End of Life Option Act

• California law allows a qualified individual with a terminal illness the right to request a prescription for aid-in-dying drugs from his or her physician for the purpose of ending his/her life.
• Individuals may choose to exercise this option if specific conditions are met, including the physical and mental ability to self-administer the aid-in-dying drugs.
• It is illegal for anyone other than the qualified individual to administer the drugs.
• Under California law, a healthcare provider is not required to participate in activities authorized under the End of Life Option Act (EOLOA) and participation is voluntary.

VNAcare reaffirms the fundamental philosophy that hospice neither hastens nor prolongs the dying process. VNAcare places high value on life and is committed to providing comprehensive symptom management and supportive care to individuals with terminal illnesses so that they may live life as fully and comfortably as possible.

VNACARE employees, independent contractors and volunteers are prohibited from assisting or participating in any activities pursuant to the Act while acting within the scope of any employment by, or contract with VNAcare. VNAcare employees, independent contractors and volunteers will not provide nor assist in obtaining an aid-in-dying drug for the purpose of ending life.  Aid-in-dying drugs will not be included in the hospice plan of care. VNAcare employees, independent contractors and volunteers shall not be in attendance if and when the patient chooses to self-administer aid-in-dying drugs.

VNAcare respects a patient’s right to self-determination.  Patients who choose to pursue aid-in-dying under the End of Life Option Act will not be denied access to hospice care.  Patients will not be discharged from hospice based on a decision to end their lives pursuant to the Act and VNAcare will continue to provide comprehensive care and supportive services to patients and their families.

VNAcare employees, independent contractors and volunteers who are morally or ethically opposed to aid-in-dying will have the option of transferring care to other available staff members if the patient chooses to exercise his/her option under this Act.

In accordance with CA law, a copy of the current policy shall be posted on the agency website.

1. If a patient requests aid-in-dying information, hospice will refer the patient to his/her attending physician and:

• Compassion and Choices 800-247-7421 compassionandchoices.org
• California Death with Dignity 503-228-4415 deathwithdignity.org

2. The patient will be informed of the agency policy, which prohibits employees, independent contractors and volunteers from assisting or participating in any activities under the Act. Hospice staff will not act as an agent in initiating activities under the Act. Employees, independent contractors and volunteers shall not encourage or discourage a patient’s request nor influence a patient’s decision.

3. Employees, independent contractors and volunteers shall notify the hospice director, interdisciplinary team and the attending physician when a patient is considering or requesting aid-in-dying information. Hospice employees shall document all discussions regarding aid-in-dying in the patient’s medical record.

4. Hospice staff shall respect a patient’s right to explore his/her option under the Act and will continue to provide customary hospice services that address the physical, emotional, social, and spiritual needs of the patient and family in a compassionate, supportive and non-judgmental manner. Thoughts of suicide among terminally ill patients is not uncommon and the hospice team will explore concerns or fears of pain, symptoms, suffering, grief and other emotions that may contribute to their desire to pursue aid-in-dying.  To ensure that the hospice plan of care addresses the needs of the patient, the interdisciplinary team shall incorporate a psych/social/emotional intervention through which the team and patient may explore concerns or fears contributing to their desire to pursue aid-in-dying.

5. For patients who choose to exercise aid-in-dying, hospice employees shall comply with the following:

a. Hospice shall respect the patient’s decision and will continue to provide customary hospice services that address the physical, emotional, social, and spiritual needs of the patient and family in a compassionate, supportive and non-judgmental manner.

b. If the attending physician is also a hospice physician and the patient requests aid in dying drugs, he/she must inform the patient of the agency policy, which prohibits employees, independent contractors and volunteers from assisting or participating in any activities under the Act while acting within the scope of any employment by, or contract with VNAcare. Patients will be informed that they have the right to choose another attending physician not contracted with VNAcare, who is willing to prescribe aid-in-dying drugs as permitted under the Act.

c. Aid-in-dying drugs will not be included in the hospice plan of care and shall not be listed on the medication profile or the plan of care. Nurses will not provide education on the use of aid-in-dying drugs as this is the responsibility of the prescribing attending physician.

d. If/when the patient chooses to ingest aid-in-dying drugs and requests staff to be present, staff and volunteers must respectfully decline and inform the patient of the policy, which prohibits staff from being in attendance when the patient self-administers the aid-in-dying drugs. Hospice may request the patient or family to notify the hospice nurse, social worker or chaplain if/when an ingestion time/day has been chosen and this will be communicated to the IDG.

i. If staff arrive at the patient’s home for a scheduled visit and the patient is in the process of taking the aid-in-dying drugs, hospice staff shall leave and delay their visit until after ingestion.

ii. After the patient has ingested the aid-in-dying drugs, staff may visit the patient and family to provide emotional support and other hospice services in accordance with the plan of care.

iii. When death has occurred following self-administration of aid-in-dying drugs, hospice will provide the usual time of death visit and initiate bereavement services.

e. Pursuant to CA Health & Safety Code 443.18, the Act provides that death caused by the self-administration of an aid-in-dying drug shall not constitute suicide. Thus, physicians should not list suicide as the cause of death on the death certificate. In accordance with guidelines from the California Medical Association, physicians can list the cause(s) of death that they feel is the most accurate. The Act does not preclude physicians from listing the underlying terminal illness and/or pursuant to the End of Life Option Act.