TO: The EMS Community
As many of you are aware, in late 2015, the California Legislature passed the End of Life Act (AB 15), which became law on June 9, 2016. This Act allows for terminally ill patients in California who are mentally competent adults to voluntarily request and receive a prescription for medication to end the patient’s life at a time of their choosing. This allows for a patient to have some control over the end of their life and gives patients dignity and comfort at the time of their death.
The law outlines many safeguards for the patient and includes language that the patient may rescind his/her wish to take the aid-in-dying drug at any time.
In order to prepare the EMS system to care for these patients with respect for their wishes, there have been modifications to a number of key EMS Agency policies including Reference No. 814 “Determination/Pronouncement of Death in the Field” and Reference No. 815 “Honoring Do Not Resuscitate Orders”, Physician Orders for Life Sustaining Treatment, and the End-of-Life Option (Aid-in-Dying drug).
Please review these updated policies on our website under Resources/Prehospital Care Manual. Note a couple of new resources within Reference No. 815: Reference No. 815.3 provides an example of an attestation that the patient intends to take the Aid-in- Dying Drug within 48 hours. An attestation may or may not be available at the time EMS arrives at a home of a patient who has taken the aid-in-dying drug. Reference No. 815.4 is an algorithm, which is intended to provide guidance on the management of these patients. The goal is to honor a patient’s end-of-life option and provide comfort and guidance to the family.
We must also work collaboratively as EMS and hospital-based providers to make the best decisions on care and transport for the patient, and their families.
Marianne Gausche-Hill, MD, FACEP, FAAP
Medical Director, LA County EMS Agency
Reference No. 814, Determination/Pronouncement of Death in the Field
Reference No. 815, Honoring Do No Resuscitate Orders, Physician Orders for Life Sustaining Treatment, and End of Life Option (Aid-In-Dying Drug)
Reference No. 815.3, Sample Final Attestation for an Aid-In-Dying Drug to End My Life in a Humane and Dignified Manner
Reference No. 815.4, End of Life Options Field Quick Reference Guide