>> on the÷úzv aba and -- we nowe five states that havesstatutes and in one case that has case law supporting the right of a terminally ill adult to take hic or her own life through the use

of aid and dying drugs. i practiced in california but not exclusively in california. my clients are throughout the countryzv but certainly more ar on the west coast. so the trend setter was oregon and we have someone here from compassion and choices in it, you can also chat with him. so the first was called the act. it took effect in 1998÷ú and it was a voter initiative. and interestingly, the oregon law was actually considered by the united states supreme court becauseu! then attorney general ash kroft was trying to prosecute both pharmacies and physicians who were participating and that's the zv magic, participating -- who are participating under the oregon law. and the supreme court determined that the controlled÷ú substance act could not be used to delegit mate a state standard of health care, kind of a states right issue. i dent think the supreme court

was interested in commenting on the substance of the law. but that kind of got it interesting. followed by that, was washington, also voter initiative, that took effect in 2009. vermont, 2013 andu! that was actually through legislation and the governor actually made the issue part of his campaign platform before thezv 2012 election. that was noteworthy. montana very interestingly, has this right under case law and you might disagree with the statement, but the court case says there's little difference between removing life support and taking aid and dying drugs. i think there areu! people who would disagree with that statement. there have been many efforts to codify that or to over turn it in montana but so far none of us have succeeded. and that brings us to california and, by the way, in november colorado also voted to pass this lawht to the next, and i'll be

talking to the trade association about the california experience next year. california has an option act. it only took effect in june and at its heart, like all the other statutes i mentioned, it allows azv terminally ill patient to e his or her life by obtaining drugs from a participating position. pretty much every word÷ú in tha sentence accept the conjunction have a specific meeting. it's the most recent and i will say probably the most second to most recent andp i'll say most refined of the laws. the same organization that put forward the oregon law also put forward washington and vermont recently, colorado and we keep on -- they keep on removing it. it's becoming a more and more refined law. so very interestingly, you must administer the drug.p this is not, which can happen

somebody gets a little bit too much. there are ways that people can÷ control drug intake, i presented with the physician who can describe that. it's very much about self administration. you must have an affirmative÷ú conscience and physical act of administering and adjusting the drug. and you must have an express sbebt, sbept, kind ofu! the norl consent dialogue. you must be mentally competent, so in my space working with seniors think about who that might ÷úexclude, people with al sorts of dementia and your agents cannot request the drugs for you, so your spouse, partner for you, so your spouse, partner ora cannot request this from you, it has to come from you directly. in california and this is an extremelyko indicative of the other state, you must be a resident that's a lot easier than it sounds. you can die in california more quickly than you can get married or ymdivorced, as long as you c show that you have some kind of

i.d. like a voter i.d. or driver's license or couple other forms, your resident.zv there's no time requirement. you must be resident, you must be 18 and must be able to understand the nature of the decision. and the benefits and the disadvantages, which are pretty evident. and you must be diagnosed with those terminal disease that was reasonable certaintyzv is expecd to cause your death within 6 months. we all know that's an art, not a science. there's a book written by his experience in hos spice. i think he lived for two-and-a-half to three years after being declared hospice eligible and the book has some kindof funny title like not dead yet or still alive or something. and apparently he continued to entertain all kind of lit -- until his death. so there's quite a lot of procedure in this and i think it reflects the tremendous tension between the supporters of this

law and the contractors. the detractors included two, maybe, obviousand maybe one less obvious group. certain organizations such as catholic health care organizations were opposed to it. the veteran's hospital and other governmental hospitals were opposed to it. and there's actually a federal law that prohibits the use of federal funds to fund any kind of -- i think they use the word assisted suicide. assisted suicide. it goes back to 1997. 3 q! surprise you, was certain parts of the disability rights movement. and the feeling among those groups that oppose the law was that it was bringing us maybe one step closer as the society to lose the nation and that was unacceptable to him. that was a fear they had. so in exchange of having a very -- well, to address÷ú the balance, to address the tension

between these two groups very large amount of processing you have to go through. just to give you the highlights days apart for the drugs. you have to make a written request and it must be witnes[ee by two witnesses and certain obvious people cannot be one of those witnesses, people who stand to benefit from from your will, spouses, and so on. you then need to go to cast potentially three characters, doctor, number one, your attendingp physician, he or she must confirm diagnosis, your capacity, your residency and your informed consent. must tell you you have the right to change your mind. must tell you there are other % options. and the doctor can recommend that not -- but not require you to tell your family of your plan, to have someone present with you and not to consume the

drugs in a public place. and this has created a kwan drink for a loot of my clients, the residents are notmy require to tell them that they plan to take these drugs. a big part of my practice is trying to get my clients to have anzv environment of open disclo sure and open discussion because you want people to tell you that they have these plans. unlike a hospital where you go in for a÷ú few days and leave. this is home for my client's client and that makes a very big difference. if you get through dr. number one, doctor number two is consulting physician, goes through all the same steps. those doctors, if they sense any kind of mental health issue have to recommend you go to mental health specialist. if i went to the doctor today and found out i have six months tklive. i'm pretty sure i will feel a whole bunch of emotion. i'm surety sure one of them will be depression including anxiety, fear and confusion.

i don't think they're really necessarily focusing on that group. but there are people who have chronic depression. there are peoplev: who are bipor and who have psycho sees and maybe they're not on their medication right now and maybe they're not going to make a sound decision &nause of the magnitude. once you go through all of those steps, you're able to get the prescription and then the question from my clients and the question for your clients will be, will we participate in this act. so what does that word mean. statutes and probably the most important term in the statute. it means, essentially, are you going to prescribe the drug, handle the ymdrug, deliver it, dispose of it, receive it, have any touch -- have your hands on any part of the chain oftáutk of the drug and will you be present at the moment. that's what boils down to it. there are some other details, that's the hwart of it.

so you can diagnose that you can give people information about it if you're a doctor. you can tell them what their prognosis is. but the real key is are you going to, as a health care provider, let your -- if you're a company, let your employees and your let÷ú contractors be present at the moment of ingestion and are you going to handle the drugs. and just to give you a sneak preview, most of my clien( are not participating. i'll explain more when we get to the q and a why that is. the other interesting part of this law is that there's a÷ú provision protecting you, whether you participate or not. so if you're a physician or a hospital or school nursing facility or farmist or hospice agency or another health care provider, you can let your employees or contractors÷ú participating, provided you give them notice and tell them the consequences that could be disciplined up to and including termination. if you are anym individual and u want to take these drugs, and of

course, the act, it is not considered suicide, assisted suicide or homicide. why÷ú is that so important? insurance is a very big issue. it does not invalidate your life insurance, health insurance or any other kind of insurance. they cannot discriminate on you dpens your plans or the rescind your position. so that's all very essential. so it's kind of a kind of a -- you can participate. you cannot participate as an employer, i tell me clients if you don't participate, you have to give kind of disclose sure and acknowledgment to your people. so the last point i want to make is that there are very interesting utilization data coming out of these, because every state is required to maintain these u!data. just to tell you a couple of the highlights, this is basically an old person's law. most of the people who are taking these drugszv are over 6

most of them have cancer. they might have copd or another various serious illness. for the most÷ú part they're telling their family in the 90 to 95%, they're telling their family, interestingly the vast majority are whiteht people are college degrees, which might have something to do with how information gets conveyed. and the other interesting thing is almost everybody is dying at home, so that also reads as interesting issues when you represent hospitals asútf where this is going to take place. medicare will not pay for these drugs. medicare the safe portion, depending on your state, and$ @% oregon the state component stays for it. california has set aside money for it. but medicare will pay for somebody end of life counseling that you get from your physician, i'm going to turn this over at this point and he's going to talk more about the philosophical issue involved. >> thank you,zv