California’s End of Life Option Act (EOLA) which took effect on June 9, 2016, allows terminally ill adults living in California to obtain and self-administer aid-in-dying drugs. The Act requires the California Department of Public Health (CDPH) provide annual reports. Data for the calendar year 2018 as well as cumulative statistics were released in July 2019.
In 2018, 337 individuals died from ingestion of aid-in-dying drugs, a rate of 12.6 per 10,000 deaths based on 268,474 deaths to California residents in 2018.
For the year ending December 31, 2018, 452 individuals received prescriptions under the Act. 337 individuals died following their ingestion of the prescribed aid-in-dying drug(s), which includes 23 individuals who received prescriptions prior to 2018. Of the 337 individuals, 88.7 percent were 60 years of age or older, 94.4 percent had health insurance and 88.1 percent were receiving hospice and/or palliative care.
Since the law went into effect on June 9, 2016 through December 31, 2018, prescriptions have been written for a total of 1,108 people under the Act and 807 individuals, 72.8 percent, have died from ingesting the medications. Of the 807 individuals who have died under the Act, 700 or 86.7 percent were receiving hospice and/or palliative care.
For the calendar year 2018, 531 individuals started the end-of-life option process, as set forth in the Act, by making two verbal requests to their physicians at least 15 days apart. 180 unique physicians prescribed 452 individuals aid-in-dying drugs. The two most common drug categories prescribed were sedatives at 37.1 percent and a combination of a cardiotonic, opioid, and sedative at 35.0 percent. Of the 452 individuals who were prescribed such drugs, 314, or 69.5 percent, were reported by their physician to have died following ingestion of aid-in-dying drugs prescribed under EOLA; and 59 individuals, or 13.1 percent, died from the underlying illness or other causes. The ingestion status of the remaining 79 individuals is unknown. Of the remaining individuals, 42, or 9.3 percent, have died, but their ingestion status is unknown because follow up information is not available yet. For the remaining 37 individuals, or 8.2 percent, both death and ingestion status are pending. 23 individuals with prescriptions written in 2017 ingested and died from the drugs during 2018. As a result, the report demographics include the 337 individuals who ingested and subsequently died during the 2018 calendar year from aid-in-dying drugs.
Of the 337 individuals who died pursuant to EOLA during 2018, 11.3 percent were under 60 years of age, 75.9 percent were 60-89 years of age, and 12.8 percent were 90 years of age and older. The median age was 74 years. The decedents were 88.4 percent white, 51.0 percent were female; 88.1 percent were receiving hospice and/or palliative care, and 80.1 percent had at least some level of college education. 87.5 percent informed their family of their decision to participate in EOLA.
Of the 337 individuals who died pursuant to EOLA during 2018, 68.8 percent were identified as having had malignant neoplasms (cancer). Neurological diseases such as Amyotrophic Lateral Sclerosis and Parkinson’s accounted for the second largest underlying illness grouping, totaling 13.1 percent.
The remaining major categories of underlying illnesses were documented as: cardiovascular diseases (7.7 percent), and respiratory diseases (non-cancer; 5.3 percent).
Most (94.4 percent) of the individuals who participated in the Act had some form of health insurance. Medicare or Medicare combined with another type of insurance accounted for 70.3 percent of individuals, individuals who had an unspecified type of insurance at 10.7 percent, and individuals with private insurance at 10.4 percent. Individuals with Medi-Cal comprised 2.7 percent of the Act participants, while individuals with another type of insurance such as Covered California or Veterans Affairs insurance, comprised 0.3 percent of participants. 17 individuals, or 5.0 percent, had undetermined health insurance coverage, while 2 individuals, or 0.6 percent, reported no health insurance coverage.
54.3 percent of individuals had a physician or trained healthcare professional present at the time of ingestion of the aid-in-dying drug. Of the individuals who had a physician or trained healthcare professional present at the time of ingestion, the attending physician was present for 70.5 percent of patients. The majority, or 92.0 percent, were in a private home for ingestion. For the full report visit: https://www.cdph.ca.gov/Programs/CHSI/CDPH%20Document%20Library/CDPH%20End%20of%20Life%20Option%20Act%20Report%202018-FINAL.pdf
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