End of Life Option Act: Resources and Materials
Below you will find detailed information on required End of Life Option Act forms, step-by-step guidelines for patients and healthcare providers, and general background information on the Act itself. For a broad overview of the Act and its implementation at UCLA, please visit: Introduction to California End of Life Option Act.
General Materials
Presentation on the End of Life Option Act at UCLA
- Video presentation and roundtable on implementation of the End of Life Option Act at UCLA
- Text of the End of Life Option Act
CMA On-Call: California End of Life Option Act
- Guidance and information regarding the End of Life Option Act from the California Medical Association
California Hospital Association: End of Life Option Act
- Guidance from the California Hospital Association
- A comparative analysis of statewide aid-in-dying laws by UCLA Center for Health Policy Research
HS 1490: The California End of Life Option Act
- UCLA Health policy on implementation of the California End of Life Option Act
State Documents
Documents may also be found on the Medical Board of California website.
Request for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner form
- Official form for patient to request aid-in-dying drug from one’s attending physician
Final Attestation for an Aid-in-Dying Drug to End My Life in a Humane and Dignified Manner form
- Official form for patient to attest plan to ingest the aid-in-dying drug within 48 hours
Attending Physician Checklist and Compliance form
- Official form for attending physician to ensure compliance in prescribing the aid-in-dying drug
Consulting Physician Compliance form
- Official form for consulting physician to ensure compliance in prescribing the aid-in-dying drug
Attending Physician Follow-Up form
- Official form that attending physician completes after the patient’s death
Request for an Aid-in-Dying Interpreter Declaration form
- Official form for interpreter to sign after helping patient complete the aid-in-dying drug request
UCLA Patient Materials
Introductory, explanatory and guiding materials were developed by the clinical consultants team under the direction of Anne Coscarelli, PhD, of the Simms/Mann–UCLA Center for Integrative Oncology.
Introduction to the End of Life Option Act
- Context and introduction to how the End of Life Option Act is implemented at UCLA Health
California End of Life Option Act: Information for Our UCLA Patients
- An introduction to the End of Life Option Act for the person contemplating participation and the role of the clinical consultant
Aid-in-dying Options: Finding One’s Way to Clarity
- Assistance in thinking about end-of-life care choices and its implications when thinking about end of life or aid-in-dying as one option
- Resources, ranging from transportation to hospice, for the patient or family facing end of life care
California End of Life Option Act: Information, Suggestions and Options for Patients
- An introduction and step-by-step guide to the End of Life Option Act for patients
Preparing for Death: Guidelines for Your Family, Loved Ones or Caregivers
- Practical information and guidance for loved ones and caregivers about being with a dying person
Preparing for Your Own Death: Instructions and Essential Information
- Personal preparation for the experience of dying
Preparing for Your Own Death: Personal Checklist
- Important things to do or discuss when preparing for end of life that may benefit patient and family
- Safe Drug Drop-Off program’s sheriff station locations in the Los Angeles Area
“Written Legacies: A Valuable Gift for Those You Love”
- Guidance on creating a written legacy, a valuable resource that may comfort and guide children and others you care about in the future
UCLA Physician Materials
Physician Information Guide
- An introduction and step-by-step guide to UCLA implementation of the End of Life Option Act for physicians and other clinicians
- Checklist of steps for physicians and patients to complete for receipt of an aid-in-dying drug
End of Life Option Act Prescription Consent Form
- Informed consent form for patient to sign before aid-in-dying drug prescription is sent to the pharmacy