California changes end-of-life options law

California changes end-of-life options law

California’s End-of-Life Options Act went into effect on June 9, 2016.1 On February 11, 2021, an amendment was proposed, signed into law, and signed into law by Governor Gavin Newsom on October 6, 2021, with the provisions taking effect on January 1, 2022.2

The provisions are as follows:

  • Exemption from final attestation form
  • Extension of the repeal clause of the law until January 1, 2031
  • Prohibit health care entities or providers from engaging in deceptive, false, or deceptive practices related to providers’ willingness to qualify a patient or provide a prescription for an assisted dying drug
  • Reduction of the waiting time for patients requesting end-of-life medication from 15 days to 48 hours between the first and second oral request
  • Require the healthcare entity to post its policy regarding assisted dying on its website
  • Require providers to disclose their reasoning as to why they will or will not support the patient’s request for end-of-life services, document the patient’s request and the provider’s notification of denial in the medical record, and that they transfer medical records upon request

Assisted suicide has been debated 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 pass legislation on the matter. Lawmakers and lobbyists are bringing this topic to legislatures and slowly such bills are being passed. There is no federal euthanasia law, so each state has the ability 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 co-founded the Euthanasia Society of America in New York. In 1947, 37% of people responding to a Gallup poll said they were in favor of physician-assisted dying, while 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 and terminally ill patients 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 that individuals could take end-of-life action. Some publications have even provided specific details on how to assist in the death of a loved one. In 1957, Lael Wertenbaker published Death of a Man, which detailed how she helped her husband end his life.

In the 1960s, many important steps were taken. Lawyer 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 has been put forward, including brain, heart, and lung death. This was slowly accepted after professors at Harvard Medical School proposed this important change.3

The Patient’s Bill of Rights, developed in 1973 by the American Hospital Association, recognizes the right to refuse treatment within the framework 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 supported medical assistance in dying and 34% opposed it.3

Because religion has long been a major factor in arguments against euthanasia, many people were shocked when a deeply religious couple attempted suicide in 1975 without health care providers present.

Henry P. Van Dusen, 77, and his wife, Elizabeth, 80, chose to end their lives to be free from debilitating illnesses. The couple, leaders of a Christian ecumenical movement, wrote a note stating: “We still believe this is the best way and the right way to go.”3 In 1976, the high-profile case of Karen Ann Quinlan became a legal milestone when the New Jersey Supreme Court granted her parents’ wish to have her disconnected from a medical ventilator. Because medical assistance in dying was not yet legal in New Jersey, Quinlan had lived for over 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 questions for pharmacists about whether they should participate in medical assistance in dying or even handle insurance claims. Recently, a cancer patient had her insurance company reject her treatment but offered to cover right-to-die medication 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 Pharmacy candidate at the University of Kentucky College of Pharmacy, Lexington.

Joseph L. Fink III, JD, DSC (Honours), BSPharm, FAPhA, is Emeritus Professor of Pharmacy Law and Policy and former Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.

References

1. Medina J. Who can die? California patients and physicians fight 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 Historic New Laws Going into Effect January 1, 2022. Press 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 events related to the right to die during the 20th century and the beginning of the millennium. Euthanasia research and guidance organization. Updated January 2, 2019. Accessed August 31, 2022. https://www.finalexit.org/chronology_right-to-die_events.html

4. A judge declares 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/

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