California’s assisted suicide laws are governed by the End of Life Option Act, which lets a terminally ill adult request a prescription for medication they can take themselves to end their life. Governor Newsom signed SB 403 in 2025, removing the Act’s sunset date and making it a permanent part of California law. The process is tightly structured: you must meet strict eligibility rules, make three separate requests, be evaluated by two physicians, and take the medication yourself.
Who Can Request Aid-in-Dying Medication
Every one of the following must be true at the time you make your request:
- You are at least 18 years old.
- You are a California resident. Proof can be a California driver’s license or state ID, California voter registration, evidence of owning or leasing property in the state, or a California tax return for the most recent year.
- Your attending physician has diagnosed you with an incurable and irreversible disease that, in their medical judgment, will result in death within six months.
- Both your attending physician and a consulting physician confirm you have the mental capacity to make medical decisions. If either sees signs of a mental health condition affecting your judgment, you’ll be referred to a mental health specialist, and no prescription can be written until that specialist confirms your capacity.
- You are physically and mentally able to take the medication yourself, with no help from anyone else.
Only you can make the request. No one can act for you through a power of attorney, advance healthcare directive, conservatorship, or any other form of surrogate decision-making. Age or disability alone can never be the basis for qualifying.1California Legislative Information. California Health and Safety Code 443.2
The Three Requests
Before a physician can write the prescription, you must make three separate requests: two spoken and one written. All three go directly to your attending physician.
Two Oral Requests, 48 Hours Apart
The two oral requests must be spaced at least 48 hours apart. Before 2022, the law required a 15-day gap; SB 380 shortened it to 48 hours to reduce suffering for patients with rapidly progressing illnesses.2California Legislative Information. SB-380 End of Life If your first oral request was documented by a physician who later declined to participate, a new attending physician can count that request rather than making you start again.
The Written Request and Its Witnesses
You must also submit a written request on a state-issued form, signed and dated in front of two witnesses. The witnesses attest to your identity, your mental capacity, and that you are acting voluntarily. Not everyone can serve:
- Your attending physician, consulting physician, and any mental health specialist involved in your case cannot be witnesses.
- No more than one of the two witnesses can be related to you by blood, marriage, domestic partnership, or adoption, or be someone entitled to inherit from your estate.
- No more than one of the two witnesses can own, operate, or work at the healthcare facility where you’re being treated or living.
In practice, at least one witness must be someone with no personal stake in your decision and no connection to the facility caring for you.3Physician Assistant Board. California End of Life Option Act Information Bulletin
The Two Physician Evaluations
Two independent physicians must sign off before any prescription is written.
Your attending physician holds primary responsibility. They must confirm your terminal diagnosis, verify a prognosis of six months or less, assess your mental capacity, and ensure the request is voluntary. They also must discuss the potential risks of the medication, the expected result, feasible alternatives including palliative care and hospice, and your right to change your mind at any point. Their findings go on state compliance forms in your medical record.4California Legislative Information. California Health and Safety Code 443.5
A separate consulting physician then examines you, reviews your records, and independently confirms the diagnosis, prognosis, and capacity determination. If the consulting physician disagrees on any point, the process cannot move forward.
You Can Withdraw at Any Time
The only mandated waiting period is the 48 hours between your two oral requests.5California Department of Public Health. End of Life Option Act The original law also required a final attestation form completed within 48 hours of taking the medication, but that requirement was eliminated in 2022 under SB 380.2California Legislative Information. SB-380 End of Life
Right before writing the prescription, the attending physician must verify one more time that you are still making an informed, voluntary decision. You keep the right to withdraw at any time, in any manner, even after the medication is dispensed. Withdrawal doesn’t have to be in writing, and it doesn’t require full mental capacity.
Filling the Prescription and Handling Unused Medication
Once every step is complete, the attending physician writes the prescription and contacts a licensed pharmacist directly, in writing, electronically, or verbally. You do not carry the prescription to the pharmacy yourself. The pharmacist may dispense the medication to you, to your attending physician, or to someone you have specifically designated to pick it up. The label must clearly state the medication’s purpose.
Not everyone who receives the drug takes it. If the patient dies without using the medication or decides not to take it, whoever has possession of the leftover drugs is legally responsible for disposal. The law requires delivery to the nearest facility that handles controlled substance disposal. If no such facility is reasonably available, disposal must go through a DEA-approved take-back program or another lawful method following California Board of Pharmacy guidelines. Flushing the drugs or throwing them in the trash is not lawful.3Physician Assistant Board. California End of Life Option Act Information Bulletin
How the Death Is Recorded
Under the Act, a death from aid-in-dying medication is not classified as suicide. The death certificate lists the underlying terminal illness as the cause of death, and the manner of death is recorded as natural. The California Department of Public Health has directed county coroners and medical examiners not to report these deaths as suicide or as “pursuant to End of Life Option Act.”
Because the death is classified this way, life insurance policies, annuities, wills, and contracts are not affected. Insurers cannot deny a claim or void a policy based on your participation, as long as all of the Act’s requirements were followed. This protection is written directly into the statute.
What Insurance Covers
Cost and coverage depend on the type of insurance you have.
- Medi-Cal. California’s Medicaid program covers aid-in-dying prescription drugs on a fee-for-service basis when all requirements of the Act are met. Only FDA-approved drugs for oral or sublingual use are reimbursable.6Medi-Cal. End of Life Option Act Services – Medi-Cal Providers
- Medicare. Federal law prohibits Medicare from paying for any item or service intended to cause death. The Assisted Suicide Funding Restriction Act of 1997 bars the use of federal funds for this purpose.7Centers for Medicare & Medicaid Services. Assisted Suicide Funding Restriction Act of 1997
- Private insurance. California law does not require private health insurers to cover aid-in-dying drugs. Some plans may; there is no guarantee.
On Medicare or an uncovered private plan, expect to pay out of pocket. The medication itself can cost from a few hundred to several thousand dollars depending on the specific drug prescribed.
When a Doctor or Hospital Refuses
No physician, pharmacist, or healthcare provider is required to participate. The law protects providers from professional consequences whether they participate in good faith or refuse. A physician who participates properly cannot be censured, disciplined, or stripped of their license, and a physician who declines faces no penalty either.8California Legislative Information. California Health and Safety Code 443.14
Healthcare facilities can go further. Hospitals, nursing homes, and hospice organizations may adopt policies prohibiting their employees and contractors from participating in the Act while on duty and on the facility’s premises. A Catholic hospital system, for example, can ban the process entirely within its walls. That authority has a hard limit: a facility cannot stop its employees from participating on their own time and off its property.
If your physician or facility declines, you will need to find a willing provider. In some parts of California, especially rural areas, that can add real time and difficulty.
Criminal Penalties for Abuse
The Act treats two categories of conduct as felonies. Knowingly altering or forging a request for aid-in-dying medication without the patient’s authorization, or hiding or destroying a patient’s withdrawal of their request, is a felony when done with the intent or effect of causing the patient’s death. Knowingly coercing someone into requesting or taking the medication, or giving the drug to someone without their knowledge or consent, is also a felony.9California Legislative Information. California Health and Safety Code 443.17
These provisions sit on top of the Act’s structural safeguards: patient self-administration, two independent physician evaluations, and the witness restrictions on the written request.