End of Life Option Act: Understanding Its Purpose

Dr. Catherine Forest, a proponent of the right to die, has assisted numerous terminally ill patients with ending their lives by prescribing aid-in-dying medication. She strongly supports the End of Life Option Act that went into effect in 2016. This law allows “an adult diagnosed with a terminal disease, who meets certain qualifications, to request the aid-in-dying drugs from their attending physician.” This practice is known as medical aid in dying (MAiD) or physician-assisted suicide.

Estimated reading time: 6 minutes

Dr. Catherine Forest shares her experience involving her husband’s request to use the End of Life Option Act
How does the End of Life Option Act work?
Legislative updates and evolution of the Act (2016-2025)
Data on implementation and usage
References

Dr. Catherine Forest shares her experience involving her husband’s request to use the End of Life Option Act

Dr. Forest recently shared her experience following her husband’s request to utilize medical aid in dying. Their relationship had been strong, and Dr. Forest immediately understood her husband’s reasoning. Will Forest had been diagnosed with amyotrophic lateral sclerosis (ALS), a terminal illness, and his decline progressed exceptionally quickly. His physicians informed him “that he was going to die by choking or suffocating.”

Dr. Catherine Sonquist Forest, M.D., M.P.H

Dr. Catherine Sonquist Forest Photo by Compassion and Choices

Will admitted to his wife, Dr. Forest, that if he had not learned about the aid-in-dying law through her, he “would be living every last day of [his] life absolutely terrified of dying this way.” Although Will’s primary health care network was Catholic and unable to provide the life-ending medication, they got him into another hospital. This allowed him to receive the needed life-ending medicine.

How does the End of Life Option Act work?

The End of Life Option Act, enacted in 2016, allows “an adult diagnosed with a terminal disease, who meets certain qualifications, to request the aid-in-dying drugs from their attending physician.” To qualify, a person must:

Be an adult (18 years or older)
Be a California resident (with no minimum timespan required)
Have a diagnosis from the attending physician of an incurable and irreversible disease that will, within reasonable medical judgment, result in death within six months
Have the capacity to make medical decisions as determined by two physicians
Make voluntary requests (two oral, one written) for a prescription for aid-in-dying drugs without influence from others
Be able to self-administer the aid-in-dying drug (by ingestion: either by mouth or through PEG or rectal tube)

Original graphic by DOPEQuickReads/SDOCNews

The law includes several safeguards. Physicians must determine that the person has the capacity to make informed medical decisions. They must ensure the patient is not being coerced. The patient must be informed of alternative options, such as palliative care. The diagnosis and prognosis must be confirmed by a second physician. Notably, the person must make two oral requests, at least 48 hours apart. This is a reduction from the original 15-day waiting period. They must also submit a written request witnessed by two adults.

The End of Life Option Act allows health care providers who “object for reasons of conscience, morality, or ethics” to decline to participate in physician-assisted suicide. Additionally, providers may not be subject to “civil, criminal, administrative,” or other penalties for refusing to participate. However, as of 2022, physicians who choose not to participate must inform the patient of their decision and transfer medical records upon request. Health care providers are also prohibited from engaging in false, misleading, or deceptive practices relating to their participation in medical aid in dying.

Legislative updates and evolution of the Act (2016-2025)

Since its inception in 2016, the End of Life Option Act has undergone several significant changes:

2018 (AB282): Governor Brown signed an amendment to protect patients and healthcare providers from prosecution when acting within the law.
2021 (SB380): The law was streamlined by reducing the waiting period between requests from 15 days to 48 hours. They also eliminated the final attestation form requirement. These changes took effect on January 1, 2022. This made access to physician aid in dying more practical and timely for individuals exercising their right to end-of-life options.
2025 (SB403): Legislation was passed to eliminate the sunset date for California’s End of Life Option Act, which would have expired on January 1, 2031. As of October 2025, this bill, which would make the End of Life Option Act permanent in California, has passed both the Assembly and Senate and was signed by Governor Newsom.

The law has also survived legal challenges. In the case of Ahn et al. v. Hestrin, filed on June 8, 2016 (just one day before the law was to take effect), opponents argued that the Act was unconstitutional. They claimed it was because it had been passed during a special legislative session on healthcare. After five years of litigation, the California Court of Appeal dismissed the case in November 2021. The court affirmed the constitutionality of the End of Life Option Act. This resolved some of the legal issues surrounding the right to die.

Data on implementation and usage

Nine years of extensive data collection show the law is working as legislators intended, with medical aid in dying being safely practiced in California. In 2024, 1,591 people received an aid-in-dying prescription. Of those, 1,032 took the medication and died. Over 92 percent were age 60 or older, and 94.8 percent were receiving hospice or palliative care. The data also showed that terminally ill adults with conditions such as ALS and terminal cancer were among those who chose to use the End of Life Option Act.

Dr. Forest says the entire experience caused her family to think “about people in other states who do not have authorized access to aid in dying.” Her husband had only two months between his diagnosis and death. She remarked,

Will knew he was dying. Having the option of medical aid in dying meant that instead of having to worry about what would happen – Would he choke or suffocate to death? – Will could decide for himself whether his own suffering was unbearable. He could focus on spending the time he had left with our children and other loved ones, rather than in a state of anxiety over the end

As of 2025, eleven states and the District of Columbia have similar medical aid-in-dying laws. Though, California is unique in having initially included a sunset provision.

The End of Life Option Act continues to provide terminally ill adults with the choice of death with dignity. This allows them to make deeply personal decisions about their end-of-life options. While physician-assisted suicide remains a topic of ongoing debate, the law in California has shown to be a compassionate approach to addressing the needs of those facing terminal illnesses.

In mid-August, 2025, Senator Catherine Blakespear, Senate District 38, held a forum regarding end-of-ife issues. Watch the full video below of Charting Your Own Exit: Medical Aid in Dying and Other End-of-Life Choices.

References

[i] Compassion and Choices, Catherine Sonquist Forest, M.D. (Nov. 21, 2022)

[ii] Center for Health Statistics and Informatics, End of Life Option Act (2022)

[iii] Compassion and Choices, Catherine Sonquist Forest, M.D. (Nov. 21, 2022)

[iv] Id.

[v] Health & Safety Code, End of Life Option Act 443 – 443.22 (Jun. 9, 2016)

[vi] Compassion and Choices, Catherine Sonquist Forest, M.D. (Nov. 21, 2022)

[vii] California Court of Appeal, Ahn v. Hestrin dismissal (Nov. 2021)

[viii] California Legislative Information, SB 380 (Eggman, 2021)

[ix] California Senate, SB 403 (Blakespear, 2025)

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[Article Note: This piece was originally published on NewsBreak and has been archived and transferred to DOPE Quick Reads to preserve its informational value. Original publication date: 2023-01-29. New Updates added 2025-10-17]