Aid-In-Dying: Not So Easy
Starting June 9, terminally ill Californians with six months or less to live can request a doctorās prescription for medications intended to end their lives peacefully.
If that sounds simple, it wonāt be.
°ä²¹±ō¾±“ړǰł²Ō¾±²¹āsĢż creates a long list of administrative hurdles that both patients and their doctors must clear.
For instance, you must make multiple requests for the drugs, orally and in writing, and provide a written attestation within 48 hours of taking the medication (you must be able to take the drugs yourself, without help, to qualify).
Two doctors must confirm your diagnosis, prognosis and ability to make medical decisions, and you must prove youāre a California resident.
And more.
āThis will not be an on-demand service,ā says Sarah Hooper, executive director of theĀ .
āThe patient has to jump through a lot of hoops before accessing the prescription. Those hoops are designed to ensure that the patient has really thought about this and is making the decision voluntarily.ā
California will be the fifth state to implement an aid-in-dying law, and the Golden Stateās version of it is considered the most stringent, says Sean Crowley, spokesman for the advocacy groupĀ .
Rather than list every requirement, Iām going describe a few potential challenges you might face if you or a loved one is considering asking for these medications āĀ from doctors who are unwilling to write prescriptions to the cost of the medications themselves.
Letās start with the doctors.
This law is voluntary āevery step of the way,ā says Democratic state Sen. Bill Monning, co-author of the law.
That means everyone āĀ patients, physicians, health systems and pharmacies āĀ gets to choose whether or not to participate.
Nothing requires patients to take the drugs once they have obtained a prescription.
Since Oregon implemented its law in 1997, more than one-third of people who obtained prescriptions didnāt take the medications, according toĀ .
āYou can still at any point decide, āIām not going to need this. The hospice care is effective. The palliative care is effective,’ā Monning says.
But before you can make that decision, you must first get a prescription āĀ and that might take some doing. Thatās because not all health care providers will be on board with the new law. It will be up to you to find the ones who are.
āPatients and families should expect that they will have to be a little proactive in asking questions and getting educated about their care,ā Hooper says.
For instance, the Kaiser Permanente system will participate, and patients will be paired with a coordinator to guide them through the process, says spokeswoman Amy Thoma.
If your Kaiser Permanente doctor chooses not to participate, which is his or her right under the law, your coordinator will connect you with a physician who does, Thoma says.
But U.S. military veterans who receive health care from the U.S. Department of Veterans Affairs will have to look elsewhere for participating doctors, because federal law prohibits the use of federal money for such a purpose, Hooper says.
Nor will the 48 Catholic and Catholic-affiliated hospitals in California participate, including their doctors and staff, says Lori Dangberg, vice president of theĀ .
Dangberg insists that those providers will not abandon any patient who chooses to end his or her own life. āWe will be with that patient and continue to care for that patient throughout their diagnosis and their dying process,ā she says. āWe just cannot participate in any action that would intentionally hasten a personās death.ā
If your doctor doesnāt participate, ask him or her to refer you to one who does. If your doctor wonāt provide a reference, ācall us and we can probably help,ā says Crowley of Compassion & Choices. That number is 800-893-4548.
Another potential obstacle is the cost of the drugs. Your insurance might not cover them. Californiaās law does not require health insurers to cover the medications, Monning says.
In Oregon, Washington and Montana ā states where aid-in-dying is legalĀ āĀ some health plans cover the cost and some donāt, he says. He expects the same to occur in California.
Insurers āare currently working on how they will implement this law,ā says Nicole Kasabian Evans of the .
If you have questions about coverage, she suggests you contact your insurer directly.
Medi-Cal, Californiaās version of the federal Medicaid program for low-income residents, will cover the cost of the drugs without relying on any federal money, says state Department of Health Care Services spokeswoman Katharine Weir.
If affordability becomes an issue, Compassion & Choices again urges you to call. āWe try to work with people to find a way for them to access the law, through any challenges,ā Crowley says.
If you need more step-by-step guidance about the law, tap into these resources:
- Compassion & Choices has online guides for consumers and doctors ²¹³ŁĢż. You can also call the groupās help line at 800-893-4548.
- The UCSF/UC Hastings Consortium on Law, Science and Health Policy has aĀ ²¹³ŁĢż.
- The California Medical Association, which represents doctors, has a detailed,Ā ²¹³ŁĢż. Youāll need to register on the site to read the document.
- Once the law takes effect, or soon thereafter, you will be able to find the forms you and your physician need to sign at the Medical Board of Californiaās website:Ā .
This story was produced by , which publishes , a service of the .