Doctor holding patient's hands
By IHPL - April 5, 2016 —

California’s End of Life Option Act was set in motion after Brittany Maynard, a California woman with inoperable brain cancer, moved to Oregon to hasten her death.

Modeled after Oregon’s Death with Dignity Act, the End of Life Option Act will take effect June 9th. With this law, California will become the fifth and the largest state to allow doctors to prescribe lethal medications to terminally ill, mentally competent, adult residents of California.

The End of Life Option Act provides legal immunity for participating physicians and pharmacists with an option to opt out. Once the “aid in dying medication” is requested and obtained, the patient must self-administer the medication to end their lives. To obtain a fatal dose of barbiturates under the End of Life Option Act:

  • Two physicians must agree that patient has less than six months to live
  • Patient must express their wish to hasten their deaths by providing:
    • Two oral requests submitted at least 15 days apart, and
    • One written request signed by at least two adult witnesses

Physicians cannot grant requests for prescription made on behalf of the patient through power of attorney, advance health care directives, or conservatorship. Click here for details.

“Physician - assisted death” or “physician - assisted suicide” is an incredibly controversial topic – one in which kind, compassionate, and thoughtful people often disagree and end up advocating for opposing sides.

Here, two distinguished faculty physicians from Loma Linda University Health make a compelling case for and against the enactment of California’s End of Life Option Act.

California’s End of Life Option Act is good law, good ethics, and good medicine. by Dr. Philip M. Gold

There is a fundamental ethical difference between “allowing to die” and “killing.” by Dr. Gina Jervey Mohr

Helen Jung, PhD

Helen Jung, DrPH, MPH

Dr. Helen Jung is the Senior Health Policy Analyst for IHPL and serves as an Assistant Clinical Professor in Loma Linda University’s School of Public Health. She conducts policy research and analysis as well as developing publications on key policy issues for the Institute and the Adventist Health Policy Association. Dr. Jung received her Doctorate in Health Policy and Management from UCLA’s Fielding School of Public Health and holds a Master of Public Health from the University of Michigan, Ann Arbor.

For more information, contact Helen at:

Did you like this article? We want to hear from you! Leave your comments or questions in the space below.

Please note that the views expressed in this article do not necessarily represent those of Loma Linda University Health or the Institute for Health Policy and Leadership.



One of the most difficult questions to answer as a physician is the question, "How long does he/she have left to live?" We may have some clinical data and probability figures for some of the conditions, but every individual is different. Ones that we may have guessed would die soon end up living much longer. Ones that we thought would live much longer end up dying sooner than expected. In other words, physicians do not have a divine handle on someone's length of life (despite our efforts to stretch it out as much as possible). Miracles do happen. And the unexpected do occur. So when this law states that "two physicians must agree that patient has less than six months to live," my question is, "How can these physicians be sure?" Would they feel comfortable making that judgment call when it could mean that a patient would decide to take his or her life as a result?

This is a useful recap of the new law and reasoned, well-written viewpoints from our Attending colleagues. Thank you both Dr. Gold and Dr. Mohr for helping us see both sides in this debate. I appreciate Dr. Jung developing this piece and hope many my colleagues take the time to read and contemplate their personal position now that PAD is a legal option in our state.

There are a lot of mixed emotions regarding this new law - I hope that this legislation prompts more openness between all parties involved to discussing end of life issues as well as increasingly the prevalence of hospice and palliative care in California and elsewhere.

I blog quite often and I really thank you for your content. This great article has truly peaked my interest. I am going to take a note of your blog and keep checking for new information about once per week. I opted in for your Feed as well.

Thank you so much for your encouragement, Rosario - this means a lot to our team as we are working hard to develop content that's both meaningful and informative to our readers.
Since this is a new blog, our plan is to provide fresh content in the beginning of each month (but will eventually grow into a biweekly publication).
So please stay tuned and share our blog with any others who may be interested. Thank you again!

Greetings! This is my first comment here so I just wanted to give a quick shout out and say I really enjoy reading through your blog posts. Can you recommend any other blogs/websites/forums that cover the same subjects? Thanks a ton!

During one of my cancer treatments at LLUMC, one of the doctors did say, and I paraphrase here..."what great news." This was regarding the passing of the California law pertaining terminally-ill patients to elect to end their lives. However, LLUH now has taken the position of opting-out of the new state law ( ).

During an online presentation, which I will try to find the link, several and respectable people that I have had personal friendships with, have stated, and I paraphrase here, "pain and suffering and death is a natural process of life," and therefore they are against the new law.

However, from my experience, none of these fine individuals have ever experienced the great pain and suffering of cancer...none of, not one.

Just as all the news is against opiates, as I once mentioned to those opposing opiates that i would have KILLED MYSELF without them...they are ALL TOO QUICK to declare that their opinion did not relate to cancer patients.

I declare the same ignorance regarding end of life issues and cancer patients. After all, it is possible that we are all living under a fraudulent system.

Let me ask a few questions: 1) What defines pain and suffering? 2) What is a natural process of life? 3) Does suicide define pain and suffering? 4) Is suicide a natural process of the human mind to escape the SHEER HOROR of the PAIN of cancer? 5) What the hell do these fine individuals ever know about dying...until they are on the burning house of death's desire?

But,, perhaps we are all living under a fraudulent system.

Now, without the assistance of LLUH, under the extreme HORROR of the pain of cancer, I a relegated to finding another medical center somewhere in the state...or shooting myself. And, as I have said before...perhaps suicide IS EXTREME PAIN AND SUFFERING just as the extreme pain and suffering of denying any relief.

As I say...perhaps we are all living under a fraudulent system. But, hey...keep up those returns and contact us way down the line.

I want to thank the person who took the time to write this obviously heart-felt expression of concern for all who suffer the pain associated with cancer. How could any of us read his words and not be moved!? As one who has given nearly three decades of service at LLU Health facilities, and as one devoted to the study of Christian ethics applied to health care decisions, I do want to offer a short perspective on the subject of physician aid in dying.

First, let's all agree that we have a strong ethical responsibility to alleviate pain to the fullest extent possible, in keeping with our other ethical commitments. Those who tout the benefits of pain for the refinement of human character are, in my view, misguided. So important is the responsibility to bring comfort to persons in pain that caregivers should, with integrity, use every evidence-based modality to reduce the pain and suffering of those in our care. This should be done even when there is some risk that the unintended effects of the pain medications may be some shortening of human life. This has been the settled conviction of those who founded the modern hospice movement, and, as a result countless individuals have been helped to live with greater dignity and active engagement through the final months of their lives.

However, a commitment to the alleviation of patients' pain is categorically different from a willingness deliberately to end their lives or assist them in committing suicide. For millennia, physicians in our culture have promised that they would not intentionally engage in ending the lives of their patients. There are far more reasons for this prohibition than can be listed here. For LLU Health, the primary reason for opting out of participation in physician-assisted death is our belief that direct action aimed at the intentional ending of life of a patient is out of harmony with our faithful commitment to preserve life and ease suffering. This prohibition on killing patients or helping them to kill themselves should not be confused with decisions about limiting life-extending treatments. Patients have every right to set limits on what measures they are willing to accept. And appropriately motivated family members can exercise this right for their loved ones when they are unable to speak for themselves and if the burdens of continued medical interventions are considered to be too great when the quality of life is taken into account.

The line we are unwilling to cross is the one that separates legitimate measures to ease the suffering of patients and those measures intended to ensure the death of a patient.

Will the LLU Health decision to opt out mean that our patients are disadvantaged because they choose to receive their care from us? I believe that the answer is clearly No. If anything, I am convinced that our decision is linked to a heightened willingness to learn everything we can about whole-person care for those who are approaching the ends of their lives. There will always be some in the medical profession who are willing to take direct steps to end patients' lives or help them do so. We will not join in these practices. But we will keep faith with our patients, and they will be assured that we will never give up on their care.


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