California’s assisted suicide laws, formally the End of Life Option Act, let a terminally ill adult California resident request a prescription for medication they can take to end their own life. The process requires two oral requests to your attending physician at least 48 hours apart, a signed written request witnessed by two people, independent evaluations by two physicians, and your own ability to swallow or self-administer the drug when the time comes. No one can make the request for you.
Who Qualifies
You must meet every one of these conditions at the time you ask:
- You are at least 18 years old.
- You are a California resident. Proof can be a California driver’s license or state ID, California voter registration, evidence of owning or leasing property in the state, or a California tax return for the most recent year.
- Your attending physician has diagnosed you with an incurable, irreversible disease expected to cause death within six months.
- Both your attending physician and a consulting physician agree you have the mental capacity to make medical decisions. If either sees signs of a mental health condition affecting your judgment, you are referred to a mental health specialist, and no prescription can be written until that specialist confirms capacity.
- You are physically and mentally able to take the medication yourself, with no one else administering it.
Only you can make the request. A power of attorney, advance healthcare directive, conservator, or any other surrogate decision-maker cannot do it on your behalf. Age or disability by itself never qualifies anyone.1California Legislative Information. California Health and Safety Code 443.2
The Three Requests You Must Make
Before a prescription can be written, you must make three separate requests to your attending physician: two spoken and one written.
Two Oral Requests, 48 Hours Apart
The two oral requests must be separated by at least 48 hours. (The gap used to be 15 days; it was shortened in 2022.)2California Legislative Information. SB-380 End of Life If the physician who documented your first oral request later declines to participate, a new attending physician can count that first request rather than making you start over.
A Written Request With Two Witnesses
You also sign a written request on a state-issued form, dated and witnessed by two people who confirm your identity, your mental capacity, and that you are acting voluntarily. Who can serve as a witness is restricted:
- Your attending physician, consulting physician, and any mental health specialist in your case cannot be witnesses.
- No more than one of the two witnesses can be related to you by blood, marriage, domestic partnership, or adoption, or stand to inherit from your estate.
- No more than one of the two witnesses can own, operate, or work at the healthcare facility where you are receiving treatment or living.
In practice, at least one witness must be someone with no personal stake in your decision and no tie to your care facility.3Physician Assistant Board. California End of Life Option Act Information Bulletin
The Two Doctors Who Must Sign Off
Two physicians have to evaluate you independently. This is the stage where many requests slow down or stop.
Your Attending Physician
The attending physician carries primary responsibility. They confirm your terminal diagnosis, verify a prognosis of six months or less, assess your mental capacity, and make sure your request is voluntary. They also discuss the medication’s risks, the expected result, feasible alternatives such as palliative care and hospice, and your right to change your mind at any point. Each finding goes on state compliance forms in your medical record.4California Legislative Information. California Health and Safety Code 443.5
The Consulting Physician
An independent second physician must examine you separately, review your records, and confirm the diagnosis, prognosis, and capacity determination. If the consulting physician disagrees on any one of those points, the process stops. The consulting physician also completes a compliance form filed with the California Department of Public Health.
Waiting Period and Changing Your Mind
The only mandated waiting period is the 48 hours between your two oral requests.5California Department of Public Health. End of Life Option Act A separate final attestation form that used to be required within 48 hours of taking the medication was eliminated in 2022.2California Legislative Information. SB-380 End of Life
Immediately before writing the prescription, the attending physician must confirm one more time that your decision is informed and voluntary. You can withdraw your request at any time and in any manner, including after the medication has been dispensed. Withdrawal does not have to be in writing and does not require that you still have full mental capacity.
Getting the Prescription Filled
Once every step is complete, the attending physician sends the prescription directly to a licensed pharmacist, in writing, electronically, or verbally. You do not carry the prescription to the pharmacy yourself. The pharmacist may release the medication to you, to your attending physician, or to someone you have specifically designated to pick it up. The label must clearly state the drug’s purpose.
What It Costs and What Insurance Covers
The medication can run from a few hundred to several thousand dollars depending on which drug the physician prescribes. Coverage depends on your plan:
- Medi-Cal covers aid-in-dying prescriptions on a fee-for-service basis when all requirements of the Act are met. Only FDA-approved drugs for oral or sublingual use are reimbursable.6Medi-Cal. End of Life Option Act Services – Medi-Cal Providers
- Medicare does not pay. Federal law bars the use of federal funds for any item or service intended to cause death.7Centers for Medicare & Medicaid Services. Assisted Suicide Funding Restriction Act of 1997
- Private insurance is not required by California law to cover the medication. Some plans do; many do not.
If you are on Medicare or an uncovered private plan, plan to pay out of pocket.
When a Doctor or Hospital Says No
No physician, pharmacist, or healthcare provider has to participate. The law protects participants and non-participants alike from professional penalties.8California Legislative Information. California Health and Safety Code 443.14
Hospitals, nursing homes, and hospice organizations can go a step further and prohibit their employees and contractors from participating while on duty and on the facility’s premises. A Catholic hospital system, for example, can ban the process entirely within its walls. The limit on that authority: a facility cannot stop its employees from participating on their own time and off its property.
If your doctor or facility declines, you will need to find a willing provider. In rural parts of the state, that search can add real time to a process already running against a six-month prognosis.
How the Death Is Recorded
A death caused by taking aid-in-dying medication under the Act is not classified as suicide. The death certificate lists the underlying terminal illness as the cause of death, and the manner of death is recorded as natural. The California Department of Public Health has directed county coroners and medical examiners not to report these deaths as suicide or as “pursuant to End of Life Option Act.”
Because of that classification, life insurance policies, annuities, wills, and contracts are not affected by your participation. Insurers cannot deny a claim or void a policy on that basis, as long as the Act’s requirements were followed. The protection is written into the statute itself.
Leftover Medication
Many patients who receive the prescription never take it. If medication is left over, whoever has possession is legally responsible for disposing of it properly. The law requires delivery to the nearest facility that handles controlled substance disposal. If none is reasonably available, a DEA-approved take-back program or another method consistent with California Board of Pharmacy guidelines is acceptable.3Physician Assistant Board. California End of Life Option Act Information Bulletin Flushing or throwing it in the trash is not lawful. For a family member holding unused drugs after a loved one’s death, prompt disposal keeps you clear of controlled substance laws.
Criminal Penalties for Misuse
Two kinds of conduct are felonies under the Act. Knowingly altering or forging a request for the medication, or hiding or destroying a patient’s withdrawal of a request, is a felony if done with the intent or effect of causing the patient’s death. Knowingly coercing someone into requesting or taking the medication, or administering it to someone without their knowledge or consent, is also a felony.9California Legislative Information. California Health and Safety Code 443.17 These sit on top of the structural safeguards: the self-administration requirement, the two physician evaluations, and the witness rules.