California Right-to-Die Law: The End of Life Option Act
Since 2016, the California End of Life Option Act (EOLOA) has allowed certain terminally ill adults who are state residents to request life-ending medicine from their doctor.
If you didn’t realize it existed, you’re in the majority. A 2024 study revealed that only 25% of Californians over 60 were aware that medical aid in dying (MAiD) is available in the Golden State.
Compare this to Canada, which has a similar population size to California and has also had a MAiD law since 2016. A total of 67% of Canada's residents are aware of the law, and, as a result, far more Canadians have taken advantage of the law than Californians.
This article discusses the California EOLOA and how it works. In addition, it will cover how MAiD differs from euthanasia, suicide, and physician-assisted suicide as well as the other states that have legalized end-of-life laws.
California’s Right-to-Die Law
The California End of Life Option Act, or EOLOA, which was amended in 2021 by SB 380, allows California residents who are terminally ill to request aid-in-dying medication from their physician and to ingest that medicine to end their lives.
Key Features of the California EOLOA
According to the language of the Act:
Aid-in-dying drug is defined under the Act and essentially means a drug that will end a person’s life.
Participation in the EOLOA is completely voluntary. Terminally ill (defined below) patients are not required to end their lives this way, and health care providers are not required to prescribe aid-in-dying drugs.
A person who is present at the death of a patient who participates in the EOLOA will not be held criminally or civilly liable for the patient’s death as long as they don’t help the patient ingest the drug. (As discussed below, one of the eligibility requirements for receiving life-ending medication under the EOLOA is that the individual is capable of ingesting the medicine without help.)
Health care providers who choose to prescribe life-ending medication following the Act’s provisions will not be subject to legal liability or professional sanctions. Likewise, health care providers who choose not to participate in the EOLOA for moral or ethical reasons will not be subject to legal liability or professional sanctions. Under the Act, a health care provider who chooses not to participate must tell the patient they don’t participate, document the date of the patient’s request and the fact they told the patient they don’t participate, and transfer the patient’s medical record to another health care professional upon request.
Only the patients themselves can request end-of-life medication; the request cannot be made on a patient’s behalf by another person. However, once a health care provider prescribes the aid-in-dying drug, the medicine can be dispensed either to the patient or someone they designate.
Health care entities must post their current medical aid-in-dying policy on their public websites.
In addition, the Coalition for Compassionate Care of California has explained two other significant aspects of the EOLOA, although these are not set out in the Act itself:
“Taking an aid-in-dying drug under [EOLOA] will not be viewed as suicide, assisted suicide, homicide, or elder abuse. If all the requirements of the [EOLOA] are followed, the patient’s death certificate should indicate they died from an underlying illness and that death occurred naturally.” In 2016, the California Department of Public Health sent a letter to county coroners and medical examiners (among others) regarding the reporting of causes of death for patients who use the EOLOA. In the letter, the health department advises that such patients’ deaths should not be reported as “pursuant to End of Life Option Act” or suicide, but should instead be reported as caused by the underlying terminal illness.
Health insurance plans are not required under California law to cover the cost of aid-in-dying drugs.
Eligibility Under the California EOLOA
To be eligible to receive aid-in-dying medicine under the California right-to-die law, a person must:
Be an adult (18 years or older)
Be a California resident
Have a terminal disease (i.e., “an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months”)
Have the capacity to make medical decisions
Be able to take the medication without assistance
Eligibility Expansions Considered in 2024
The California legislature considered expanding eligibility requirements in 2024 to allow access to the EOLOA by non-Californians and people with certain stages of dementia as well as allowing delivery of end-of-life drugs through intravenous methods. However, the bill didn’t make it out of committee.
How to Access the End of Life Option Act
A person seeking to use the EOLOA must:
Make two oral requests
The requests are made to the attending physician.
The requests must be a minimum of 48 hours apart.
SB 380, signed into law in 2021, amended the Act to reduce the waiting period from 15 days to 48 hours.
Make a written request
Among other requirements, the written request (also made to the attending physician) must:
Use specific wording (set out in the Act)
Be witnessed by two people who attest to, among other things, the patient’s identity and mental capacity and the fact their request is voluntary (the wording of the attestation is also set out in the Act).
Health Care Providers’ Rights and Obligations Under the EOLOA
The Act provides many provisions directed toward the patient’s health care provider (which could include physicians, doctors of osteopathic medicine, or other providers licensed under relevant state laws). Key terms include:
Health care providers may decline to participate in the EOLOA. A health care provider who objects “for reasons of conscience, morality, or ethics” may decline to participate in a patient’s access to EOLOA.
A health care provider who declines to participate must inform the individual of this and, if requested, must transfer the individual’s medical records to a new doctor.
Importantly, although SB 380 also states that a health care provider who declines “shall … document the individual’s date of request,” the state is prohibited from enforcing this provision against physicians who decline to participate. This prohibition is the result of an injunction issued by the United States District Court for the Central District of California after the Christian Medical & Dental Association filed a lawsuit complaining that the documentation requirement amounted to compelled speech, which was argued to violate the First Amendment.
This means that if a physician declines to participate and declines to document the patient’s request, the patient must make a note of their request so it can be viewed as one of the two oral requests required by the act.
Health care entities may prohibit their employees, independent contractors, etc., from participating in the EOLOA but only while acting in the course and scope of the entity and on the entity’s property (i.e., they may not prohibit participation on the employee’s own time and off the entity’s premises).
Health care providers who choose to participate in the EOLOA must follow a long list of requirements, including deciding that the individual has mental capacity to make the decision, ensuring the person is making an informed decision (i.e., they understand their medical condition, the risks and results of ingesting the aid-in-dying medicine, and other available options, such as hospice), and confirming they're not being coerced into ending their life.
Medical Aid in Dying is Not Euthanasia, Suicide, or Physician-Assisted Suicide
As explained by Compassion & Choices, a nonprofit devoted to improving end-of-life options and care, medical aid in dying — which is the only conduct addressed by the EOLOA — is not the same as:
Euthanasia, which refers to the act of someone intentionally causing the death of another
Euthanasia is also referred to as mercy killing and is not legal in the U.S. The most famous U.S. case involving euthanasia was Dr. Jack Kevorkian, who was convicted of second-degree murder for practicing euthanasia on a Michigan man with amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s Disease. Kevorkian allegedly assisted over 100 patients in ending their own lives by instructing them how to use certain machines that would deliver lethal drugs or carbon monoxide. In the case that led to his conviction, Kevorkian actually administered the lethal chemicals, making the act both euthanasia and illegal.
Suicide, which is the act of someone ending their own life
Suicide is a public health concern that covers far more deaths than those permitted by the very limited medical aid-in-dying process, which applies only to adults with terminal diseases that will kill them within 6 months.
Physician-assisted suicide, which occurs when a doctor prescribes life-ending medicine to a person outside the limited confines of the EOLOA
Physician-assisted suicide is not legal in the U.S. and is expressly not covered by states with medical aid-in-dying acts, such as the California EOLOA, which establishes requirements for the patient and health care provider.
The Right to Die in Other States
Although California has long led the nation in many areas, it was not the first state to legalize medical aid in dying. It was actually the fifth. First was Oregon, which passed the Death with Dignity Act in 1997. It was followed by Washington, Montana, and Vermont, which enacted similar legislation in subsequent years. In fact, it was because California didn’t have such a law that Brittany Maynard, a young woman with terminal cancer, moved from California to Oregon in 2014 in a case that captivated the nation.
Now, Hawaii, Maine, New Jersey, and New Mexico have passed similar laws. Death With Dignity, a nonprofit that “serves the public with information and education on a broad range of end-of-life topics,” is tracking legislative movements nationwide. It notes that while some states are considering adding such a law — and California considered expanding eligibility under its EOLOA — others are considering repealing their laws or otherwise opposing the practice of medical aid in dying.
An Option for Californians — and California Lawyers — to Know About
Californians, and future California lawyers, should be aware of end-of-life options under the law, including developments in the End of Life Options Act.
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