Overview
This page outlines important tips for preparing to take End of Life Option Act Medications and for medication administration.
Planning tips
Once you complete the EOLOA process, it's important to seek ongoing guidance from your health care team as you approach the day of administration, especially if you're nearing the end of your life or experiencing confusion, difficulty swallowing, nausea, vomiting, or bowel obstruction.
The EOLOA process can proceed only if you have:
- The capacity to make medical decisions. You must be able to clearly express your choice to pursue EOLOA and your understanding of alternatives to EOLOA, and to acknowledge that ingestion of these medications is expected to result in death.
- The ability to self-administer the medications via mouth, feeding tube, or rectal tube. Please note that someone else can legally help you mix the medications prior to ingestion, but you must administer them yourself.
- The ability to safely absorb the medications. A bowel obstruction or other intestinal issue may prevent you from absorbing these medications as intended. If this applies to you, it's very important to talk with your doctor about a safe alternate plan for taking the medications.
Week-of tips
The week leading up to administration
- Notify your doctor, hospice team and loved ones (if you want them to know) that you are planning to ingest your medications and when you plan to do so.
- Arrange to have loved ones in your home on the day of administration. If some members of your “support team” don't know each other, consider having a meeting – ideally, prior to the day of ingestion – to introduce them and clarify each person's role. We also encourage you to ask your hospice team whether a volunteer or nurse can be present during this meeting.
- Consider identifying a “point person,” such as your main surrogate decision-maker (who may be your emergency contact or your durable power of attorney), to be the main spokesperson with your medical team.
- Visualize the experience you want to have on the day you take the medications, and discuss this with your loved ones, if applicable. For example, consider whom you want to be present, as well as whether you want any special music, food or other experiences in the hours leading up to ingesting the medications.
- If taking the medications orally, practice swallowing one half-cup (4 ounces) of slightly thickened liquid in the days leading up to your ingestion. You may use a straw, if helpful.
- Ensure your bowels are moving regularly (at least every other day) leading up to your ingestion. If needed, talk to your doctor about ways to increase the frequency of your bowel movements.
- Continue all your usual medications unless your medical team advises you otherwise.
- Finalize plans for your remains by talking with your loved ones and your local mortuary. If you wish to have a specific ritual after your death, make this clear ahead of time. The mortuary doesn't need to be called immediately after death, but it does need to be selected ahead of time.
Day-of tips
The day you take the medications
We recommend eating and drinking lightly beginning the night before, so as to avoid significant nausea and ensure your body can fully absorb the medications.
Instructions for mixing your medications
- Choose a clean, safe and well-lit surface on which to mix your medications. Ensure that pets and other people, especially children, stay clear of this area as the medications are prepared. These are dangerous substances.
- Cover the surface with a clean paper towel. You may use medical gloves, if desired, but this is not required.
- Have all supplies ready nearby, including the powdered medications, a liquid measuring cup, and a liquid of your choice (this may be water, but apple juice or another beverage whose taste you like may be preferable due to the medications' bitter taste).
- Pour 4 ounces (a half-cup) of your desired liquid into a measuring cup.
- Before opening the medication bottle, gently tap the bottom so the powdered contents settle.
- Open the medication bottle away from your face. Pour 2 ounces (a quarter-cup) of your desired liquid into the bottle, reseal it and shake vigorously.
- Reopen the bottle and pour the remaining 2 ounces of fluid into the bottle. Shake vigorously.
Instructions for administering your medications
- Once the medication is mixed, it can be brought to your bedside for ingestion. Ensure that you are settled comfortably in a bed or chair prior to taking the solution.
- After ingestion, your support person will need to thoroughly clean the medication bottle and the measuring cup. This person should seal the bottle in a plastic bag and place it directly in the garbage.
- Instructions for administering EOLOA medications:
- Take your anti-nausea medications one hour before ingesting the EOLOA medications.
- One hour after taking the anti-nausea meds, self-administer your EOLOA medications. Please ingest the medications within 2 minutes or less.
- Note that these medications are bitter and can cause mild burning and coughing. This will resolve within a few minutes after ingestion. In the meantime, feel free to take sips of juice, lick a frozen ice pop, or take small bites of sorbet (not ice cream, as it can interfere with medication absorption) to soothe these sensations.
- These educational videos from the American Clinicians Academy on Medical Aid in Dying provide more information on enactment of EOLOA at the bedside and proper mixing of medications.