As I previously reported, in the August 1 WAVE, SB 380, the End of Life Option Act (EOLOA) became a law in California in 2016 and was amended in 2021 to shorten to two days the time from the first oral request to the second one. In addition, all healthcare facilities (acute care hospitals, SNFs, hospices, and medical offices) are to post a publicly visible notice on their website and offices stating their policy with respect to the EOLOA, including if they and their employees are prohibited from participating in this Act.

In my WAVE August 15, 2025 MAID (Medical Aid in Dying) Update I reviewed CDPH’s annual report regarding the use of EOLOA in 2024. I noted that the number of persons in our state who completed EOLOA has about doubled in the last 3 years and that of the 1,032 deaths in 2024, 2.3% reportedly occurred on SNFs.

Recently, I was surprised to receive my first request for this option from a nursing home resident receiving hospice services. In compliance with this revised law, I recorded when the request was made, including the date and time. Neither I nor this patient’s PCP nor the facility had prior experience with a patient making this request. I had previously decided to not participate. but no longer have an office and have not posted my policy since I do not have a website. The facility may have a policy, but the patient, their family and I were not aware of it. The patient’s hospice was non-participating.

Fortunately, the Academy of Aid in Dying Medicine (https://www.aadm.org/ ) has a valuable section for Patients and Families that includes “Find a Provider.” I previously assisted a former patient's daughter with the form. I advised this patient’s PCP to complete that request, and soon an experienced provider became the certifying physician, with the PCP serving as the consultant physician. The involvement of an experienced provider has enhanced outcomes for individuals requesting MAID.

Because our facility was not participating, this patient agreed to be discharged home, which his hospice facilitated, including covering the transportation home.

However, some of our facility team members were not supportive of this patient’s decision and raised questions about the need for a suicide watch in the remaining two days he would be at our facility. Some kept referring to the patient’s choice as “Assisted Suicide.” While technically correct and a term commonly used in Europe (and still endorsed by the American Medical Association), the EOLOA views this choice as a part of the terminal illness, which is what is stated as the cause of death on the death certificate. All staff must respect a patient's right to choose MAID, even if they disagree with the decision. The time to influence these hard decisions (if such a time exists at all) is prior to the patient’s declaring their choice. Disparaging a choice by calling it suicide only adds to the pain of dying and puts the facility at risk for regulatory and legal jeopardy. The preferred term for their choice is MAID.

For facilities that are not participating, now is the time to prepare your team to fully support patients who make this difficult choice. Also, as health care providers who should give our patients unconditional positive regard and respect, it should be remembered that many people who request MAID medications never get the prescription filled, and even more obtain the medication (up to 1/3 of all prescriptions) but never take it. For me, I need to be more in tune with my patients’ suffering and values to make sure that palliative care is optimal and addresses the causes of hopelessness so common in persons who are dying. Then fewer people may feel that this option is their best one.