California’s End of Life Option Act gives adults that are over 18 years the authority to request and self-administer lethal drugs upon providing proof from a physician that they are suffering from a terminal illness (Wolk & Monning, 2016). The law establishes the conditions under which an individual is granted the authority to exercise this authority. The patient must be aware of alternative options including use of relievers and availability of palliative care. The basis for this law is compassionate death where an individual is relieved from suffering. Again, the decision must be independent, free from coercing and external influence. Most existing laws allow a patient to grant authority to an attorney to make decisions on their behalf under situations where the person is incapacitated by illness (Wolk & Monning, 2016). Thus, this law is not only transformative but also controversial. On the positive side, the act of ending one's own life to end the suffering is seen necessary while on the downside individuals tasking others likely influence such decisions. Thus, this paper will explore the ethical and legal issues tied to this law and establish its advantages and disadvantages while supporting the Act.
Ethical Considerations
Ethics in today's society are tied to morality. Morals are the society's accepted methods of doing things that are deemed right, though they cannot be proven. Ethics, on the other hand, are rational methods of doing things which have justifications. Thus, although ethics have a justification, they borrow heavily from society's moral standards. Thus the ethical issues tied ton this law fall under the four ethical pillars if beneficence, non-maleficence, autonomy, and justice (Christensen, 2016).
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Beneficence
Matters of life and death are sensitive. Hence healthcare professionals work under the principle of beneficence. The principle of beneficence states that individuals have to show concern and act in good faith when caring for others (Kelleher, 2014). Therefore, medical professionals owe the duty of beneficence to terminally ill patients. This principle implies that these professionals must always act and make decisions with the needs of the patient in mind. In relation to the end of life option act, professionals need to ensure that the existence together with decisions taken to end their lives must always be facilitated in good faith.
Additionally, the end of life option act introduces a new perspective into the principle of beneficence. Beneficence is founded on doing good to the patient while he or she is under the care of the healthcare professionals. However, the question of assisting the patient in ending their life in the case of terminally ill patients amounting to a good or bad deed arises. Terminally ill patients often experience pain and despair especially in advanced stages of treatment when it is determined that medical intervention can do little to transform their situations. The thinking behind the decision to exercise the authority to self-administer lethal drugs is to end the suffering (Christensen, 2016). For a healthcare professional who is not the directly affected by the conditions, the dilemma arises in the process of assisting the patient in accessing and administering the drugs. The physician in the case is faced with two options, maintaining the sanctity of life or fulfilling the wishes of the patient to end their suffering. In such a situation, the professional's decision to assist the patient does not go against the principle of beneficence. Considering that the decision to exercise the end of life option is taken independently by the patient, the physician's actions do not go against the principles of the sanctity of life.
However, healthcare professionals have a duty to inform the patients of the availability of other options like palliative care. Also, they have to ensure that the process is conducted professionally. The drugs taken must no cause pain to the patient before death. Therefore, the principle of beneficence in the context of exercising the end of life option are not in contradiction. The two are independent of each other, and health care professionals are not barred by the beneficence principle from assisting a patient exercising this option.
Non-maleficence
Healthcare professionals are morally required to avoid harming patients. Ethically, this is the principle of non-maleficence in medicine. Non-maleficence is the requirement of not harming patients in the process of aiming to achieve positive outcomes during treatment (Baumann et al., 2013). This principle covers both harms done with the practitioner's consent or due to mistakes. Thus, non-maleficence applies to the end of life option act through avoidance of harming. To the health practitioner, non-maleficence is a major consideration while assisting the patient in this process. The practitioner must ensure that no harm is done to the patient during the whole process.
Thus, the key consideration is understanding whether the law itself is a form of harm to the patient. Inherently, illness is a form of harm since it causes pain, both physical and psychological, to the patient. The practitioner has to eliminate this pain. However, for patients suffering from terminal illnesses and are illegible to exercise the end of life option, medical intervention is often determined to be inconsequential. Therefore, to end the suffering, they may opt to self-administer lethal drugs. The purpose of the drugs to cause death causes the non-maleficence adherence question to arise. In this case, however, the decision taken by the patient to end the suffering outweighs the intention to preserve life. Thus, the practitioner does not go against the principle of non-maleficence.
Again, the kind of drugs administered in the process of ending the life of the patient must adhere to the principle of non-maleficence. Prevention of physical harm is vital in the type of drugs used to induce death. Although the purpose of the drugs is to cause death, physical as well as psychological pain must be avoided. Therefore, the death-inducing drugs need to be administered concurrently with the anesthetic to ensure that the patient is not aware of the pain. Again, the period from the time the lethal drug is self-administered to when death occurs is crucial. This period needs to be short to avoid psychological torture to the patient.
Autonomy
Both the patient and the doctor have the right to exercise autonomy in the healthcare process. Autonomy concerns the free will of a person to make a decision. Thus, autonomy is the freedom to exercise or perform an action without imposed external influence (Baumann et al., 2013, p. 139). However, autonomy needs to be accompanied by knowledge and informed decisions in the case of health care. The end of life option act recognizes the need for autonomy in exercising the option by providing that the person must be eighteen years o above and also have proof from a physician that they are suffering from a terminal illness (Wolk & Monning, 2016). However, autonomy can only be exercised by the patient when they have all the necessary information about their condition. It is, therefore, the duty of the practitioner to explain to the patient the extent of their illness, the options available for them and other considerations that the patient has to make before making a decision.
Therefore, the patient’s autonomy needs to be respected in the whole process of the end to life option. There is always the possibility of the patient’s decisions being influenced by a close friend, family members and other parties. Critics of the End to Life Option Act have always used this as a major point of argument in advocating for recalling the law. Given that its difficult to prove whether other parties have influenced the decision to exercise the option, the law is often seen as weak. However, autonomy while exercising the option is a major is important in the whole process. Autonomy of the health practitioners is also an essential consideration. The practitioners have individual beliefs and are free to make informed decisions about the law. It is thus unwarranted to force a health practitioner to assist a patient in the processes of self-administering the drugs against their wishes. The option must be exercised with the consent of the doctor and the terminally ill patient.
Justice
Justice, one of the ethical principles of medicine, plays a huge role as an ethical consideration in assessing the End of Life Option Act. Justice in health care is closely related to the principle of utilitarianism which states that the course of action taken must promote the overall welfare of individuals (Morhaim & Pollack, 2013). In relation to justice, utilitarianism considers the benefits of the End of Life Option Act. The question of whether the law provides justice for the individual needs consideration. While the decision to take life-ending drugs to end the suffering may seem like the only option for a terminally ill patient who is about to die, the implications of the law is another matter. However, the Act is just since the needs of those who opt for the exercise and those who refrain are considered.
Additionally, justice in the way that the law stipulates the handling of the issue is a necessity. Since welfare is the basis of the principle of justice in medicine, the law must cater to the needs of the majority and not the few minorities. In this case, the law must consider the wishes of the majority of terminally ill patients. The End of Life Option Act passes the justice threshold since the patient is given the option of exercising the option or going through palliative care. Considering the healthcare practitioners, their welfare is also catered for through their freedom to choose whether to assist the patient through the process or not. However, they have to maintain the non-abandonment requirement such that they always consider the principle of beneficence.
Legal Issues
The healthcare environment is government by set laws and regulations that protect both the patients and caregivers from practices that may put them in danger or the line of harm. These laws apply within the state like California's End of Life Option Act or nationally. Enforcement of such laws is the responsibility of the hospital's management or other bodies mandated by the government. The End of Life Option Act has several issues arising from the drafting of the law and the way it is applied. Some of these issues include external influence on the decision of the patient, responsibility for errors during the process and contradiction with other existing laws.
External Influence on the Patient’s Decision
The End of Life Option Act gives the terminally ill patient the freedom to decide whether to exercise this option or not to exercise. Such a sensitive issue requires critical thinking before arriving at a decision. However, the patients’ psychological and physical condition may not allow them to think critically before making a decision. Thus, their condition leaves them vulnerable to external influence. Although the law states that the patient should independently make then the final decision (Wolk & Monning, 2016), it does not protect the patients from external influence in making their decision. The consequence of this loophole that can easily be exploited is that the patient's condition might be exploited to make a decision that is not representative of their will. Given that it may be challenging to prove that the patient was coerced into taking the option, the purpose of the act is lost. Such a weakness in a sensitive law like this one proves that there are loopholes that need to be sealed. However, until the gap is acknowledged and addressed by the legislators, a significant percentage of stakeholders will continue to view the law as weak.
Again, there are legal implications for people who coerce patients to exercise or refrain from exercising this option although the draft does not state how the influence will be proven. Some of these people may be close family members or friends. The End of Life Option Act is mute on the strategies that will be applied in preventing these people from exerting undue influence on the patient (Wolk & Monning, 2016). Given the fact that the influencers may be closely related to the patient, enforcing this part of the law becomes difficult since differentiating between undue influence and advice to the patient is difficult until the patient clarifies the matter.
Responsibility for Errors during the Process
The process of exercising the option of taking life-ending drugs begins with an oral or written request for the drugs. The laid down procedures are meant to ensure the patient’s certainty over the decision. The law also provides immunity and protections for people who chose to become involved with the patient (Carlifornia Hospital, 2016). These people include physicians and other healthcare professionals providing care and treatment for the patient. In essence, they cannot be prosecuted or penalized for involvement in the process. This section is crucial in preventing victimizations of these professions. However, this law has a downside. In case, the practitioner performs an act that causes harm to the patient in the process of assisting them in administering the life-ending drug. The practitioner is not liable for the act. Thus, this section of the law is against the principle of non-maleficence in health care.
Contradiction with Other Existing Laws and Regulations.
The sanctity of life is a vital aspect of health care upon which most medical laws and regulations are founded. Morality also dictates that the option to give or take the life does not fall on the individual. Medical practitioners are required to preserve the sanctity of life in every aspect of their profession. Therefore, the end of life option act contradicts these established laws by allowing the elimination of patients. This situation provides a dilemma for healthcare professionals. While assisting in the process is done in goodwill according to the principle of beneficence, this contradiction is a source debate and discussion. The act itself is a process that eliminates the life of an individual, going against the doctrine of sanctifying life (Rabiu & Sugand, 2014). However, the act of ending life is done in good faith hence does not need to be castigated.
Also, this law is perceived to go against some of the most common hospital regulations which advocate for life-saving measures in any situation. Although arguments in support for the law downplay the statistics of those, who opt for the choice of life-ending drugs, in a healthcare setting, every life matters. Just like palliative care aims to prolong the lives of the individuals (Seow et al., 2014), the act of enhancing the death of an individual is against hospital regulations. Therefore, the option of ending one's life is against established rules in health care. But still, the Act acknowledges this anomaly and provides immunity for physicians who assist in the process.
Benefits of the End of Life Option Act
Undoubtedly, this option presents various benefits to terminally ill patients, health care practitioners, and family and friends of the patient. According to the principle of autonomy in medical ethics, the patient has the free will to choose to exercise the option of using life-ending drugs. However, limits to the way the autonomy is applied require that the patient is given all the information about alternative actions. Since the act acknowledges the autonomy of the patient and also the health practitioners, it allows these parties to make independent decisions about the issue (Cain, 2016). To the patient, the Act portrays a significant understanding of their situation. The drafters of the bill that was passed into law understood that terminally ill patients need to be given a choice and some level of control over their situation. Since the ultimate fate is death, the suffering can be minimized if the patient decides to use the life-ending drugs.
Additionally, care providers are provided with the choice of associating with the person who decides to exercise this option. For those who believe that by assisting the patient amounts to do good to the patient, they have the right to assist. Also, practitioners who have reservations about the practice can comfortably disassociate with it. The act grants immunity from prosecution to practitioners who decide to assist patients through the process. Thus, the care providers are protected from unfair prosecution by persons who hold divergent beliefs concerning the Act.
Furthermore, the benefits of the Act extend to family members and close associates. Terminally ill patients with less than six months to live experience mental and physical pain. This situation is often draining to loved ones given that pain-relieving medication sometimes fails to achieve its purpose. By providing the option of lethal drugs, the family members are saved the psychological torture of helplessly watching the patient suffering.
Criticism of the Act
The End of Life Option Act has received its fair share of criticism not only from individuals from the medical field but also from the society at large. Critics of the Act argue that the mental and psychological condition of the patient at such a stage of the illness does not allow them to make rational decisions about their lives. Decision making in such a situation needs to be assisted and not left to the patient alone (Reyna, Nelson, Han, & Pignone, 2015). However, the act criminalizes any attempt to exert the influence of the decision of the patient.
Again, the act of self-administration of the life-ending drugs is seen as inconsequential in the whole process of exercising the end of life option (Tyden, 2017). Despite the advocating for ending life with dignity, the process of self-administering the drugs is inconsequential since the patient does not prepare the same drugs. Given that the patient consent allows the lethal drugs to be prepared through the decision to exercise the end of life option, there is no point in insisting on self-administration. Another criticism of the law is that it goes against the sanctity of life requirement. The society’s moral standing identifies the sanctity of life. Thus, allowing a person to end their life is wrong from a moral standpoint.
In conclusion, California’s End of Life Act elicits discussions and assessments of its applications and consequences. The Act’s ethical and legal implications, especially to the health care profession, prove that arguments for and against the application of the law all hold some merit. However, considering the four principles of medical ethics, if beneficence, non-maleficence, autonomy and justice (Christensen, 2016), the end of life option act does not contradict most these beliefs. The legal implications of the Act provide various perspectives of the Act. The Act protects the patient from undue external influence, but loopholes still need to be filled concerning the responsibility for medical errors during the process. Thus, the benefits of the Act outweigh its disadvantages.
Annotated Bibliography
Baumann, A., Audibert, G., Lafaye, C. G., Puybasset, L., Mertes, P. M., & Claudot, F. (2013). Elective non-therapeutic intensive care and the four principles of medical ethics. Journal of medical ethics, 139-142.
Summary : The authors of this article assess the four principles of medical ethics, beneficence, non-maleficence, autonomy, and justice. They relate each of the principles to the process of providing intensive care to patients. The paper explains the benefits of these principals and their applications in the process of providing care to patients.
Reliability : This article provides a systematic statement and explanation of facts. Coming from a peer-reviewed journal, the paper is undoubtedly reliable. The arrangement of the content and its relevance to the topic attest to its reliability.
Reflection: This paper is appropriate for this research since it provides relevant content relating to the four principles of medical ethics. The four are well explained and related to the process of providing care, thus proving that the paper is an excellent resource.
Cain, C. L. (2016). Implementing Aid in dying in California: Experiences from the other States indicates the need for strong implementation guidance . Retrieved on 5 April 2018, from http://healthpolicy.ucla.edu/publications/Documents/PDF/2016/AID-brief-may2016.pdf.
Summary : Cain addresses the issue of assisting patients who opt for the life-ending drugs. According to the author, the issue of aiding these patients is sensitive and needs further guidance in its implementation. Practitioners face a number of challenges in implementing these practice. The paper use data from various states to put arguments concerning the issue of aid at the end of life option forwards.
Reliability : Cain's article is a reflection of the views of a significant percentage of healthcare practitioners. The content is well-researched and explained. Use of data from various states to support the facts makes the paper reliable.
Reflection: the issues affecting medical practitioners are often ignored when discussing the End of Life Option Act. However, Cain takes on the issue of aiding the patients, thus proving that the paper is a vital resource in the overall discussion of End of Life Option Act.
California Hospital. (2016). End of life option act . Retrieved on 5 April 2018, from
https://www.compassionandchoices.org/wp-content/uploads/2016/02/End-of-Life- Option-Act.pdf
Summary : California Hospital breaks down the End of Life Option Act. The material explains the steps that the law requires the patient to fulfill while requesting for the life-ending drugs. The bulk of the paper stipulates the physicians' role and responsibilities through the whole process. The documentation process together with the freedoms of the physician is also explained.
Reliability : The paper is prepared b California Hospital as a guide to its staff concerning the Act. The source of the paper together with the purpose for which it is prepared indicates that its reliability cannot be doubted.
Reflection : Physicians and other healthcare providers require the simplification of the law in terms that they can easily under. This paper serves this purpose. It provides a breakdown of the law into its crucial functions.
Christensen, S. (2016). End of life option Act: Ethical considerations . Retrieved on 5 April 2018, from http://meccinc.com/wp-content/uploads/2016/10/Christensen-End-Of-life-Option-Act-Ethical-Considerations.pdf.
Summary: Christensen addresses the ethical issues tied to the End of Life Option Act. He relates the ethics of this law to society's moral standing. Using the four ethical pillars of beneficence, non-maleficence, autonomy, and justice, the paper assesses the ethics in this law. He also introduces other ethical topics like integrity, honesty, and respect.
Reliability : Discussing ethics and how the End of Life Option Act is affected by these ethical pillars proves that the paper sticks to its topic. Christensen is an experienced doctor with experience on how ethics affect the field of medicine.
Reflection : The author ties morality to ethics in his discussions. Since the End of Life Option Act is controversial, discussions on its ethical issues make the paper a welcome piece of knowledge.
Kelleher, J. P. (2014). Beneficence, justice, and healthcare. Kennedy Institute of Ethics Journal, 24 (1), 27-49.
Summary : Kelleher goes deeper into the principle of beneficence and its application in health care. According to him, beneficence is not just a principle but a duty that every practitioner must fulfill to the patient. He again discusses justice and the way it applies to healthcare.
Reliability : the article is peer-reviewed hence making it a reliable source of information. It is also published under the Kennedy Institute of Ethics, an organization that is renowned for dealing with ethical issues.
Reflection : Beneficence and justice are among the four principles of ethics in medicine. These ethical principles are vital in discussing the ethics of the End of Life Option Act.
Morhaim, D. K., & Pollack, K. M. (2013). End-of-life care issues: A personal, economic, public policy, and public health crisis. American Journal of Public Health, 103 (6), e8-e10.
Summary : Morhaim and Pollack assess issues the issues that relate to the type of care accorded to terminally patients in the last months of their lives. Decision making during this period is a major issue that the authors acknowledge. The factors that affect decision making are also addressed.
Reliability : The article is peer-reviewed hence giving it credibility. Furthermore, the arrangement of facts together with the citations used makes the article a reliable academic source.
Reflection : This paper introduces new perspectives into the processes of caring for terminally ill patients. The authors provide evidence that factors such as the economic position of the patient affect decision making.
Rabiu, A. R., & Sugand, K. (2014). Has the sanctity of life law ‘gone too far? ‘Analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not ‘gone too far.' Philosophy, Ethics, and Humanities in Medicine, 9 (1), 5-16 .
Summary : Life's sanctity according to the society's morality deserves to be preserved. The authors argue that current ideologies on the sanctity of life do not exceed expectations. They explain that the sanctity of life must be withheld at all costs.
Reliability : appearing in a peer-reviewed journal, the article uses real-world examples to address issues surrounding the sanctity of life. Hence, the authors' argument has strong backing, giving the article its reliability.
Reflection : The question of life's sanctity and societal expectations is a matter of discussion. This article addresses this issue while providing evidence for the facts.
Reyna, V. F., Nelson, W. L., Han, P. K., & Pignone, M. P. (2015). Decision making and cancer. American Psychologist, 70 (2), 105-116.
Summary : Decision making for terminally ill patients is explained in details. The nature of the decisions that these patients make is affected by various factors. The views of each of the four authors on the issue are incorporated into the article.
Reliability : the content provided as well-researched with proper use of citation. Also, the article is peer-reviewed making is a vital and reliable piece of knowledge on the topic.
Reflection : incorporating the views of the authors, who are professionals in the medical field provides an essential aspect to the nature of decisions made by cancer patients. The authors draw on their experience while interacting with cancer patients, hence providing the reader with crucial knowledge.
Seow, H., Brazil, K., Sussman, J., Pereira, J., Marshall, D., Austin, P. C., & Barbera, L. (2014). Impact of community-based, specialist palliative care teams on hospitalizations and emergency department visits late in life and hospital deaths: a pooled analysis. BMJ, 348.
Summary : The authors explore how community-based care affects patients in the final days of their lives. They analyze how palliative care teams can improve the type of care given to patients through community-based methods. They also explain how emergency care practitioners handle hospital visits.
Reliability : The researchers use data from hospitals and analyze it to arrive at conclusions. Analysis of the data provides reliable information on the topic. The article is also peer-reviewed.
Reflection : Palliative care for cancer patients is an area that needs constant improvement. This article provides suggestions for improvement. Thus, the article proves crucial in relation to the End of Life Option Act.
Sprung, C. L., Truog, R. D., Curtis, J. R., Joynt, G. M., Baras, M. M., & Bulpa, P. (2014). Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study. American Journal of Respiratory and Critical Care Medicine, 190 (8), 855-866.
Summary : End of life care is a sensitive topic, and people hold different opinions on the issue. The authors explore these opinions relating to the end of life care. Then, they attempt to reconcile these divergent opinions to come up with a positive ground that can accommodate a majority of the population.
Reliability : The authors state their facts and provide evidence for them. The article is also published in a journal that is known to provide reliable information.
Reflection : the relationship between the authors' views and the end of life option is seen in the way the facts are presented. Thus, the middle ground that this article seeks also affects the discussion on life-ending drugs.
Tyden, A. M. (2017). Death with Dignity and Assistance: A Critique of the Self-Administration Requirement in California End of Life Option Act. Chapman Law Review, 20 (2), 420-446.
Summary : Tyden offers an unbiased critique of the process of self-administering life-ending drugs. He argues that the process needs to be clarified further. Although he supports the Act, he goes further to explain that self-administration must also include preparation of the drugs.
Reliability : the opinions presented are from a person who is familiar with both the law and medical fields. Thus, the information is reliable.
Reflection: Tyden's critique of the End of Life Act helps the reader to consider details of the law and how they are applied. Accordingly, the relevance of his critique becomes apparent.
Wolk, L., & Monning, B. (2016). SB 128, as amended, Wolk. End of life. California Legislative Information . Retrieved April 05, 2018, from https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128.
Summary : Wolk and Monning, the legislators who sponsored the bill that eventually passed to become the End of Life Option Act, explain the intricacies of the bill. Amendments to the bill are also highlighted. The authors of the bill provide the details and the methods that the Act will be enforced.
Reliability : this is the original form of the law together with the amendments. Therefore, this is a reliable source since no alterations have been made.
Reflection: this source offers the ideas of the legislators in the raw form before the bill was passed into law. Thus, providing a view of the law in the eyes of those who drafted it.
References
Baumann, A., Audibert, G., Lafaye, C. G., Puybasset, L., Mertes, P. M., & Claudot, F. (2013). Elective non-therapeutic intensive care and the four principles of medical ethics. Journal of medical ethics, 139-142.
Cain, C. L. (2016). Implementing aid in dying in California: Experiences from the other States indicates the need for strong implementation guidance . Retrieved on 5 April 2018, from http://healthpolicy.ucla.edu/publications/Documents/PDF/2016/AID-brief-may2016.pdf.
California Hospital. (2016). End of life option act . Retrieved on 5 April 2018, from https://www.compassionandchoices.org/wp-content/uploads/2016/02/End-of-Life-Option-Act.pdf.
Christensen, S. (2016). End of life option Act: Ethical considerations . Retrieved on 5 April 2018, from http://meccinc.com/wp-content/uploads/2016/10/Christensen-End-Of-life-Option-Act-Ethical-Considerations.pdf.
Kelleher, J. P. (2014). Beneficence, justice, and healthcare. Kennedy Institute of Ethics Journal, 24 (1), 27-49.
Morhaim, D. K., & Pollack, K. M. (2013). End-of-life care issues: A personal, economic, public policy, and public health crisis. American Journal of Public Health, 103 (6), e8-e10.
Rabiu, A. R., & Sugand, K. (2014). Has the sanctity of life law ‘gone too far? ‘Analysis of the sanctity of life doctrine and English case law shows that the sanctity of life law has not ‘gone too far.' Philosophy, Ethics, and Humanities in Medicine, 9 (1), 5-16.
Reyna, V. F., Nelson, W. L., Han, P. K., & Pignone, M. P. (2015). Decision making and cancer. American Psychologist, 70 (2), 105-116.
Seow, H., Brazil, K., Sussman, J., Pereira, J., Marshall, D., Austin, P. C., & Barbera, L. (2014). Impact of community-based, specialist palliative care teams on hospitalizations and emergency department visits late in life and hospital deaths: a pooled analysis. BMJ, 348 .
Sprung, C. L., Truog, R. D., Curtis, J. R., Joynt, G. M., Baras, M. M., & Bulpa, P. (2014). Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study. American Journal of Respiratory and Critical Care Medicine, 190 (8), 855-866
Tyden, A. M. (2017). Death with Dignity and Assistance: A Critique of the Self-Administration Requirement in California End of Life Option Act. Chapman Law Review, 20 (2), 420-446.
Wolk, L., & Monning, B. (2016). SB 128, as amended, Wolk. End of life. California Legislative Information . Retrieved April 05, 2018, from https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB128.
