5)CA Health and Safety Code § 443.19(b)(5) The number of physicians who wrote prescriptions for aid-in-dying drugs.
(6)CA Health and Safety Code § 443.19(b)(6) Of people who died due to using an aid-in-dying drug, demographic percentages organized by the following characteristics:
(A)CA Health and Safety Code § 443.19(b)(6)(A) Age at death.
(B)CA Health and Safety Code § 443.19(b)(6)(B) Education level.
(C)CA Health and Safety Code § 443.19(b)(6)(C) Race.
(D)CA Health and Safety Code § 443.19(b)(6)(D) Sex.
(E)CA Health and Safety Code § 443.19(b)(6)(E) Type of insurance, including whether or not they had insurance.
(F)CA Health and Safety Code § 443.19(b)(6)(F) Underlying illness.
(c)CA Health and Safety Code § 443.19(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.
aid-in-dying prescriptions patient privacy confidential data public health reporting data collection physician compliance forms demographic statistics end-of-life care hospice program reports palliative care enrollment healthcare privacy annual public report death with dignity vital statistics medical provider confidentiality
Section § 443.2
This section allows a terminally ill adult in California with the capacity to make medical decisions to request a prescription for a drug to help them end their life, known as aid-in-dying. To qualify, the person must be diagnosed with a terminal illness by their doctor, express their wish voluntarily, and be a California resident, proven by documents like a driver's license or tax return. They must document their request according to specific rules (see Section 443.3) and be able to take the drug themselves. Simply being old or disabled doesn't qualify someone for this. The individual must personally make the request without relying on others, such as a power of attorney or health care agents, to act on their behalf.
(a)CA Health and Safety Code § 443.2(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)CA Health and Safety Code § 443.2(a)(1) The individual’s attending physician has diagnosed the individual with a terminal disease.
(2)CA Health and Safety Code § 443.2(a)(2) The individual has voluntarily expressed the wish to receive a prescription for an aid-in-dying drug.
(3)CA Health and Safety Code § 443.2(a)(3) The individual is a resident of California and is able to establish residency through any of the following means:
(A)CA Health and Safety Code § 443.2(a)(3)(A) Possession of a California
driver’s license or other identification issued by the State of California.
(B)CA Health and Safety Code § 443.2(a)(3)(B) Registration to vote in California.
(C)CA Health and Safety Code § 443.2(a)(3)(C) Evidence that the person owns or leases property in California.
(D)CA Health and Safety Code § 443.2(a)(3)(D) Filing of a California tax return for the most recent tax year.
(4)CA Health and Safety Code § 443.2(a)(4) The individual documents his or her request pursuant to the requirements set forth in Section 443.3.
(5)CA Health and Safety Code § 443.2(a)(5) The individual has the physical and mental ability to self-administer the aid-in-dying drug.
(b)CA Health and Safety Code § 443.2(b) A person shall not be considered a “qualified individual” under the provisions of this part solely because of age or disability.
(c)CA Health and Safety Code § 443.2(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.
terminal illness aid-in-dying drug self-administration voluntary request California residency attending physician terminal diagnosis medical decision capacity self-request California documentation Section 443.3 requirements individual request not based on age not based on disability end-of-life decisions
Section § 443.20
If a person has unused aid-in-dying drugs after the patient has passed away, they must personally take these drugs to a nearby facility that can safely dispose of them. If no such facility is available, the person must dispose of them following guidelines from the California State Board of Pharmacy or through an approved federal take-back program.
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.
aid-in-dying drugs unused medications disposal controlled substances disposal qualified facility California State Board of Pharmacy guidelines DEA approved take-back program drug disposal post-death procedures responsibilities after patient death end-of-life care drugs
Section § 443.21
If a qualified person ends their life in a public area under this specific law, and it causes costs for any government body, that government can seek to recover these expenses from the deceased person's estate. The government can also claim reasonable attorney fees related to enforcing this claim.
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.
qualified individual public place government costs estate claim end of life recovery of costs reasonable attorney fees enforcing claim life termination costs governmental entity estate liability
Section § 443.215
This law will only be effective until January 1, 2031, and will be repealed after that date.
This part shall remain in effect only until January 1, 2031, and as of that date is repealed.
repeal date expiration sunset clause January 1 2031 temporary law time-limited statute law expiration California Health and Safety Code end date law termination legislation expiration
Section § 443.22
This section allows the Medical Board of California to update key forms used by physicians when complying with specific procedures. These forms include the attending physician checklist, compliance form, consulting physician compliance form, and attending physician follow-up form. Once updated, the State Department of Public Health must publish these forms online. Until any updates are made, these forms will remain as outlined in the 2015 legislation.
(a)CA Health and Safety Code § 443.22(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)CA Health and Safety Code § 443.22(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:
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
NOTICE OF INCOMPLETE TEXT: The physician compliance and
follow-up forms appear in the published chaptered bill. See Sec. 1
of Chapter 1 (pp. 18–25), 2nd Ex. Session, Statutes of 2015.
* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
Medical Board of California attending physician checklist compliance form consulting physician compliance attending physician follow-up State Department of Public Health update forms physician compliance healthcare procedures form publication medical documentation
Section § 443.3
If someone wants to get a prescription for an aid-in-dying drug, they need to make two verbal requests at least 48 hours apart and submit a written request to their doctor. The doctor has to document these requests in the patient's medical record. Even if the request was made to a previous or non-participating doctor, it still counts.
The written request must follow a specific format laid out in another section. It has to be signed in front of two adult witnesses, and these witnesses must know the person, believe the person is signing voluntarily and is of sound mind, and they cannot have a role in the person's medical care as their doctor or mental health specialist.
One of the witnesses can be a family member or have a stake in the person's estate, or work at the facility where the person is being treated. However, none of these witnesses can be the patient's doctor or mental health professional.
(a)CA Health and Safety Code § 443.3(a) An individual seeking to obtain a prescription for an aid-in-dying drug pursuant to this part shall submit two oral requests, a minimum of 48 hours apart, and a written request to their attending physician. An attending physician shall directly, and not through a designee, receive a request required pursuant to this section and shall ensure the date of a request is documented in an individual’s medical record. An oral request documented in an individual’s medical record shall not be disregarded by an attending physician solely because it was received by a prior attending physician or an attending physician who chose not to participate.
(b)CA Health and Safety Code § 443.3(b) A valid written request for an aid-in-dying drug under subdivision (a) shall meet all of the following conditions:
(1)CA Health and Safety Code § 443.3(b)(1) The request shall be in the form described in Section 443.11.
(2)CA Health and Safety Code § 443.3(b)(2) The request shall be signed and dated, in the presence of two witnesses, by the individual seeking the aid-in-dying drug.
(3)CA Health and Safety Code § 443.3(b)(3) The request shall be witnessed by at least two other adult persons who, in the presence of the individual, shall attest that to the best of their knowledge and belief the individual is all of the following:
(A)CA Health and Safety Code § 443.3(b)(3)(A) An individual who is personally known to them or has provided proof of identity.
(B)CA Health and Safety Code § 443.3(b)(3)(B) An individual who voluntarily signed this request in their presence.
(C)CA Health and Safety Code § 443.3(b)(3)(C) An individual whom they believe to be of sound mind and not under
duress, fraud, or undue influence.
(D)CA Health and Safety Code § 443.3(b)(3)(D) Not an individual for whom either of them is the attending physician, consulting physician, or mental health specialist.
(c)CA Health and Safety Code § 443.3(c) Only one of the two witnesses at the time the written request is signed may:
(1)CA Health and Safety Code § 443.3(c)(1) Be related to the qualified individual by blood, marriage, registered domestic partnership, or adoption or be entitled to a portion of the individual’s estate upon death.
(2)CA Health and Safety Code § 443.3(c)(2) Own, operate, or be employed at a health care entity where the individual is receiving medical treatment or resides.
(d)CA Health and Safety Code § 443.3(d) The attending physician, consulting physician, or mental health specialist of the individual shall not be one of the witnesses required pursuant to paragraph
(3) of subdivision (b).
aid-in-dying drug oral requests written request attending physician medical record witness requirements proof of identity voluntarily signed sound mind not under duress undue influence health care entity witness restrictions estate concerns mental health specialist
Section § 443.4
This law allows a person to change their mind about using or requesting an aid-in-dying drug at any time, regardless of their mental state.
Before a prescription for such a drug is made, the attending doctor must personally offer the individual a chance to withdraw their request. If the person chooses a new doctor, the current doctor must share all important medical records related to their aid-in-dying request.
(a)CA Health and Safety Code § 443.4(a) An individual may at any time withdraw or rescind their request for an aid-in-dying drug, or decide not to ingest an aid-in-dying drug, without regard to the individual’s mental state.
(b)CA Health and Safety Code § 443.4(b) A prescription for an aid-in-dying drug provided under this part may not be written without the attending physician directly, and not through a designee, offering the individual an opportunity to withdraw or rescind the request.
(c)CA Health and Safety Code § 443.4(c) If the individual decides to transfer care to another physician, upon request of the individual the physician shall transfer all relevant medical records including written documentation including the dates of the individual’s oral and written requests seeking to obtain a prescription
for an aid-in-dying drug.
aid-in-dying mentally state withdraw request rescind request attending physician prescription process transfer of care medical records end-of-life choice patient autonomy oral and written requests drug prescription patient right physician responsibilities decision to ingest
Section § 443.5
This section outlines the steps a doctor must take before prescribing an aid-in-dying drug. First, the doctor needs to ensure the patient can make medical decisions, doesn't suffer from impaired judgment due to a mental disorder, and is making the choice voluntarily.
The patient must have a terminal illness and be informed about their diagnosis, prognosis, and potential risks and outcomes of taking the drug. The doctor verifies these through a consulting physician and ensures the patient is not coerced. The doctor will also discuss the importance of having another person present when taking the drug, not doing it in public, and the option to notify family, among other counseling points.
The patient can withdraw their request anytime. If all conditions are met, the doctor can dispense the drug directly or via a pharmacist and complete necessary documentation.
(a)CA Health and Safety Code § 443.5(a) Before prescribing an aid-in-dying drug, the attending physician shall do all of the following:
(1)CA Health and Safety Code § 443.5(a)(1) Make the initial determination of all of the following:
(A)Copy CA Health and Safety Code § 443.5(a)(1)(A)
(i)Copy CA Health and Safety Code § 443.5(a)(1)(A)(i) Whether the requesting adult has the capacity to make medical decisions.
(ii)CA Health and Safety Code § 443.5(a)(1)(A)(i)(ii) If there are indications of a mental disorder, the physician shall refer the individual for a mental health specialist assessment.
(iii)CA Health and Safety Code § 443.5(a)(1)(A)(i)(iii) If a mental health specialist assessment referral is made, no aid-in-dying drugs shall be prescribed until the mental health specialist determines that the individual has the
capacity to make medical decisions and is not suffering from impaired judgment due to a mental disorder.
(B)CA Health and Safety Code § 443.5(a)(1)(B) Whether the requesting adult has a terminal disease.
(C)CA Health and Safety Code § 443.5(a)(1)(C) Whether the requesting adult has voluntarily made the request for an aid-in-dying drug pursuant to Sections 443.2 and 443.3.
(D)CA Health and Safety Code § 443.5(a)(1)(D) Whether the requesting adult is a qualified individual pursuant to subdivision (q) of Section 443.1.
(2)CA Health and Safety Code § 443.5(a)(2) Confirm that the individual is making an informed decision by discussing with them all of the following:
(A)CA Health and Safety Code § 443.5(a)(2)(A) Their medical diagnosis and prognosis.
(B)CA Health and Safety Code § 443.5(a)(2)(B) The potential risks associated with ingesting the requested aid-in-dying
drug.
(C)CA Health and Safety Code § 443.5(a)(2)(C) The probable result of ingesting the aid-in-dying drug.
(D)CA Health and Safety Code § 443.5(a)(2)(D) The possibility that they may choose to obtain the aid-in-dying drug but not take it.
(E)CA Health and Safety Code § 443.5(a)(2)(E) The feasible alternatives or additional treatment options, including, but not limited to, comfort care, hospice care, palliative care, and pain control.
(3)CA Health and Safety Code § 443.5(a)(3) Refer the individual to a consulting physician for medical confirmation of the diagnosis and prognosis, and for a determination that the individual has the capacity to make medical decisions and has complied with the provisions of this part.
(4)CA Health and Safety Code § 443.5(a)(4) Confirm that the qualified individual’s request does not arise from coercion or undue influence by another person by discussing with
the qualified individual, outside of the presence of any other persons, except for an interpreter as required pursuant to this part, whether or not the qualified individual is feeling coerced or unduly influenced by another person.
(5)CA Health and Safety Code § 443.5(a)(5) Counsel the qualified individual about the importance of all of the following:
(A)CA Health and Safety Code § 443.5(a)(5)(A) Having another person present when they ingest the aid-in-dying drug prescribed pursuant to this part.
(B)CA Health and Safety Code § 443.5(a)(5)(B) Not ingesting the aid-in-dying drug in a public place.
(C)CA Health and Safety Code § 443.5(a)(5)(C) Notifying the next of kin of their request for an aid-in-dying drug. A qualified individual who declines or is unable to notify next of kin shall not have their request denied for that reason.
(D)CA Health and Safety Code § 443.5(a)(5)(D) Participating in
a hospice program.
(E)CA Health and Safety Code § 443.5(a)(5)(E) Maintaining the aid-in-dying drug in a safe and secure location until the time that the qualified individual will ingest it.
(6)CA Health and Safety Code § 443.5(a)(6) Inform the individual that they may withdraw or rescind the request for an aid-in-dying drug at any time and in any manner.
(7)CA Health and Safety Code § 443.5(a)(7) Offer the individual an opportunity to withdraw or rescind the request for an aid-in-dying drug before prescribing the aid-in-dying drug.
(8)CA Health and Safety Code § 443.5(a)(8) Verify, immediately before writing the prescription for an aid-in-dying drug, that the qualified individual is making an informed decision.
(9)CA Health and Safety Code § 443.5(a)(9) Confirm that all requirements are met and all appropriate steps are carried out in accordance with this part before writing a
prescription for an aid-in-dying drug.
(10)CA Health and Safety Code § 443.5(a)(10) Fulfill the record documentation required under Sections 443.8 and 443.19.
(11)CA Health and Safety Code § 443.5(a)(11) Complete the attending physician checklist and compliance form, as described in Section 443.22, include it and the consulting physician compliance form in the individual’s medical record, and submit both forms to the State Department of Public Health.
(b)CA Health and Safety Code § 443.5(b) If the conditions set forth in subdivision (a) are satisfied, the attending physician may deliver the aid-in-dying drug in any of the following ways:
(1)CA Health and Safety Code § 443.5(b)(1) Dispensing the aid-in-dying drug directly, including ancillary medication intended to minimize the qualified individual’s discomfort, if the attending physician meets all of the following criteria:
(A)CA Health and Safety Code § 443.5(b)(1)(A) Is authorized to dispense medicine under California law.
(B)CA Health and Safety Code § 443.5(b)(1)(B) Has a current United States Drug Enforcement Administration (USDEA) certificate.
(C)CA Health and Safety Code § 443.5(b)(1)(C) Complies with any applicable administrative rule or regulation.
(2)CA Health and Safety Code § 443.5(b)(2) With the qualified individual’s written consent, contacting a pharmacist, informing the pharmacist of the prescriptions, and delivering the written prescriptions personally, by mail, or electronically to the pharmacist, who may dispense the drug to the qualified individual, the attending physician, or a person expressly designated by the qualified individual and with the designation delivered to the pharmacist in writing or verbally.
(c)CA Health and Safety Code § 443.5(c) Delivery of the dispensed drug to the
qualified individual, the attending physician, or a person expressly designated by the qualified individual may be made by personal delivery, or, with a signature required on delivery, by United Parcel Service, United States Postal Service, FedEx, or by messenger service.
aid-in-dying drug prescribing physician requirements patient capacity mental health assessment terminal illness voluntary request informed decision consulting physician coercion prevention patient counseling drug dispensing pharmacist role withdrawal of request drug delivery methods record documentation
Section § 443.6
Before someone can receive a drug to assist in dying, a second doctor (consulting physician) must do several things. They need to check the person's health and medical files and verify the first doctor's diagnosis and estimate of how long the person will live. The consulting doctor also has to ensure the person can make their own medical choices, is doing this of their own free will, and understands what it means. If there's any sign of a mental health issue, they must refer the person to a specialist. They also need to document all of this and send a form showing they've followed the rules to the first doctor.
Before a qualified individual obtains an aid-in-dying drug from the attending physician, the consulting physician shall perform all of the following:
(a)CA Health and Safety Code § 443.6(a) Examine the individual and his or her relevant medical records.
(b)CA Health and Safety Code § 443.6(b) Confirm in writing the attending physician’s diagnosis and prognosis.
(c)CA Health and Safety Code § 443.6(c) Determine that the individual has the capacity to make medical decisions, is acting voluntarily, and has made an informed decision.
(d)CA Health and Safety Code § 443.6(d) If there are indications of a mental disorder, refer the individual for a mental health specialist assessment.
(e)CA Health and Safety Code § 443.6(e) Fulfill the record documentation required under this part.
(f)CA Health and Safety Code § 443.6(f) Submit the compliance form to the attending physician.
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Section § 443.7
This section outlines the duties of a mental health specialist when they receive a referral from a physician. The specialist must examine the patient's medical records and ensure the patient can make decisions and act voluntarily. They also need to confirm that the patient doesn't have impaired judgment from a mental disorder. Finally, they must document everything in the patient's records as required by the law.
Upon referral from the attending or consulting physician pursuant to this part, the mental health specialist shall:
(a)CA Health and Safety Code § 443.7(a) Examine the qualified individual and his or her relevant medical records.
(b)CA Health and Safety Code § 443.7(b) Determine that the individual has the mental capacity to make medical decisions, act voluntarily, and make an informed decision.
(c)CA Health and Safety Code § 443.7(c) Determine that the individual is not suffering from impaired judgment due to a mental disorder.
(d)CA Health and Safety Code § 443.7(d) Fulfill the record documentation requirements of this part.
mental health specialist duties patient medical records mental capacity assessment voluntary decision making informed medical decision impaired judgment mental disorder evaluation record documentation requirements attending physician referral consulting physician referral
Section § 443.8
This law details what must be recorded in a person's medical record when they request aid-in-dying drugs. It includes all oral and written requests, diagnoses, prognoses, and mental capacity assessments from attending and consulting physicians. Additionally, any mental health evaluations and the offer to withdraw the request must be documented. Finally, it requires a note confirming that all legal requirements have been met and the prescription details of the aid-in-dying drug.
All of the following shall be documented in the individual’s medical record:
(a)CA Health and Safety Code § 443.8(a) All oral requests for aid-in-dying drugs.
(b)CA Health and Safety Code § 443.8(b) All written requests for aid-in-dying drugs.
(c)CA Health and Safety Code § 443.8(c) The attending physician’s diagnosis and prognosis, and the determination that a qualified individual
has the capacity to make medical decisions, is acting voluntarily, and has made an informed decision, or that the attending physician has determined that the individual is not a qualified individual.
(d)CA Health and Safety Code § 443.8(d) The consulting physician’s diagnosis and prognosis, and verification that the qualified individual has the capacity to make medical decisions, is acting voluntarily, and has made an informed decision, or that the consulting physician has determined that the individual is not a qualified individual.
(e)CA Health and Safety Code § 443.8(e) A report of the outcome and determinations made during a mental health specialist’s assessment, if performed.
(f)CA Health and Safety Code § 443.8(f) The attending physician’s offer to the qualified individual to withdraw or rescind his or her request at the time of the individual’s second oral request.
(g)CA Health and Safety Code § 443.8(g) A note by the attending physician indicating that all requirements under Sections 443.5 and 443.6 have been met and indicating the steps taken to carry out the request, including a notation of the aid-in-dying drug prescribed.
aid-in-dying drugs oral requests written requests attending physician diagnosis consulting physician verification mental health assessment informed decision voluntary action medical decision capacity withdraw request prescription documentation second oral request Sections 443.5 and 443.6 qualified individual determination medical record documentation
Section § 443.9
If a doctor prescribes a medication for a patient to end their life, they must send specific documents to the State Department of Public Health within 30 days. These documents include the patient’s written request, and forms confirming the process was followed correctly by both the attending and consulting physicians.
Additionally, if the patient who was prescribed the medication passes away, whether from taking the medication or another cause, the doctor must also send a follow-up form to the State Department of Public Health within 30 days.
(a)CA Health and Safety Code § 443.9(a) Within 30 calendar days of writing a prescription for an aid-in-dying drug, the attending physician shall submit to the State Department of Public Health a copy of the qualifying patient’s written request, the attending physician checklist and compliance form, and the consulting physician compliance form.
(b)CA Health and Safety Code § 443.9(b) Within 30 calendar days following the qualified individual’s death
from ingesting the aid-in-dying drug, or any other cause, the attending physician shall submit the attending physician followup form to the State Department of Public Health.
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