Improving Access to Medical Aid in Dying in California by Including Nurse Practitioners as Providers
Document Type
DNP Project
Department
School of Nursing
Date of Degree
Spring 2025
Degree
Doctor of Nursing Practice (DNP)
Primary Advisor
Dr. Mary Jean Schumann, DNP, MBA, CPNP-PC, FAAN
Keywords
medical aid in dying; California; nurse practitioners
Abstract
Background: Medical aid in dying (MAiD) in the United States is the process by which a terminally ill individual with a prognosis of six months or less can request a lethal prescription to end their life. In California, it became legal through a 2016 statute called the End-of-Life Option Act. The act mandates that two physicians agree on the prognosis of the terminally ill individual; one of the physicians is then responsible for prescribing the lethal medication. There is a significant physician shortage in primary and palliative care in the state, as well as a substantial percentage of physicians who choose not to participate in the program, leading to decreased access. Nurse practitioners (NPs) provide an ever-increasing percentage of primary care in California and are providers of MAiD in other states. Allowing NPs to function as MAiD providers will increase access to the program in the state without a decrease in quality.
Aims: This health policy project aimed to increase the knowledge among legislators of the difficulties with access to MAiD for persons who see nurse practitioners as providers, to educate legislators on other possible improvements to the current law, to increase knowledge among the legislators of the importance of the nurse practitioner profession in the state, and to increase understanding in the legislature that the current law with sunset in 2031.
Methods: This health policy project's design involved a governmental analysis of MAiD in the state. Then an educational endeavor to increase legislators' knowledge of the limitations of the current bill ensued. This focused on potential improvements to the act, particularly focusing on adding NPs as providers of MAiD and the sunsetting of the bill in 2031.
Results: Sixty-one legislative offices were provided an infographic on MAiD and the importance of allowing NPs to function as providers. Thirty legislative offices agreed to meetings, which took place over a six-month period. Meetings revolved around the lack of access to MAiD, nurse practitioner practice, the current bill’s sunset provision, and how to improve it in its next iteration. Meetings were initially made with legislators who had voted for both expanded nurse practitioner practice and the 2022 medical aid in dying bill, then expanded to those on the health committee and newly elected legislators.
Conclusions: Most legislative staff had some knowledge of the current iteration of MAiD in the state but had a limited understanding of nurse practitioner practice, particularly the critical role they provide to the traditionally underserved. The legislative staff was generally receptive to the expansion of the End-of-Life Option Act. Still, no legislator decided to sponsor a bill this legislative session, and many expressed a likelihood they would co-sponsor the bill if another legislator introduced such a bill. Barriers included a lack of urgency since the current bill does not sunset until 2031, worry about another scope of practice bill so soon after AB890, which succeeded in expanding NP scope of practice, and a recent decrease in the number of bills a legislator could introduce.
Copyright Notice
©2025 Paul Slobodny. All rights reserved.
Recommended Citation
Slobodny, P. (2025). Improving Access to Medical Aid in Dying in California by Including Nurse Practitioners as Providers. , (). Retrieved from https://hsrc.himmelfarb.gwu.edu/son_dnp/191
Open Access
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