California Modifies End of Life Option Act
Amendments reflecting more contemporary options could raise ethical questions for health care workers.
California's End of Life Options Act took effect on June 9, 2016.1 On February 11, 2021, an amendment was proposed, enacted, and signed into law by Governor Gavin Newsom on October 6, 2021, with provisions becoming effective on January 1, 2022.2
The provisions are as follows:
- Exempting the final attestation form
- Extending the law’s repeal clause until January 1, 2031
- Prohibiting health care entities or providers from engaging in deceptive, false, or misleading practices related to the willingness of providers to qualify a patient or provide a prescription for aid-in-dying medication
- Reducing the waiting period for patients requesting end- of-life drugs from 15 days to 48 hours between the first and second oral requests
- Requiring the health care entity to post its policy regarding aid-in-dying on its website
- Requiring providers to disclose their reasoning as to why they will or will not support the patient’s request for end-of-life services, to document in the medical record the patient’s request and the provider’s notification of rejection, and transfer medical records upon request
Assisted suicide has been a subject of debate for more years than most people realize. A number of parties have argued the pros and cons of this issue, but 40 states have yet to enact a bill on this subject. Legislators and lobbyists are bringing this topic to legislatures, and slowly such bills are being passed. There is no federal law on euthanasia, so each state has the opportunity to assess the ethical and moral issues surrounding end-of-life procedures.
Legislation addressing this issue was first introduced in 1906 in Ohio. However, the bill was not enacted. Several years later, Reverend Charles Potter cofounded the Euthanasia Society of America in New York. By 1947, 37% of individuals responding to a Gallup survey said they were in favor of physician-assisted dying, whereas 54% said they opposed it.3
The concept of a legally protected right to die motivated Oxford law professor Glanville Williams to publish The Sanctity of Life and the Criminal Law in 1958.3 The work proposed that mentally competent, terminally ill patients should be allowed to choose euthanasia as an option related to an individual’s well-being.
Between the mid-1950s and mid-1980s, more books were published advocating individuals be able to take end-of-life measures. Some publications even provided specific details about how to assist in the death of a loved one. In 1957, Lael Wertenbaker published Death of a Man, which described in detail how she helped her husband end his life.
In the 1960s, many significant steps were taken. Attorney Louis Kutner wrote the first living will
in 1969, and politician and physician Walter W. Sackett Jr, MD, introduced an unsuccessful right-to-die bill in 1967.3 Additionally, a proposal to redefine death was advanced, including brain, heart, and lung death. This was slowly accepted after professors from Harvard Medical School proposed this significant change.3
The Patient’s Bill of Rights, developed in 1973 by the American Hospital Association, recognized the right to refuse treatment as part of informed consent.1 That year, the first American hospice opened in New Haven, Connecticut,3 and the Euthanasia Society changed its name to the Society for the Right to Die.
In 1974, the health care community was surprised by the results of a Gallup poll. The results showed that 53% of Americans favored physician-assisted dying and 34% opposed it.3
Because religion has long been a significant factor in arguments against euthanasia, many people were shocked when a deeply religious couple attempted suicide in 1975 with no health care providers present.
Henry P. Van Dusen, 77, and his wife, Elizabeth, 80, chose to end their lives so they would not continue to suffer from disabling conditions. The couple, leaders of a Christian ecumenical movement, wrote a note stating, “We still feel this is the best way and the right way to go.”3 In 1976, the highly publicized case of Karen Ann Quinlan became a legal landmark when the New Jersey Supreme Court granted her parents’ wish to have her disconnected from a medical ventilator. Because physician-assisted death was not yet legal in New Jersey, Quinlan had lived for more than 8 years in a vegetative state.3
Ten states, with New Mexico being the most recent in 2021, have enacted assisted-dying laws. This raises ethical and moral issues for pharmacists as to whether they should participate in physician-assisted dying or even process insurance claims. Recently, a patient with a cancer diagnosis saw her insurance company reject her treatment but offer to cover the medication for right-to-die drugs at $68,000 vs $1.20.4 These bills could mean significant changes for pharmacists and other health care providers.
About The Authors
Rebecca F. Renier is a PharmD candidate at the University of Kentucky College of Pharmacy, in Lexington.
Joseph L. Fink III, JD, DSC (Hon), BSPharm, FAPhA, is professor emeritus of pharmacy law and policy and former Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.
1. Medina J. Who may die? California patients and doctors wrestle with assisted suicide. New York Times. June 9, 2016. Accessed August 31, 2022. https://www.nytimes.com/2016/06/10/us/assisted-suicide-california-patients-and-doctors.html?smid=nyt-core-ios-share&referringSource=articleShare
2. Governor Newsom highlights landmark new laws taking effect January 1, 2022. News release. Office of Governor Gavin Newsom. December 29, 2021. Accessed May 10, 2022. https://www.gov.ca.gov/2021/12/29/governor-newsom-highlights-landmark-new-laws-taking-effect-january-1-2022/
3. Humphry D. Chronology of right-to-die events during the 20th century and into the millenium. Euthanasia Reasearch & Guidance Organization. Updated January 2, 2019. Accessed August 31, 2022. https://www.finalexit.org/chronology_right-to- die_events.html
4. Judge rules California’s assisted suicide law unconstitutional. Life Legal Defense Foundation. May 15, 2018. Accessed May 10, 2022. https://lifelegaldefensefoundation.org/judge-rules-californias-assisted-suicide-law-unconstitutional/amp/