FAQs: End of Life Option Act at UCSF

The following provides information about California's End of Life Option Act, as well as some special rules for UCSF patients.

• What is the End of Life Option Act?
• Who can use the act?
• What steps do I take to use the act?
• If I ask my doctor for the life-ending drug prescription, do I have to take it?
• If I ask for the life-ending drug prescription, does my doctor have to prescribe it?
• How does the law protect me?
• How does the act affect my insurance, will or other contracts?

What is the End of Life Option Act?

The End of Life Option Act ("the act") is a new California law that goes into effect on June 9, 2016. It allows patients who have a terminal disease (with a life expectancy of six months or less) to request a life-ending drug prescription from their doctor.

Participation in the act is voluntary for patients, doctors and staff. UCSF allows our doctors and employees to participate in the act if they choose and UCSF respects any decision not to participate.

Who can use the act?

A UCSF patient receiving care for a terminal disease who:

• Is at least 18 years of age and able to make medical decisions;
• Is a California resident (there are several ways to prove this);
• Has been told by two doctors that the terminal disease will probably end his or her life within six months;
• Is asking to use the act voluntarily without any pressure from anyone;
• Makes two verbal requests at least 15 days apart and one written request on a special form;
• Is willing to meet with three different physicians to discuss the request, learn information about the act and learn about other ways we can take care of the patient's terminal disease; and
• Is able to take the life-ending drug without help from anyone.

What steps do I take to use the act?

You and your doctor must follow these steps:

1. If you ask for information about the act, a UCSF social worker who is well versed in the requirements will inform you about the act, and will provide educational materials for your review, before you decide if you wish to make a request for a life-ending drug prescription.

2. The doctor who takes care of you for your terminal disease must tell you that he or she believes that the disease cannot be cured or reversed, and believes that you have six months or less to live.

3. You must tell your doctor twice in person that you want the life-ending drug prescription. There must be at least 15 days between these two requests. No one else may ask your doctor for you.

4. You must complete and sign a special form telling your doctor that you want the life-ending drug prescription.

5. You must talk about your decision alone with your doctor. No one else can be present, except an interpreter if you need one.

6. You must see a second doctor who must agree that you have a terminal disease and that it cannot be cured or reversed. This doctor must also agree with your main doctor about how long you may live.

7. You must see a psychologist or psychiatrist who will make sure that you are mentally healthy to use the act.

8. You must talk with these doctors about:

• How the life-ending drugs will affect you.
• How death might not come right away.
• Other ways to deal with your terminal disease.
• How you may change your mind and take back your request at any time. You do not have to take the life-ending drug even if you get the prescription. You should keep the drugs in a safe place at all times.
• How you may decide to tell your family about your decision.
• The importance of having someone with you when you take the drugs.

9. If you and your doctors agree, your doctor may write the drug prescription. If any of your doctors do not agree that you can meet all of the requirements, they will not write a drug prescription for you. Note: There are special rules about how you obtain the drugs.

10. Within 48 hours before you take the drug, you must complete and sign a form that says that you decided to take the prescription drug and no one forced you to take it.

11. At any time during this process, you are welcome to speak with a representative (a chaplain) from UCSF's Spiritual Care Services.

If I ask my doctor for the life-ending drug prescription, do I have to take it?

No. If you ask for the drug prescription and your doctors agree that you qualify, you do not have to take it. But if you decide to take the drug, you may not take it on UCSF premises or in any public place.

If I ask for the life-ending drug prescription, does my doctor have to prescribe it?

No. Your doctor's participation in the act is voluntary — based on her or his own personal beliefs. Even if you may qualify, if your doctor does not feel comfortable using the act, your social worker will assist you in finding a doctor who has agreed to participate in the act. Your doctor will always be willing to speak with you about other ways she or he can support you during your terminal disease.

How does the law protect me?

The law says that:

1. Your doctors must feel certain that you qualify to use the act by meeting all of the requirements.

2. Your doctors must feel certain that you are voluntarily making this request without any pressure from anyone else.

3. Two people must be present to see that you signed the special form and they must sign the form too. They will not sign the form if they believe you are not able to make your own medical decisions.

4. None of your doctors may sign your form.

5. Only one person signing your form may be related to you, and at least one person must be someone who does not work for UCSF.

6. UCSF will provide a certified interpreter if you need one. The interpreter who helps you may not be related to you.

7. You can change your mind at any time. No one but you can decide to take the drug prescription and you have to take the drug yourself without help from anyone else.

How does the act affect my insurance, will or other contracts?

The law states what insurance companies and others can and cannot do. For example:

• A health plan may not tell you that you cannot get health insurance just because you asked for the life-ending drug prescription.
• A health plan may not tell you that life-ending drug prescriptions are covered unless you ask them. If you are concerned about the insurance coverage or cost, you should ask your health insurance provider.
• A health plan may not refuse treatment for your disease at the same time it offers coverage for life-ending drug prescriptions.
• A life insurance carrier may not deny life insurance benefits because you have used the act.
• A will, contract or other agreement may not make you receive a life-ending drug prescription or prevent you from doing so.

Note: This document provides information only about the act as it relates to UCSF patients.