UCSF

Abstract The legalization of physician-assisted death in California, via the End of Life Option Act, expands the possible pathways open to older adults facing the end of life. The law raises many questions, ranging from the practical to the philosophical. In order to prepare healthcare providers to care for adults who might request physician-assisted death, we invited 112 key stakeholders from across California to share their expertise in the areas of ethics, medicine, advocacy, and the law in a statewide conference. Six healthcare professionals and researchers from Oregon and Washington presented their experience with their states’ laws, and California healthcare leaders led discussions on a range of topics. The goal of the conference was to identify issues providers and healthcare systems may consider in responding to the law, in order to expand and improve end-of-life care generally. We report major themes identified by participants: (1) All healthcare systems should develop policies that reflect the values of the organization; (2) Institutions must anticipate and address the implications for vulnerable patients, such as older adults, in order to mitigate harm; (3) Institutions should create policies that account for conscientious objection and moral distress among providers; and (4) Palliative care should be an essential part of the response. The process of developing a response to the End of Life Option Act provides healthcare systems the opportunity to reflect on the law’s ethical and social implications and thereby implement system-wide changes that can benefit all patients facing the end of life.