The 15-page guide is designed to help physicians with the aid-in-dying law that will go into effect later this year. The guide explains the legal and medical steps physicians must take before they prescribe medications for patients to end their own lives.
This article originally appeared in California Healthfax.
The California Medical Association (CMA) has issued guidelines for physicians on how to help terminally ill patients who choose to end their own lives as part of the state's End of Life Option Act.
The 15-page guide released January 20 is designed to help physicians with the new aid-in-dying law that will go into effect later this year. The guidelines explain the legal and medical steps physicians must take before they prescribe medications for patients to end their own lives along with options for opting out of providing aid-in-dying for moral or religious reasons.
"CMA was fielding calls from not only our members, but the general public about what the End-of-Life Option Act means and how it will impact care moving forward," said CMA General Counsel Francisco Silva. "This is a complicated issue and both physicians and patients should have access to answers that help further the patient-physician relationship."
The guide is written in a question-and-answer format and provides detailed information about the new law for physicians and patients. The End of Life Option Act was approved during a special legislative session on healthcare convened in September 2015 and will go into effect 90 days after the special session ends. There is currently no termination date for the special session but it's likely to end during the first half of 2016.
The guidelines note that "an adult with the capacity to make medical decisions and with a terminal disease may make a request to receive an aid-in-dying drug." The guidelines note that terminally ill patients must be diagnosed by their attending physician and a consulting physician as having a terminal illness with less than six months to live. Patients must then make two verbal requests to their physician at least 15 days apart and one written request for medication to end their lives.
The guidelines also explain that the request for medication cannot be made on behalf of a patient through an agent using a power of attorney, advanced care directive, or a conservator. And once the prescription is filled, the patient must fill out a 'Final Attestation for Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner' form. Physicians must also fill out an 'Attending Physician Checklist & Compliance' form.
For a terminally ill patient with a mental disorder, physicians must refer the patient to a mental health specialist for an assessment. The guidelines state that "no aid-in-dying drugs may be prescribed until the mental health specialist determines that the individual has the capacity to make medical decisions …"
The guidelines currently don't recommend what type of drug physicians should use to facilitate aid-in-dying. And the guidelines state that physicians can choose not to assist patients to end their own lives.
"A healthcare provider who refuses to participate in activities under the act on the basis of conscience, morality, or ethics cannot be subject to censure, discipline, or other penalty by a healthcare provider, professional association, or organization," the guidelines state.
CMA president Steve Larson, MD, said the guidelines mark a starting point for physicians in adjusting to the new aid-in-dying law.
"As physicians, there are a lot of questions about requirements under the new law, required documentation and forms, request for the drug, consulting physicians, and so on," said Larson. "There certainly will be areas that evolve as we look to best practices in areas like which drugs to prescribe. This is a resource to help us all navigate the new landscape."
The End of Life Option Act was approved with the passage of Senate Bill 128 in 2015. The bill was initially defeated but was revived and approved during a special legislative session on healthcare convened in September to address Medi-Cal funding issues.
This article originally appeared in California Healthfax.