LAUSR

Palliative care has become increasingly widespread and demonstrated extraordinary utility in improving quality of life in patients with neurological diseases, particularly surrounding end-of-life care. However, there is ongoing debate on whether physician-assisted dying (PAD) for people with terminal illnesses should also be a legal right. Healthcare professionals, including those in the field of movement disorders, provide care for people with illnesses that may reach a point where medical interventions will not extend life or improve the quality of remaining life. In the state of California, the End of Life Option (EOLO) Act was enacted on June 9, 2016, which allows patients with terminal illnesses and grave prognoses to choose to end their lives by self-administered medications otherwise known as PAD. To be eligible to participate in the EOLO program in California, patients must have a terminal diagnosis with a prognosis of 6 months or less. The patient, and only the patient, must express an interest to end their life through the program on two separate occasions separated by a minimum of 2 weeks. The patient must have the “physical and mental ability to self-administer the aid-in-dying drug.” Importantly, the patient’s power of attorney, advance health care directive, conservator, health care agent, or surrogate may not request these drugs on a patient’s behalf. Medical decision-making capacity is determined by the individual’s physician, psychiatrist, or psychologist and involves individuals needing to understand and communicate their decision to healthcare providers. The term “self-administer,” according to the written law, is defined as “qualified individual’s affirmative, conscious, and physical act of administering and ingesting the aid-in-dying drug” but does not further specify the route of administration. In the United States, there are currently 10 states/ jurisdictions that have similar PAD statutes in place: California, Colorado, District of Columbia, Hawaii, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington. Each of the participating states has similar inclusion criteria as described earlier. Outside of the United States, there are eight countries (Switzerland, the Netherlands, Belgium, Luxembourg, Germany, Canada including Quebec, Colombia, and Australia including Victoria and Western Australia) that have legalized either PAD or euthanasia. Euthanasia differs from PAD in that euthanasia refers to “the act of intentionally ending the life of a patient by a health care practitioner through medical means at that patient’s explicit request to alleviate suffering” while PAD involves the provision or prescribing of drugs by a health care practitioner for a patient to end their own life. PAD specifically refers to “a physician providing, at the patient’s request, a prescription for a lethal dose of medication that the patient can self-administer by ingestion, with the explicit intention of ending life.” Since the EOLO Act became law in California, 1985 individuals have requested PAD. In 2019, 736 individuals had started the PAD process, 618 obtained aid-indying medications, and 405 people were reported to have completed the process. More than two-thirds (67.5%) had cancer as their terminal diagnosis, while neurological conditions such as amyotrophic lateral sclerosis and Parkinson’s disease made up the second largest disease group at 10.1% in that year. Since 2016, neurological conditions have consistently been the second largest group participating in PAD following cancer in California. This is similar to the trend in Oregon and Washington, states with a 30-year history of medical assistance in dying. In this article, we aim to describe our experiences with PAD as a tertiary care center for movement disorders and discuss the need for © 2022 International Parkinson and Movement Disorder Society