California’s End of Life Option Act

In recent years there has been a dramatic increase in the number of states considering death with dignity laws. Sometimes called "assisted suicide" or "right to die" initiatives, these laws make it possible for terminally ill patients to use prescribed medication to end their lives peacefully rather than suffering a painful and protracted death.

The catalyst for greater national attention to this issue was 29-year-old Brittany Maynard, a woman diagnosed with terminal brain cancer who moved from California to Oregon to end her life in 2014. Maynard chose Oregon because California had not yet passed its aid-in-dying law, and Oregon is one of just a few other states to allow terminally ill patients to legally end their lives.

In 2015, during a special session on health care, the California legislature passed a death with dignity bill called the California End of Life Option Act. Signed into law by Governor Jerry Brown in October 2015, the act took effect on June 9, 2016. It allows terminally ill patients to request aid in dying in certain clearly defined situations. In 2022, 1,270 people received prescriptions under the act, and 853 people used them to die. (For additional statistics, see the California End of Life Option Act 2022 Data Report published by the California Department of Public Health.)

This article first clarifies some confusing language related to death with dignity laws and then sets out the basics of California's law.

Death With Dignity, Assisted Suicide, Right to Die: What's the Difference?

"Death with dignity" is one of the most commonly accepted phrases describing the process by which a terminally ill person ingests prescribed medication to hasten death. Many people still think of this process as "assisted suicide" or "physician assisted suicide." However, proponents of death with dignity argue that the term "suicide" doesn't apply to terminally ill people who would prefer to live but, facing certain death within months, choose a gentler way of dying. In fact, California's law states that terminating one's life under the law is not suicide. (Cal. Health & Safety Code § 443.18 (2024).)

Increasingly, health organizations are turning away from the term "suicide" to describe a terminally ill patient's choice to reduce the suffering of an inevitable death. The phrase "aid in dying" is becoming a more accepted way to refer to this process. California's End of Life Option Act uses the phrase "aid in dying"—for example, under the law, the prescribed life-ending medication is called "aid-in-dying medication."

You may also see the phrase "right to die" used in place of "death with dignity." However, "right to die" is more accurately used in the context of directing one's own medical care—that is, refusing life-sustaining treatment such as a respirator or feeding tubes when permanently unconscious or close to death. You can provide your own health care directions by completing a California advance health care directive. (See the end of this article for more information.)

Death With Dignity Requirements in California

Both doctors and patients must comply with certain legal requirements for a patient to receive a prescription for aid-in-dying medication.

Which Patients Can Obtain Aid-In-Dying Medication?

To request a prescription for life-ending medication in California, a patient must be:

• at least 18 years old
• a California resident
• mentally capable of making and communicating health care decisions
• mentally and physically able to self-administer the aid-in-dying drug, and
• diagnosed with a terminal disease that will result in death within six months.

(Cal. Health & Safety Code §§ 443.1; 443.2 (2024).)

How Can a Patient Get Aid-In-Dying Medication?

A patient who meets the requirements above will be prescribed aid-in-dying medication only if:

• The patient makes two verbal requests to their doctor, at least 48 hours apart.
• The patient gives a written request to the doctor. (The law sets out the specific form that the patient must use.)
• The patient signs and dates the request for aid-in-dying medication in front of two qualified, adult witnesses. (See below for witness qualifications.)
• The witnesses confirm the patient's identity in their attestation.
• The witnesses attest that the patient voluntarily signed the request in their presence and is of sound mind and not under duress, fraud, or undue influence.
• The witnesses attest that they aren't the patient's physician or mental health specialist.

(Cal. Health & Safety Code §§ 443.3; 443.11 (2024).)

California law limits who can be the two witnesses for the patient's request for aid in dying. A witness can't be the patient's attending physician, mental health specialist, or the consulting physician who evaluated the patient's suitability for aid-in-dying medication. Also, one of the two witnesses can't be:

• related to the patient by blood, marriage, registered domestic partnership, or adoption
• entitled to inherit from the patient, or
• an employee, owner, or operator of the health care facility where the patient is receiving care.

(Cal. Health & Safety Code § 443.3 (2024).)

What Are the Doctor's Obligations?

A doctor may prescribe aid-in-dying medication to an eligible patient only if:

• The prescribing doctor and one other doctor confirm the patient's diagnosis and prognosis.
• The prescribing doctor and one other doctor determine that the patient is capable of making medical decisions.
• The patient has a psychological examination, if either doctor feels the patient's judgment is impaired.
• The prescribing doctor confirms that the patient is not being coerced or unduly influenced by others when making the request.
• The prescribing doctor informs the patient of any feasible alternatives to the medication, including care to relieve pain and keep the patient comfortable.
• The prescribing doctor asks the patient to notify their next of kin of the prescription request. (The doctor cannot require the patient to notify anyone, however.)
• The prescribing doctor offers the patient the opportunity to withdraw the request for aid-in-dying medication before granting the prescription.

(Cal. Health & Safety Code §§ 443.4; 443.5; 443.6 (2024).)

To use the medication, the patient must be able to ingest it on their own. A doctor or other person who administers the lethal medication may face criminal charges. (Cal. Health & Safety Code §443.14 (2024).)

In addition, no other person—such as a health care agent, attorney-in-fact, or conservator—may make a request for aid-in-dying medication on behalf of the patient. (Cal. Health & Safety Code §443.2 (2024).)

You can read the full text of California's End of Life Option Act on California's Legislative Information website.

Learn More

To find out more about the history and current status of death with dignity laws in the United States, visit the website of the Death With Dignity National Center.

For information about appointing a health care agent and making known your own wishes for medical care at the end of life, see the Living Wills & Medical Powers of Attorney section of Nolo.com.

Updated February 23, 2024