In the final episode of our comprehensive healthcare planning series, Kirsten and Ariana tackle one of the most misunderstood areas of healthcare planning: life-ending decisions. This episode cuts through the confusion to deliver clear, factual information about California’s End of Life Option Act, the strict requirements for assisted suicide, how passive and active euthanasia differ, and why many people don’t actually qualify for the options they think exist. You’ll also learn how California compares to other states and what alternatives exist internationally. Whether you’re planning for yourself or helping a loved one understand their options, this episode provides essential information about one of life’s most difficult decisions. Knowledge is power—especially when it comes to maintaining control over your final chapter.
Time-stamped Show Notes:
0:00 Introduction
1:09 Three categories of life-ending decisions explained: assisted suicide, passive euthanasia, active euthanasia
2:12 Passive euthanasia defined – withdrawal/withholding of life-sustaining treatment (legal in California)
3:07 What is active euthanasia? Many people don’t realize it’s not legal in the United States
3:39 California’s End of Life Option Act (2016) – medical aid in dying requirements
4:49 Strict eligibility requirements: terminal illness (6 months or less), California residency, cognitive capacity, physical ability
5:02 The three-request requirement: two oral requests 48 hours apart, plus one written, witnessed request
6:29 Physician responsibilities and the right to decline participation
7:35 California vs. Oregon comparison – residency requirements and waiting periods
9:37 Geographic distribution of assisted suicide laws across the United States
10:29 Active euthanasia discussion – the dementia dilemma and client concerns
11:40 European options for active euthanasia: Belgium, Luxembourg, the Netherlands, and Spain legal frameworks
13:27 Practical considerations for California residents seeking international options
15:12 The importance of knowledge and control in end-of-life planning
Transcript:
Hello and welcome back to Absolute Trust Talk. I’m Kirsten Howe, the managing attorney at Absolute Trust Council, and Ariana Flynn, one of our associate attorneys, is here with me today. If you’ve been watching or listening to our last couple of episodes, you’ll know that we have a little bit of a story arc going here. We have a three-episode arc, and this is the third of three. You will notice that we’re wearing the same clothes and our hair is the same. We’re recording this all in one go. It could have been one long episode, but the marketing people say, “No, don’t do that to your audience. Break it up. Make it short.”
So we’ve talked about legal documents for healthcare planning and end-of-life planning. We’ve talked about medical orders for end-of-life healthcare planning, and now we’re going to talk about something that, in my experience, a lot of people don’t really understand—what the options are and what they are not. So we’re really now talking about life-ending decisions.
There are a few different categories in the life-ending realm. There is what we call assisted suicide, where somebody is going to, with the help of others, commit suicide because of medical reasons or what have you. Largely, it’s because they’re in a medical situation where suicide seems like a better choice. So that’s assisted suicide. That is legal in a number of states in the United States, including California, and we’re going to talk about that in a minute.
Another category of life-ending decision-making is what we call passive euthanasia. Euthanasia means when one person kills another. Euthanasia is what happens with our pets when they get to the end of their life, and for purposes of mercy, we put them to sleep—put them down, as the euphemism we use. That’s euthanasia. Passive euthanasia is the withdrawal of life-sustaining treatment or the withholding of life-sustaining treatment, such as hydration, nutrition, or ventilation. If we don’t provide nutrition or hydration, a person who is not able to feed themselves will die, and that’s considered passive euthanasia. That is legal in California. We do allow for that under all of our healthcare laws.
The last category would be active euthanasia, which is not legal in the United States, and it’s something that I’ve been talking to clients about a lot. There are a lot of misconceptions, and that’s why we’re here today to talk about these various things and what can and can’t be done. So we’ll start by talking about California’s assisted suicide—what we have, what we can do, what we can’t do. Ariana, do you want to just kind of set that up?
“Absolutely, and this is the clear-cut factual law. We’re not talking philosophically—this is what is there, whether you believe it or like it or not.”
“Yeah, the whole premise of assisted suicide came from the End of Life Option Act, which was enacted in 2016. This allows terminally ill patients—so terminally ill being the key word here—to request that a doctor’s prescription for medication to end their life. The doctor prescribes it; the patient takes it themselves. It’s also known as medical aid in dying. I’ve also heard the phrase ‘dying with dignity.’ All those phrases and terminologies kind of mean the same thing.
It does require very specific conditions to be met, including a terminal illness prognosis from a doctor of six months or less. So the prognosis has to be six months or less, California residency—so they have to have California residency, live in California, can’t take travelers from other states—and they have to have the ability to administer the medication themselves. So if they are on any sort of life-sustaining support treatment or anything where they cannot administer it, this would not be an option. The individual also has to be an adult, so age 18 or over, again California resident, and the ability, as I already mentioned, to self-administer the medication.”
“Yeah, and the other thing important to remember is the person—the patient who is asking for assisted suicide—has to ask for it themselves. In other words, they have to have the capacity to actually make medical decisions for themselves and ask for this prescription. The technical requirement is they have to ask for it twice verbally. They have to say aloud to their doctor, ‘This is what I want,’ and they have to say it two times separated by 48 hours. When the law was originally passed, it was 15 days, and then we amended it—we updated it—and now it’s only 48 hours apart. But you have to ask two times orally, and then you have to ask in writing one time. So basically, you have to say three times, ‘This is what I want,’ and that writing does need to be witnessed as well. I’m assuming this is innate, but they also have to have the ability to understand the document that they’re signing and what they’re saying. They can’t just sign it, right?”
“Yeah, sometimes we have family members who say, ‘Well, my dad doesn’t have cognitive ability, but he’ll sign something if I tell him to.’ Right, we don’t want that, and that’s not permitted here.”
“Okay, so then the physician who’s signing the document—they’ve got to confirm that all of these things are true: that the person is 18 years or older, they are California residents, they have a terminal illness, all these things, that they’ve made the requests as required, and then they are legally authorized to write that prescription. But they don’t have to. I guess here’s where we get into the philosophical part, right? Some doctors would not want to participate in this, and just because your patient has asked for it, they are not required to participate in it. They could just say, ‘Nope, sorry, I can’t help you,’ or they could hand it off to a colleague. But if it’s something that’s against a doctor’s beliefs, they don’t have to participate.”
“Right. Okay, so we’re just talking about California. A lot of times when I have conversations with clients, they’ll say something like, ‘Well, you know, if I ever get in this extreme condition, I’m just going to go to Oregon because they have assisted suicide in Oregon.’ And that was true for a long time. Oregon was the only state. They were the leaders. But as far as I can tell, their assisted suicide process is really no better than ours. The only difference that I can see is that you don’t have to be an Oregon resident to avail yourself of Oregon assisted suicide, whereas in California, you do have to be a California resident. And the other thing—and this is interesting—Oregon still has a 15-day waiting period, whereas we in California have a 48-hour waiting period. I think I read that just this year, they attempted to shorten the 15 days in Oregon, and that legislation didn’t pass. So, you know, whatever that’s worth, but that can be significant depending on your medical situation—to have to wait 15 days can be significant.”
“Absolutely, especially if the prognosis is six months too, which I think is a big factor here, because it’s—I don’t want to say it’s hard, but it’s a very niche and specific prognosis to be diagnosed within a mortality of six months, right? So a lot of individuals may have a life-debilitating illness, but maybe their prognosis isn’t six months—maybe it’s a year. And this doesn’t apply to them either.”
“Right, exactly. Okay, so that’s assisted suicide, and as we said a little earlier, this is legal in a number of states in the United States, and you can probably imagine what that map looks like—legal on the Left Coast, legal on the East Coast, not so much in the middle, as with many things. But we do have it here in California. So that is of some comfort to our clients, that if you ever are in a terminal situation, you have that option.
It’s important to point out, though, that you have to actively participate. You have to have the cognitive ability, and you have to have the physical ability to take the medication. So it’s not even a solution for everybody, unfortunately.
Okay, so now we’re going to shift gears and start talking about euthanasia—active euthanasia. This is what I mean by active euthanasia: one person is going to administer the medication that will end the life of another. That is what we call active euthanasia. This is not legal in any of the states in the United States, but this conversation comes up all the time with my clients because they want to know. I think we all are worried about dementia—I’m just going to throw that out there. We all are worried about that. What if I get dementia? Now I’m not able to ask for these things. I’m not able to administer it. I’m not eligible for assisted suicide, but I don’t want to live that kind of life.
So active euthanasia is available in some European countries. Ariana, do you want to talk a little bit about that?”
“Absolutely, yes. So it’s generally illegal, except for a few exceptions, and some of them include Belgium, Luxembourg, the Netherlands, and Spain. All have active euthanasia legal in some ways. I can’t say that they’re all the same, but they do have some sort of legal active euthanasia. In the Netherlands specifically, the patient can make that request in their advance euthanasia directive. So that’s a separate legal document that they have over there, and Netherlands residency is not required.”
“Yeah, so that’s a very important distinction from the assisted suicide that we have here. I mean, aside from the fact that we’re talking about another person actually administering the medication to you—you don’t have to do it yourself—but at least in the Netherlands, in theory, it’s possible for you to, in advance, say, ‘This is what I want in this circumstance,’ sort of like an advance healthcare directive. So you write on this form—it’s an official advance euthanasia directive—’If I’m ever in this situation, I want active euthanasia.’
That’s really going far down that philosophical path. That’s going really far, and we don’t have anything even close to that in the US. I don’t know, as a practical matter, how workable that would be for, say, one of our California clients to fill out an advance euthanasia directive that is acceptable in the Netherlands, and then when the time comes, fly themselves to the Netherlands and say, ‘I’m here. I want my euthanasia.’ I don’t know, as a practical matter, how that really would go, but reading through the statutes, it could work. It could work.
I don’t know if someday we’re going to get something like that in California, where you can say, ‘If I have dementia and now I’m no longer communicative, I don’t know anything, I don’t know where I am, I don’t know what I’m doing—that’s when I want euthanasia.’ I don’t know if we’re ever going to get there. But anyway…”
“Yeah, I would say some other common illnesses—maybe Parkinson’s, MS, multiple sclerosis, dementia obviously—things like that where there’s no six-month prognosis, right, but the individual feels as if their quality of life has gotten to a point where it’s no longer worth living. Something like this would be more suitable for them.”
“Right, yeah, that is an important point—that this could be useful in those kinds of situations where it’s a long-term, very debilitating disease with no treatments. We don’t have cures for those things at this point. So it is, in effect, a terminal illness—not necessarily a six-month terminal illness.”
“Yeah, okay, well, on that cheery note… sorry, people. An episode about assisted suicide and euthanasia is kind of a downer, but very helpful and necessary, because I also get asked this question a few times in the past couple of months, and it’s good information. You know, the more you’re prepared and thinking about these things, the more control that you do have. And I think that’s the most powerful thing—just having the control when you don’t have it anymore.”
“That’s 100%. I agree with that. Things that seem scary and threatening—if you can just feel like you’ve got control about some aspect of it, you’re going to feel a lot better.”
“Okay, thank you, Ariana. This has been a very interesting conversation, and I hope you all listening at home got a lot out of it. We appreciate your listening, and we look forward to connecting with you next time.”
Resources Related to This Episode:
- Absolute Trust Talk Episode 190: Your Healthcare Voice (Part 2): Emergency Medical Orders https://absolutetrustcounsel.com/190-your-healthcare-voice-part-2-emergency-medical-orders/
- Absolute Trust Talk Episode 189: Your Healthcare Voice: Understanding Advanced Directives https://absolutetrustcounsel.com/189-your-healthcare-voice-understanding-advanced-directives/
- Absolute Trust Talk Episode 125: Cher Files for Conservatorship of Son Elija Blue Allman https://absolutetrustcounsel.com/125-cher-files-for-conservatorship-of-son-elijah-blue-allman-over-alleged-substance-abuse/
- Absolute Trust Talk Episode 124: Beach Boys Founder Brian Wilson Suffering from Dementia as Rep Seeks Conservatorship https://absolutetrustcounsel.com/124-beach-boys-founder-brian-wilson-suffering-from-dementia-as-reps-seek-conservatorship/
- Absolute Trust Talk Episode 113: How to Avoid a Chaotic “Casey Kasem” Estate Plan https://absolutetrustcounsel.com/113-how-to-avoid-a-chaotic-casey-kasem-estate-plan/
- Blog: Estate Planning for College Students https://absolutetrustcounsel.com/estate-planning-for-college-students/
- Blog: Summer’s Here, It’s Time to Open Up (to Your Estate Planning Attorney) https://absolutetrustcounsel.com/summers-here-its-time-to-open-up-to-your-estate-planning-attorney/
- A Will is Not Enough – Securing Your Legacy with Estate Planning Life can change in an instant. A will is not enough to be prepared. Get free access to our actionable E-book Guidebook #1 and start protecting your legacy today. https://absolutetrustcounsel.com/guidebooks/
- Learn how to comfortably define gray areas and assess your unique needs to build a secure future now effortlessly. Check out Guidebook #2, Estate Planning Beyond the Basics, here > https://absolutetrustcounsel.com/guidebooks/
- Get our free introductory guide to the most used estate planning tool, family trusts, and understand how we plan to help protect your family. Guidebook #3: https://absolutetrustcounsel.com/guidebooks/
- Absolute Trust Counsel would love to offer access to our Incapacity Planning resource page: https://AbsoluteTrustCounsel.com/Incapacity-Planning/. We’ve collected our top planning information all in one place so listeners can find videos, guidebooks, blog posts, and a host of information with tips and strategies on implementing, planning, and protecting themselves and their loved ones.
- We’re pleased to provide a library of e-books to address common estate planning questions and concerns in practical, easy-to-understand language. https://AbsoluteTrustCounsel.com/Resources/.
- ASK KIRSTEN: If you’d like Kirsten to answer your question on the air, please email her at Info@AbsoluteTrustCounsel.com.
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