California Death with Dignity Act: Eligibility, Requests, and Refusals

California’s aid-in-dying law is formally called the End of Life Option Act, not the Death with Dignity Act (that name belongs to Oregon’s statute). It lets a terminally ill adult who lives in California request a prescription for medication they can take themselves to end their life, provided two physicians confirm a six-month prognosis and decision-making capacity. The law took effect on June 9, 2016, and was amended in 2022 to shorten the waiting period between the two required oral requests from 15 days to 48 hours.¹

Who Qualifies

You must meet every one of the following to be eligible:²

You are at least 18 years old.
You live in California. There is no minimum length of residency.
Your attending physician has diagnosed you with an incurable and irreversible disease expected to cause death within six months, and a second consulting physician independently confirms that diagnosis.
Both physicians find that you can understand the nature and consequences of requesting aid-in-dying medication, along with its risks and alternatives.
You are physically and mentally able to take the medication yourself.

If either physician thinks your judgment might be impaired by a mental health condition, they must refer you to a psychiatrist or licensed psychologist. No prescription can move forward until that specialist confirms you have the capacity to make medical decisions.³

How to Request the Medication

The request process has three parts, all of which the patient initiates.

First, you make a verbal request to your attending physician. Second, you make another verbal request at least 48 hours later. Even a physician who personally objects to the Act must document your first oral request and note the date in your medical record.⁴

Third, you submit a written request on the statutory form titled “Request for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner.” You sign and date it in front of two adult witnesses who attest that you signed voluntarily, appear to be of sound mind, and are not under duress.⁵ Neither witness may be your attending physician, consulting physician, or mental health specialist.

The two witnesses also have to be independent of each other in certain ways. Only one may be related to you by blood, marriage, domestic partnership, or adoption. Only one may stand to inherit part of your estate. And only one may own, operate, or work at the healthcare facility where you receive treatment or reside. In practice, that means at least one of your witnesses has to be a person with no personal or financial connection to you or your care facility.

The old “final attestation” form that patients used to sign within 48 hours of taking the medication was eliminated in 2022. You no longer complete any paperwork at the end of the process.⁴

What the Physicians Must Confirm

Before writing the prescription, the attending physician has to confirm your terminal diagnosis, verify your decision-making capacity, and make sure you understand all of the following:²

Your diagnosis and prognosis.
The potential risks of the medication.
The probable result of taking it.
That you can choose at any point not to obtain or ingest the medication.
Alternatives, including comfort care, hospice, palliative care, and pain management.

The consulting physician examines you separately, reviews your records, and reaches an independent conclusion about the diagnosis, prognosis, and your capacity. If the two physicians disagree on any of these findings, the prescription cannot proceed until the disagreement is resolved. Both physicians document each oral request, the written request, their clinical findings, the alternatives discussed, and confirmation that you were told you could withdraw. Within 30 calendar days of writing the prescription, the attending physician has to submit completed forms to the California Department of Public Health.

Taking the Medication Yourself

You have to take the medication yourself. “Self-administer” means your own conscious, physical act of ingesting the drug. No one else may put it in your mouth, inject it, or otherwise cause you to consume it.²

Someone present with you may help prepare the medication, such as mixing it, without facing civil or criminal liability, so long as they do not help with the actual ingestion.⁵ A family member who stirs the medication into a drink is acting within the law. A family member who holds the cup to your lips is not. If you lose the physical or mental ability to self-administer before you take the medication, you cannot use it, and no one can use it on your behalf.

If Your Doctor or Hospital Refuses

Participation is voluntary throughout the system. An individual physician, pharmacist, hospice, or entire hospital organization can decline to participate for reasons of conscience, morality, or ethics, without facing civil, criminal, or professional discipline.⁶

A provider who refuses still has obligations to you. They must tell you they don’t participate, record the date of your request in your medical record, and transfer your relevant records to you or to a new provider on request. The law also forbids misleading practices about willingness to participate, so a facility cannot lead you along and then refuse at the final stage. If your current provider or hospital won’t participate, the practical next step is finding one that will, and your records have to follow you when you go.

Cost, Insurance, and the Death Certificate

California law states that death under the End of Life Option Act is not suicide for any legal purpose, including insurance.⁵ Your decision to use aid-in-dying medication cannot affect the terms, pricing, or coverage of any life insurance, health insurance, or annuity policy. Insurers cannot invoke a suicide exclusion, and making or rescinding a request cannot change your policy status.

The death certificate lists your underlying terminal disease as the cause of death, not the medication and not the Act. The California Department of Public Health instructs physicians, coroners, and medical examiners not to write phrases like “pursuant to End of Life Option Act” on the certificate, and suicide should not appear anywhere on it.⁷

Federal law is another matter. The Assisted Suicide Funding Restriction Act of 1997 bars Medicare, Medicaid, and other federally funded programs from paying for aid-in-dying medication or related services.⁸ The medication typically comes out of pocket or through private insurance that voluntarily covers it. California’s Medi-Cal program has offered some coverage for end-of-life option services, but the federal restriction limits what can be reimbursed. Costs vary, and compounding pharmacies prepare multi-drug protocols that generally cost less than brand-name alternatives. Your attending physician or a participating pharmacist can walk you through options and whether your private insurance covers the prescription.

Changing Your Mind and Handling Unused Medication

You can rescind your request at any time, by any means, and no paperwork is required to do so. Many people who receive a prescription never take the medication, either because they die from their illness first or because they decide against it.

Any unused medication that remains after a patient’s death has to be disposed of properly. Whoever has custody must deliver the drugs to the nearest facility that disposes of controlled substances or use a DEA-approved take-back program.⁵ Flushing the medication or throwing it in the trash is not a lawful option. Families should act promptly, since leaving lethal medication unsecured in a home after a death is a clear safety risk.

Criminal Penalties Protecting the Patient

The Act is built around the idea that the choice is entirely the patient’s, and it treats manipulation of that choice as a felony. Knowingly altering or forging a request without the patient’s authorization, or hiding or destroying a patient’s withdrawal, is a felony when done with the intent or effect of causing the patient’s death.⁹ Knowingly pressuring someone to request or ingest the medication, destroying their withdrawal, or administering the medication to someone without their knowledge or consent is also a felony. These penalties sit on top of existing homicide and elder abuse statutes.

1
CDPH – CA.gov. California End of Life Option Act 2022 Data Report
2
California Legislative Information. California Health and Safety Code HSC 443.1
3
Medi-Cal. End of Life Option Act Services
4
California Department of Public Health. End of Life Option Act
5
Physician Assistant Board. California End of Life Option Act Information Bulletin
6
California Legislative Information. California Health and Safety Code HSC 443.14
7
CDPH – CA.gov. Reporting Causes of Death for End of Life Option Act
8
Office of the Law Revision Counsel. 42 USC 14402 – Restriction on Use of Federal Funds Under Health Care Programs
9
California Legislative Information. SB-380 End of Life