End of Life Option Act Update

by Timothy L. Gieseke, MD, CMD

In California, this Option (physician aid in dying) went live June 9, 2016 for persons with less than 6 months to live and intact decision-making capacity.  By law CDPH reports annually by July 1 of each year data on the previous year’s statewide experience with this option. For the year 2017, 632 persons started the process and 241 unique physicians prescribed 577 aid-in-dying drugs.  62.9% died following ingestion of these drugs, 14.9% died without ingestion of the prescribed drugs, and the outcome of the remaining 22.2% was not reported (some may have taken it in 2018). Most of the individuals taking the drugs were in the 60-89-year-old age range (77%), white (88.9%), had some college education (72.7%), and were enrolled in hospice (83.4%).  The most prevalent illnesses identified were malignancies (68.5%), followed by neurologic disorders (9.4%) like ALS and Parkinson’s. You can read the executive summary on the CDPH web site at: https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/2017EOLADataReport.pdf

This option continues to be controversial with the act temporarily suspended in June, but then resumed in July pending resolution of the legal challenge to the validity of the law.  

In the July issue of Caring for the Ages, Dr. Jeff Nichols responds to the question, “What is a Good Death?”  As a former hospice medical director, I asked this question many times of my team, as we grappled with individual patients & family preferences, goals of care, and our ability to palliate the identified problems.  I appreciated his impartial and thoughtful discussion of this question in the context of the demand for this option. This article is available at: https://www.caringfortheages.com/article/S1526-4114(18)30276-2/pdf

I agree with Dr. Jeff’s observation that most of our SNF patients don’t meet the criteria for this option and most SNFs have likely opted out of permitting ingestion of aid-in-dying drugs within their facilities.  However, facilities connected to assisted living or independent living communities will likely receive requests for this benefit. It’s apparent that this option is likely here to stay with 6 states adopting a similar law and others considering doing so.  The details of the law are on the CDPH web site. If your facility has not adopted a policy and procedure for how to process these requests, this would be a good time to develop a detailed practical policy that meets the laws legal requirements.

For facilities that are comfortable with their P&P or have experience with patients exercising this option, please share your learning and experience with our readers.  (Facility names and locations can be de-identified upon request.)