EOLCCA Centered Medical Aid in Dying by and for Keith Torkelson MS, BS V Torkel Saga
Feature Image
Requirement | Specification |
Unit | End of Life |
Lesson | End of Life Choices California (EOLCCA) |
Audience | General |
Author(s) | Keith “Buster” Torkelson & Avey C. |
Blog(s) | Google Blogger – HealthMan & The Torkel Saga |
BHAB | Introduce to EOLCCA |
Computer(s) | Vivobook, Dell (Developmentally Disabled) & Student Asus |
Connectivity | Wi-Fi and Hotspot |
Family | Ahnika MD PhD our niece is Keith’s EOL Advocate |
Filename | 08_Managed_Passing_EOL_Choices_California_25031302_Content |
Measures(s) | WHOQOL_BREF - How satisfied are you? - Sleep USC Tool: Insomnia Section - Behavioral Health Fitness Scores (Index) – Pain & Suffering Scale |
Method | Desktop Publishing |
Publish | August 1, 2025 (F) |
Purpose(s) | Advanced Planning & Prevention |
Theme | Medical Aid In Dying (MAID) |
Title | EOLCCA Centered Medical Aid in Dying by and for Keith Torkelson MS, BS |
Topic(s) | Advocacy - Voice |
Associated Documents > Metadata >
AED or EAD
Legal_EOL_Managed_Passing_EAD_Euthanasia_25030702_Actual
Legal_EOL_Managed_Passing_EAD_Euthanasia_20250627_Notes
GHlth_Pain_AHCD_24102101_Situational
EOLCCA Request Support Form
https://endoflifechoicesca.org/request-support/
Manual & Electronic
Pain
Panoe universalis terminalis
^The phrase "universalis terminalis" doesn't appear to be a recognized scientific term, but it could potentially be a misremembered or informal way of describing something related to a "universal terminal" or a "final universal point", although this is speculative.
Universal Terminal Pain
^In the context of end-of-life care, "universal terminal pain" refers to the concept that pain is a common and significant experience for people with advanced, life-limiting illnesses. While not everyone experiences pain at the end of life, it is a frequent concern and a major focus of palliative and hospice care.
Palliative Care
^Palliative care is specialized medical care focused on improving the quality of life for individuals with serious illnesses, aiming to relieve symptoms and stress associated with the illness and its treatment. It provides relief from pain, shortness of breath, fatigue, and other symptoms, while also offering support for emotional and spiritual well-being. Palliative care can be provided alongside curative treatments and is not limited to end-of-life care.
Intractable Sleep Disorder
^Intractable sleep disorders are chronic conditions where a person experiences persistent difficulty falling asleep, staying asleep, or experiencing restful sleep, despite adequate opportunity and effort to sleep. These disorders can significantly impact daytime functioning, causing fatigue, impaired concentration, mood disturbances, and increased risk of accidents.
Welcome to End of Life Choices California - EOLCCA
Request Support
https://endoflifechoicesca.org/request-support/
Mission Statement
EOLCCA’s mission to provide Californians with information and support to successfully navigate all legal end-of-life options. Whether you are considering this option for yourself, seeking information for a loved one, or a healthcare professional looking to support your patients, EOLCCA is here to guide you through every aspect of the law and provide free support you need during this important journey.
Request Client Volunteer Support
Privacy Statement: We do not sell our data or share this information. All data collected is for internal use only. Please note: ALL client volunteer services are provided at NO charge.
EOLCCA
https://endoflifechoicesca.org/
Is the California End of Life Option Act still in effect?
^California's Right-to-Die Law. The California End of Life Option Act, or EOLOA, which was amended in 2021 by SB 380, allows California residents who are terminally ill to request aid-in-dying medication from their physician and to ingest that medicine to end their lives. Apr 29, 2025
Needless Suffering
^"Needless suffering" refers to pain, hardship, or distress that could have been avoided or lessened through reasonable measures. It often implies a failure in systems, practices, or individual actions that contribute to unnecessary hardship. The concept is explored in various contexts, including chronic pain, behavioral health, social injustices, and ethical considerations.
Suffering
Suffering, or pain in a broad sense, may be an experience of unpleasantness or aversion, possibly associated with the perception of harm or threat of harm in an individual. Suffering is the basic element that makes up the negative valence of affective phenomena. The opposite of suffering is pleasure or happiness. Wikipedia
Baseline Assessment Scores
WHOQOL-BREF
How satisfied are you?
Sleep
USC Tool - Insomnia Section
Behavioral Health Fitness Scores (Index)
Pain & Suffering Scale
Self-scores for Keith “Buster” Torkelson MS, BS
WHOQOL-BREF Quality of Life
Time Stamp | DOW | Assessment | Score |
20180808 | W-Real Time | WHOQOL-BREF | 76.0% |
20241031 | TH-Real Time | WHOQOL-BREF | 64.4% |
20250320 | TH-Real Time | WHOQOL-BREF | 74.2% |
Self-scores for Keith “Buster” Torkelson MS
How Satisfied are You?## | Time Stamp
| Source | OC HCA Satisfy | Note |
1 | 20081231 | A | 68.7% |
|
2 | 20090205 | A | 66.3% | Low |
3 | 20090205 | B | 66.3% | Low [DITTO] |
4 | 20090418 | A | 76.9% |
|
5 | 20090515 | A | 84.7% |
|
| 2012 |
|
| Catastrophic Loss Year |
6 | 20160312 | B | 86.1% |
|
7 | 20170902 | B | 77.6% |
|
8 | 20231006 | A | 94.9% | Peak |
9 | 20241108 | C | 75.2% |
|
10 | 20250325 | C | 81.0% | Baseline 2025 |
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Sleep
Self-scores for Keith “Buster” Torkelson MS, BS
Time Stamp | DOW Real Time | Assessment | Score | Low Scores are Favorable |
20200220 | TH: RT | Sleep Interruption Impact Score | 60.9% | LSF |
20250609 | M:RT | Sleep Interruption Impact Score | 39.8% | LSF |
20240801 | TH:RT | DSM 5 Derived Sleep Assessment | 56.6% | LSF |
20250709 | W:RT | DSM 5 Derived Sleep Assessment | 19.4% | LSF |
Assessment Dates – USC Tool – Subject – Keith “Buster” Torkelson
Data for Insomnia Section – 8 Items of 38 (Part 2 of 5 categories)
Low Scores are Favorable
Time Stamp
| DOW | Note | % (LSF) | Location of Data |
2012_05-Retro | NA | Without CloZAPine Dr. Daniels Experiment | 94% | Excel |
2012_11-Retro | NA | With CloZAPine Dr. BS Lee puts us back on CloZAPine | 22% | Excel |
20151213-RT | F | CloZAPine Lorazepam (PRN) | 25% | Excel & Here |
20160120-RT | W | CloZAPine Lorazepam (PRN) | 18% | Excel |
20190403-RT | W | The Crash Appointment |
| Lost |
20190524-RT | F | Lull | 34% | Here |
20190711-RT | TH | Shared summary view with Christine (sister) |
| Lost |
20250512-RT | M | With sleeper set – Ambien, Ativan & CloZAPine | 34% | Here |
LSF = Low Scores are Favorable | RT = Real Time | USC = University of Southern California
Metadata > Search “USC” >
Note: 20151213-F: Real Time data collection started
Self-scored by Keith “Buster” Torkelson
Behavioral Health Fitness Scores (Index)
Behavioral Health Fitness Scores (MSG-BHFS, 2017) 2025 Scored | |||
Low Scores are Favorable | |||
NLZD | |||
Behavior | Scale/Index | Date | Score % |
Adjustment | Dialing In on Adjustment Scale | ||
Adjustment | Subscales | ||
ADD/ADHD | Adult ADHD Self-Report Scale - 18 | 20250512 | 19.4 |
Anxiety | Beck Anxiety Inventory - 21 | 20250510 | 44.0 |
Chronic Fatigue Syndrome | Chronic Fatigue Syndrome Risk Assess - 12 | 20250512 | 15.0 |
Depression | Personal Health Questionnaire - 9 | 20250512 | 21.0 |
Depression | Burns Depression Checklist - 25 | 20250512 | 23.5 |
Mood Swings | Mood Disorder Questionnaire - 17 | 20250512 | 44.1 |
Mania | TRC-ECM - 52 (Excess Checklist Mania) | 20250512 | 10.1 |
PTSD | After The Injury (ATI - 23) | 20250512 | 40.4 |
PTSD | PTSD Screening Scale - 10 | 20250512 | 30.0 |
Rest Disorders | Sleep Disorder Self Test - 25 | 20250512 | 19.0 |
Rest Disorders | Insomnia Sub-scale - 8 | 20250512 | 34.4 |
Schizoid | Schizophrenia Screening Test - 20 | 20250512 | 10.8 |
Trauma | Trauma Symptom Checklist - 40 | 20250512 | 16.6 |
Schizoid | Positive Symptoms - 31 | 20250512 | 12.4 |
Schizoid | Negative Symptoms - 23 | 20250512 | 7.6 |
Subject = Keith Torkelson, MS, BS
Pain & Suffering Scale Score(s)
Time Stamp | DOW: Real Time | Assessment | Outcome |
20250801 | F:RT | Pain & Suffering Scale Score | 45.5% (Low Scores are Favorable) |
Request Support
https://endoflifechoicesca.org/request-support/
Main Contact
Tell us about yourself*
I am filling this out for someone else, and I will be the primary contact.
I am filling out this form for myself
>I was born in 1959. My conditions, primarily anxiety and bipolar disorder, come and go in an episodic nature. I also suffer an intractable chronic sleep disorder. Over the course of my life, I have worked and attended college to the best of my ability. I hold a Master’s Degree in Pathology. I first became ill with behavioral health symptoms the first year in veterinary school (1988). In preparation for veterinary school I suffered a Vaccine Adverse Event (VAE). I’ve completed four quarters of veterinary school. In 1993 I withdrew from veterinary school completely. For a term (1998-2004) I was the partner that ran the family business, a call center. I have had several episodes since 1989 punctuated by hospitalizations. As of March 30, 2024 I am pretty much retired. Presently I help the Orange County Health Care Agency as an informal volunteer.
Client Contact Information
This area is for the person requesting information or support.
Client Name*
First – Keith
Last - Torkelson
Client Address*
Street Address – #### Knott
Address Line 2 - #
City – Buena Park
State - California
ZIP Code - 90620
Client Email* X@X.com
Client Phone* ###.###.####
Is it ok to leave messages at this phone number? Yes V No
How Can We Help?
Briefly share how EOLCCA can help?*
^End of Life Choices California (EOLCCA) is a non-profit organization that provides information, support, and guidance to Californians regarding all legal end-of-life options. Their mission is to help individuals facing terminal illnesses and their families navigate end-of-life decisions with dignity and autonomy.
Warehousing & Competency
>I would like to promote expanding the criteria by which one qualifies for medical aid in dying (MAID) to include if an individual is in the early stages of suffering. I have suffered periodically too much. The next time I am hospitalized or interred in a skilled nursing or other lock-down I would like to have the MAID option. I need guidance and support with how my End-of-life (EOL) plans can be warehoused and implemented. Can you, EOLCCA, advocate for me and others to promote updating the appropriate laws(s). Not just the terminally ill are suffering. We, my family, would like the Right of Choice. We are putting this on file while I, Keith Edward Torkelson, am still considered competent to make medical decisions.
Here's how EOLCCA can assist
Providing comprehensive information on end-of-life options
^Thoroughly explain choices like stopping life-sustaining treatments, seeking palliative or hospice care, voluntarily stopping eating and drinking (VSED), and medical aid in dying (MAID).
Avoid Unnecessary Suffering
>Keith manages both Bi-polar Disorder (2025 In Remission) and an Intractable Sleep Disorder. Keith with his natural supports: Are in the process of advance planning for his next episode with the intention of mitigating or preventing it. The last time Keith was not given his medication (2024) he went sleepless leading to brain damage as measured by symptoms of dementia. It took considerable therapy and the better part of a year for Keith to function again. If he ends up in skilled nursing or other lock down suffering he would like you, EOLCCA, to step in and help manage his passing. It is much more humane to help him pass rather than be bedridden, suffering, in a containment or treatment facility.
Life-sustaining treatments
>We are in the progress of completing Keith’s POLST and DNR documents. It would be acceptable to us if palliative care were given if it prevents Keith suffering and promotes sleep while he is bedridden. We would like end-of-life measures as specified in this document be implemented before Keith has the need for hospice care. Keith will probably keep eating and drinking up till the end. We would like to be assigned a Thanatologist (MD) to mediate the MAID process. We find that Thanatologists in Orange County are hard to come by.
Thanatologist MD
A Thanatologist MD is a medical doctor who specializes in the study of death and dying (thanatology), often working in end-of-life care, hospice, or with patients facing terminal illnesses. They may provide support to patients and their families, manage the emotional and psychological aspects of death, and conduct research or teach about death and dying.
Orange County Thanatologist
O'Connor Mortuary: Notes that Becky, with a background in psychology and senior care, is a Certified Thanatologist (CT) who acquired her certification in 2015. She provides education on bereavement and grief.
Becky Lomaka - Director of Grief Support
O'Connor Mortuary
https://www.oconnormortuary.com/how-we-care/staff/becky-lomaka/
Becky Lomaka, MA, FT
Becky signed on as the Director of Grief Support and Education in 2013, with a determined passion to bring education, encouragement, and validation to the professional and volunteer communities we interact with. Becky believes that “Education is our most powerful tool in our efforts to help the community learn more about how to cope with death and the journey of grief after loss.” Through our quarterly workshops, seminars and in-service programs Becky is making a difference in our community and changing grief-care for the better.
Need Help?
Call now to speak to one of our caring staff. (877) 872-2736
Education
Association for Death Education and Counseling: The Association for Death Education and Counseling (ADEC) offers two levels of thanatology certification: Certified in Thanatology (CT®) and Fellow in Thanatology (FT®).
Insurance – Cal Optima
>We are working with Keith’s insurance, Cal Optima, to get a referral to a licensed Thanatologist MD. Thanatologists are few and far between. In the meantime we are working with Keith’s PCP.
Offering one-on-one support:
^Trained client volunteers offer personalized guidance, helping individuals and their families navigate the dying process from beginning to end.
When does EOL begin?
>We would like to start the process of dying or managed passing now. We tried to get the help of Death with Dignity and it garnered no response, they just want donations from us. Your site, EOLCCA, came up while we were researching Death with Dignity. We as a family are on board with MAID. We hope to get an volunteer EOLCCA worker. The worker might assist Keith with having his wishes met with regards to pain, sleep and symptom management. Keith requires continuity in his medications, especially his sleep medications.
Facilitating family discussions
^EOLCCA volunteers can help families communicate about end-of-life wishes and provide support to loved ones during this challenging time. Guidance on Medical Aid in Dying (MAID): They explain the process and legal requirements under the California End of Life Option Act (EOLOA).
EOLOA – Amending the Law
>Once again, we would like the California End of Life Option Act (EOLOA) to be expanded to include any person late in life suffering. We outlined Keith’s end-of-life wishes later on in this document. We are requesting someone to talk to who can help us manage Keith’s case.
Assistance with Advance Care Planning
^EOLCCA helps individuals understand and complete advance directives and appoint healthcare agents.
Directives
>We have completed and had notarized Keith’s Advanced Health Care Directive (AHCD). Yet no one other than the family wishes to keep or act upon it. Appended to our AHCD is our Euthanasia Advance Directive (AED). We would like EOLCCA to warehouse Keith’s EOL related documents.
^Healthcare agents: Connecting with healthcare providers: They can assist in finding physicians and hospices willing to support end-of-life choices.
>We are not sure if Keith’s insurance covers EOL services including doctors. Keith’s doctors want little to do with the EOL process. His acting PCP: Says: “You worry too much, enjoy life”. On July 21, 2025 (M) we connected with a different PCP who is willing to help with some of the paperwork such as Keith’s POLST.
Bereavement Support
^They offer specialized support groups for those who have lost loved ones through MAID. In essence, EOLCCA provides a vital service by empowering individuals with information, support, and advocacy to make informed decisions about their end-of-life care, promoting dignity, autonomy, and peace during life's final journey.
Dignity and Choice
>We as a family have discussed EOL considerations on and off. Keith needs his EOL considerations to be addressed on a routine basis so he can enjoy life for as long as possible. If possible he would like to be referred to a Thanatologist. We researched online and could not find a Thanatologist MD. Keith needs support to make informed decisions. We hope the EOLCCA advocates for Keith. For Keith there can be no Peace without Sleep. If he is placed in a lock-down or other containment facility Keith wishes to be considered for MAID.
What are you seeking?
Aspect | Note |
MAID Physician | Would like one on-call as needed for monthly conversations |
MAID Hospice | Keith hopes to have your intervention while he is skilled nursing or other lockdown before suffering to badly |
Day of Death Volunteer Support | Would like to discuss things once per month |
Other | Would like EOLCCA to maintain and act upon Keith’s EOL desires as outline in his documentation |
Thanatologist | Educate Keith in the science and social science of End of Life |
Illness & Care - Primary Illnesses* - Bipolar, Anxiety and Sleep Disorder
Bipolar Disorder
Bipolar disorder is a mental health condition characterized by extreme shifts in mood, energy, and activity levels, which can significantly impact a person's ability to function and experience suffering. These shifts, known as mood episodes, include periods of elevated mood (mania or hypomania) and periods of depressed mood. The experience of bipolar disorder can be incredibly challenging, marked by both intense highs and debilitating lows, and can lead to significant suffering.
Anxiety and Suffering
Anxiety and suffering are closely linked, as anxiety can be a significant source of suffering and can also exacerbate existing pain and other physical ailments. Furthermore, chronic pain can, in turn, trigger or worsen anxiety, creating a cyclical relationship. Understanding this connection is crucial for effective management of both conditions.
Sleep Disorder and Suffering
Sleep disorders significantly contribute to suffering by worsening pain perception, increasing pain sensitivity, and negatively impacting mental health. Disrupted sleep can lead to a vicious cycle where pain interferes with sleep, and poor sleep, in turn, exacerbates pain and other health issues. This cycle can lead to increased disability, depression, and a diminished quality of life.
Sleep Deprivation and Suffering - Feedback
Sleep deprivation significantly contributes to suffering by impairing physical and mental health, increasing pain sensitivity, and negatively impacting emotional well-being. Chronic sleep loss can lead to a cycle of suffering, where pain disrupts sleep, and sleep deprivation then worsens pain perception, creating a feedback loop that can be difficult to break.
Terminal Prognosis
Has your physician given you a terminal diagnosis with less than six months life expectancy?
While bipolar disorder itself is a chronic condition, it can be associated with a shortened life expectancy due to various factors.
Factors contributing to reduced Life Expectancy
Increased risk of suicide: Suicide rates are significantly higher in individuals with bipolar disorder compared to the general population, according to the National Institutes of Health (NIH).
Co-occurring physical illnesses
Individuals with bipolar disorder have a higher prevalence of conditions like cardiovascular disease, diabetes, and respiratory illnesses. These physical health issues can contribute to reduced life span.
Lifestyle factors
Factors such as substance use, smoking, unhealthy diet, and lack of exercise can further impact overall health and contribute to reduced life expectancy.
Biological changes:
Studies suggest that bipolar disorder may contribute to accelerated biological aging, potentially affecting longevity.
Important Considerations:
Bipolar disorder is not inherently a terminal illness in the sense of a physical disease with a certain and short prognosis of death.
Treatment adherence and comprehensive care are crucial
Managing bipolar disorder through medication, therapy, and lifestyle changes can significantly improve quality of life and potentially increase life expectancy.
End-of-life options in California
The California End of Life Option Act allows eligible adults with a terminal illness and a prognosis of six months or less to request aid-in-dying medication. However, this option is not applicable to mental disorders like bipolar disorder, as eligibility requires a terminal disease that cannot be cured or reversed and is expected to result in death within six months.
Summary
In summary, while bipolar disorder is not considered a terminal illness under California law, it is associated with a reduced life expectancy due to a range of factors that need to be addressed through comprehensive care and support.
Additional Information
^Please tell us your age and provide any information about treatment history, physical limitations, pain management, or other issues pertinent to your illness.
Age – Born 1959 (Age 66)
Treatment History
>Keith was first treated for behavioral health issues back in 1989 while a student, on medical leave, from UC Davis’ School of Veterinary Medicine. Since that time Keith has been treated with more than 20 psychotropic medications. During the period 1989-2025 he has had more than 9 hospitalizations the last being March 2024. In 2024, Keith was moved to skilled nursing awaiting an Assisted Living Waiver. During his tenure in skilled nursing there were several medication gaps. Due to these medication gaps Keith suffered sleeplessness. Currently Keith is being treated with: Ambilify, Ambien, CloZAPine, Wellbutrin, Lorazepam, and Lithium. He lives in a retirement home. Since June 20, 2024 there have been no medication gaps. His housing has been stable for more than a year.
Physical Limitations
Physical limitations refer to restrictions in a person's ability to perform physical activities due to a health condition or disability. These limitations can vary widely, affecting mobility, strength, stamina, or dexterity. They can stem from various causes, including injuries, chronic illnesses, or congenital conditions.
Problems
>Keith has problems with: Strength, stamina, fatigue and handwriting. He has a tremor that seems to be improving.
Pain Management
Pain management encompasses various strategies to alleviate and control pain, ranging from medication and physical therapies to psychological and mind-body techniques. It's a personalized approach, with treatment plans tailored to the type and severity of pain, as well as individual needs and preferences.
Is sleeplessness painful?
Yes, sleeplessness can be painful. Sleep deprivation can lead to increased sensitivity to pain and even exacerbate existing pain conditions. A study published by the University of California says that sleep loss can intensify pain perception, potentially contributing to cycles of pain and sleep disruption.
Other Issues - What is the Issue?
>Important topics or problems for debate or discussion are euthanasia and MAID. Keith has cycled through misery and suffering several times. These bouts are called episodes. Keith is stable as of July 9, 2025 (W). His doctor has down-graded his appointment frequency from a couple times per month to once every three (3) months. Keith’s conditions may change if his Rent a Shared Room (RASR) roommate falls too ill and leaves. His last roommate died miserably while in skilled nursing. For us: The issue is “Keith doesn’t want to suffer needlessly again or put himself at risk for a painful passing”. If continuity in Keith’s Sleep Medication is broken he will not sleep. Without sleep, peace and quiet Keith wishes to engage in MAID (put-to-sleep). Unless he quits smoking cigarettes Keith is at an elevated risk for Lung Cancer. He is also at risk for Skin Cancers such as Melanoma.
Are you currently enrolled in hospice care?* Yes V No
Physician Information – In need of an EOL related physician (Thanatologist). Doctor Ryan Quochu Nguyen MD in Garden Grove is covering for now.
Physician name:*
Please provide the name of the Physician(s) currently treating you.
Rosemary Reyes, Ryan Q Nguyen, Min A Cen, and Rimal B Bera.
Have you discussed your end-of-life choices with your physician? Yes V No
Both my PCP and Psychiatrist at this point are of little help when it comes to EOL planning and assistance.
How did you hear about us?*
Please choose one
Death with Dignity online - While searching for EOL information online.
How can EOLCCA help me?
>EOLCCA can help us, Keith’s Family, by guiding us and advocating about his humane journey from life to death. EOLCCA can help us understand our role(s) in Keith’s humane and dignified transition (graduation) from life to death. If Keith were younger he would volunteer for EOLCCA. In the mean time being until we connect with a formal or informal Thanatologist we would like a trained client volunteer to help us find competence in knowing: End-of-life options, how to navigate the dying process, advocate for Keith’s wishes, help us as a family, and when the time comes provide guidance on medical aid in dying (MAID).
End of Life Choices California
https://endoflifechoicesca.org
Compassion - Empowerment
>We have explored your online resources and believe you can help us. Keith’s niece (MD, PhD) is on board. See has notarized Powers of Attorney: Financial and Medical. He would like to have a dignified passing at the time of his and our choices. We call this process dying gracefully and in Peace (Grace Peace). Keith needs help and guidance as to what to do and how to do it. From what we have read the main hurdles are that Keith isn’t eligible at this time and that he will be asked to take the medication himself. If Keith decays too far his niece will help him with his affairs.
Explore the California End of Life Option Act with EOLCCA
The California End of Life Option Act (ELOA)
The new California End of Life Option Act law is in effect as of January 1, 2022. The California End of Life Option Act (ELOA) of 2021 makes much-needed adjustments to the original bill. The improved ELOA is now in effect for anyone seeking Medical Aid in Dying (MAID) in the state of California:
Amendment
The new bill reduces the 15-day waiting period between the required two oral requests, to 48 hours. Healthcare systems and hospices will now have to post their aid-in-dying policies on their websites. Unfortunately, due to a May 2023 lawsuit, if a terminally-ill patient requests MAID and their physician does not wish to participate for any reason, the physician is required to inform their patient, but is no longer obligated to document the request. They still must transfer the patient’s medical records upon request. The amendment also clarifies that MAID medication can be taken within a specific care facilities.
Eligibility Requirements to Access the Law remain unchanged
- Must be 18 years or older.
- Must be of sound mind and exhibit appropriate decision-making capabilities to the attending physician.
- Must be able to self-ingest the medication either orally or by pushing through an NG tube.
- Must be diagnosed with a terminal disease, with a life expectancy of six months or less, by two physicians.
- Must be a California resident.
Options
The California End of Life Option Act (ELOA) ensures that Californians have access to medical aid in dying, also known as Medical Aid in Dying (MAID).
EOLCCA – Drop-down Menu
Aspect | Note |
Medical aid in dying (MAID) | This is the goal if Keith is suffering |
Voluntarily stopping eating and drinking (VSED) | Probably unlikely |
Stop unwanted medical treatment | Anything that is really uncomfortable or not likely to work |
Hospice | Hope Keith doesn’t have to go this far |
Palliative Care | A consideration |
Palliative Sedation | Yes if it involves adequate sleep medication |
Request support | We would like our Thanatologist to show up |
Bereavement Group | Our family has lost so many people that bereaving Keith should not be a concern |
End of Life Choices California
https://endoflifechoicesca.org/
What We Do at End of Life Choices California
^End of Life Choices California offers trained Client Volunteers to work with Californians who are seriously or terminally ill, or those simply thinking ahead and planning ahead for the future.
Is Bi-polar a serious illness?
Yes, bipolar disorder is a serious mental illness. It is characterized by extreme shifts in mood, energy, and activity levels, ranging from manic highs to depressive lows. These mood swings can significantly interfere with daily life, impacting relationships, work, and overall well-being. While it is a chronic condition requiring ongoing management, with proper treatment, individuals with bipolar disorder can learn to manage their symptoms and lead fulfilling lives.
What We Do: We Provide
Compassionate End-of-Life Support
^It’s more than what we do it is also what we stand for. At End of Life Choices California (EOLCCA), we are deeply committed to empowering individuals and families with the knowledge and support needed during one of life’s most challenging transitions. Understanding that each journey is unique, we offer personalized guidance to ensure that all Californians can approach the end of their lives with dignity, autonomy, and peace.
Support
^Through the dedication of our trained Client Volunteers, we provide a comprehensive suite of services designed to navigate the complexities of end-of-life planning and decision-making. Our approach is grounded in empathy, respect for personal choices, and a commitment to informed decision-making. Whether it’s through direct support or facilitating crucial conversations within families, our goal is to make the process of end-of-life planning as clear and peaceful as possible.
EOL – Ending Stigma
^In a society where talking about end-of-life care often remains a taboo, EOLCCA stands as a guiding light, offering resources, education, and support to demystify the processes involved. From explaining legal rights under the California End of Life Option Act to supporting bereavement groups, we are here to ensure that every Californian has access to compassionate and dignified end-of-life care.
Stigma
>There is a good deal of stigma surrounding end-of-life and end-of-life care. We need someone who can help us. Once again, we would like to be connected with a MD Thanatologist. We are going to submit this material online to EOLCCA and publish it on one of our Blogs. Next we will fill out the EOLCCA Support form as found online. We might mail it also.
FYI > Metadata > Request Support
https://endoflifechoicesca.org/request-support/
Promotion
End of Life Option Act
(760) 636-8009
Planning
https://endoflifechoicesca.org/advance-care-planning/
Component | Note |
Having the Conversation | Adding EOLCCA to our family conversation |
Talking to your Family and Loved Ones | We have been talking on and off about all our EOL options |
Talking to your physician | Current physicians will not entertain my wishes – Need referral to an EOL physician in Orange County |
Advance Directives | AHCD finished and notorized, no one wants to enforce it, we also have a Euthansia Advanced Directive |
Psychiatric Advanced Directive | We have one yet no one wants to champion it |
Dementia Directive | Will look into this |
POLST in California | When we asked our PCP to fill it out he said: You worry too much, enjoy life – Found a different physician in the medical group who will help us with our POLST |
Out-of-hospital DNR | Pending |
Planning Workbooks | This document is part of our planning workbook |
Request Support | Intend to submit this or a rendition via EOLCCA’s website |
Address Later
https://endoflifechoicesca.org/advance-care-planning/dementia-directive/
FYI – Article >
Who gets to die with dignity in California and who doesn’t?
The complicated ethics of California’s end-of-life act (3 Pages)
Nuala Bishari’s opinion piece which quotes our own Lynne Calkins in the San Francisco Chronicle brings important attention to the fact that too many Californians are unaware the state has a compassionate medical aid in dying law.
Last month, California released its’ annual report on terminally ill Californians who took aid-in-dying drugs to end their lives. All told, 884 people died in California by using end-of-life medication prescribed by their doctors.
FYI - Aid-in-dying drugs - End-of-life medication
Pharmacological Review of Medical Aid in Dying (MAiD)
Peter J. Rice, PharmD, PhD, BCPS, FAPhA
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
University of Colorado Anschutz Medical Campus
Barbiturates are favored MAiD drugs based on their unique chemistry.
Diazepam, as a base with a pK of 3.4 and good lipid solubility, is immediately absorbed starting in the stomach and acts within minutes.
Morphine, has poor qualities for stomach absorption and will saturate opioid receptors in the intestines to slow motility.
Digoxin is empirically administered prior to other drugs as a strategy to coincide peak concentrations with those of amitriptyline.
Amitriptyline has been added for its synergistic toxicity but is also synergistic w morphine for GI slowing and has the slowest absorption.
Formulation changes might improve MAiD. Administration in basic medium (eg antacid) could promote absorption of basic drugs.
Alternative drugs might be considered based on absorption properties; fentanyl (highly potent and lipid soluble) could be formulated for rapid absorption from the oral mucosa and require lower doses than currently used for morphine dosage while decreasing the bulk of the cocktail.
California
FYI - Compassion & Choices
[GO BACK – A GOOD DEAL OF MATERIAL]
https://compassionandchoices.org/in-your-state/california/
Taking Medication
The CDSS issued a notice to adult and senior care facilities about the End of Life Option Act. Residents who qualify for medical aid in dying living in assisted facilities and other adult or senior care facilities are able to take their medication in their home and can’t be evicted for choosing this option.
Status of Medical Aid in Dying
The California End of Life Option Act went into effect on June 9, 2016. This compassionate option allows for an eligible terminally ill adult, with a prognosis of six months or less to live, to request and receive a prescription from their doctor that they can self-ingest to peacefully end their suffering.
Search 20250711-F
SB 403, introduced by Senator Catherine Blakespear, seeks to make the End of Life Options Act a permanent law by removing the sunset provision that would expire the law on January 1, 2031. On June 4th, the bill passed out of the Senate with a vote of 25-6. On July 8, the Assembly Health committee passed SB 403 by a vote of 13-2. The bill moves next to the Assembly Judiciary committee. We will continue to work on reauthorizing this law, removing the sunset provision, and reducing barriers to access while ensuring safeguards remain intact.
California End of Life Option Act (EOLOA)
The California End of Life Option Act (EOLOA), also known as the "right to die" law, allows terminally ill adults in California to request and self-administer life-ending medication. This law, which took effect on June 9, 2016, provides safeguards to ensure patient autonomy and informed decision-making.
UCLA Health
Participation - Suffering
The California End of Life Option Act (EOLOA) allows a terminally ill adult with a life expectancy of six months or less to end their life with an aid-in-dying drug. We would like assistance to understand when the time comes for ending Keith’s life if we and / or he determine he is suffering, period. The terminally ill person must be a California resident and must request the drug from their physician. We need help getting an effective and committed physician. Participating in this end-of-life option is voluntary for both patients and physicians.
Forms and Methods
https://www.cdph.ca.gov/Programs/CHSI/pages/end-of-life-option-act-.aspx
End of Life Option Act
The End of Life Option Act (EOLA) allows an adult diagnosed with a terminal disease, who meets certain qualifications, to request the aid-in-dying drugs from their attending physician. The Act requires physicians to submit specified forms and information to the California Department of Public Health (CDPH). CDPH will collect data from forms submitted by physicians. Annual reports will be made pursuant to the Act and relevant privacy requirements.
Appendix
FYI – Keith’s Current Euthanasia Advanced Directive (EAD or AED)
Slideshow – Near Death & Dying People – Some Suffering
Compelling Evidence
