By Ben Tinker

CNN

(CNN) -- One hundred eleven people died last year under California's new right-to-die law, according to a report released Tuesday by the state's Department of Public Health.

The End of Life Option Act went into effect on June 9, 2016. It allows for California residents, age 18 and older, to request life-ending medication from their doctor if they are suffering from a terminal illness and want to set their own timetable for their death.

Between June 9 and December 31, 2016, 258 people initiated the process, according to the report. One hundred ninety-one people were prescribed the lethal medication, of which 111 patients "were reported by their physician to have died following ingestion of aid-in-dying drugs prescribed under EOLA." Twenty-one people died as a result of their underlying terminal illness, and the outcome of the other 59 people who were prescribed drugs "is currently undetermined, as there has been no outcome reported for these individuals within the time period covered by this report."

The majority of the 111 people who utilized the law were cancer patients, according to the report. The median age at time of death was 73. Most patients were white (89.5%), enrolled in hospice/palliative care (83.8%), and were covered by some type of health insurance (96.4%). Sixty women and 51 men died as a result of ingesting aid-in-dying drugs.

"The state's data show that even during the early months of the law's implementation, the law was working well and terminally ill Californians were able to take comfort in knowing that they had this option to peacefully end intolerable suffering," Compassion & Choices California State Director Matt Whitaker said in a statement. "We continue to work to ensure that every terminally ill Californian has equal access to all end-of-life care options, including hospice, pain control, palliative care and medical aid in dying." The nonprofit organization helped to get the law passed in California, and advocates for similar legislation nationwide.

End of Life Option Act

In California, a mentally competent adult is eligible to partake in the End of Life Option Act if he or she is determined to have a terminal illness -- meaning they have six months or less to live. The patient must make two verbal requests of their doctor, at least 15 days apart, as well as one written request. The patient must affirm his or her request 48 hours before ingesting the medication, which they must be able to self-administer, without the help of a physician, family member or friend.

Physician-assisted aid-in-dying is different from euthanasia (commonly referred to as physician-assisted suicide), which is illegal in all 50 states. Aid-in-dying advocates such as former California state Sen. Lois Wolk and state Sen. Bill Monning -- who co-authored the End of Life Option Act -- dislike the term "suicide," because it implies an impulsive and irrational act.

"Is this suicide?" CNN Chief Medical Correspondent Dr. Sanjay Gupta pointedly asked the pair in an interview last year.

"No, not at all," said Wolk.

"The person is dying. The people we've met with -- they want to live," said Monning. "They're not choosing death. That decision has been made unfortunately because of an uncontrolled disease, a terminal cancer. ... What this does is allows them to gain autonomy, self-determination in what will be the path of that certain death."

Both Wolk and Monning said it was important that any attempt to influence a person to hasten his or her own death under their bill would be cause for felony prosecution.

"The health plans cannot influence a patient in their choices," said Monning. "They're not mandated to cover the costs. Some may, some may not ... but no plan can say, 'You can't pursue (an expensive or long-term) treatment option; we want you to use this end of life option.' That's cause for a felony."

Under California's law, the cause of death that is listed on an official death certificate is the underlying terminal illness, such as cancer -- not "suicide" or use of the End of Life Option Act. That has important implications not only for patient confidentiality, but also for sensitive family matters such as a will or life insurance.

The legacy of Brittany Maynard

In 2014, 29-year-old Brittany Maynard brought the right-to-die movement back into the country's consciousness. On New Year's Day, she found out that she had brain cancer. After multiple procedures to remove part of the tumor, Maynard learned that it had come back and was more aggressive. Doctors said she had fewer than six months to live.

"I do not want to die. But I am dying," she wrote in an emotional essay for CNN in October 2014. "And I want to die on my own terms."

Because California had not yet legalized medical aid in dying, Maynard and her husband, Dan Diaz, moved to Oregon to utilize that state's Death With Dignity law.

Oregon was the first state to enact such a law, in 1997. In the 18 years after, 1,545 prescriptions have been written for a lethal dose of medication, of which 991 patients used that prescription to hasten their death, according to a study released in April. Most of those patients, like Maynard, had cancer.

Maynard made a series of videos with Compassion & Choices, the medical aid-in-dying advocacy group.

"I can't even tell you the amount of relief it provides me to know that I don't have to die the way that it's been described to me that my brain tumor would take me on its own," Maynard said in the first video.

Maynard and Diaz had been married just over a year when she was diagnosed with cancer. Uprooting their lives in California to move to Oregon was challenging for their entire family.

"That was one of the worst things, having to leave our home at that time," Diaz told CNN's Dr. Sanjay Gupta in an interview last year. "We move to Oregon; Brittany applies for this (lethal) medication; she puts it in the cupboard, and that's it.

"We continue doing everything we can to extend her life," Diaz said. "The fact that we had that medication, it didn't change anything with regards to her battling cancer or her fighting. When you have cancer, you fight. That's what you do."

On the morning of November 1, 2014, Maynard had a small seizure.

"It passed," Diaz said, "so we slept a little bit later that day. ... We had breakfast. Brittany wanted to go for a walk, so we did. We took the dogs -- because, again -- being outdoors, that's what fed Brittany's soul.

"When we got back to the house ... she just told me, she says, 'Dan, it's time. It's my time,' " he recalled. "The suffering that she had endured leading up to that day, the seizure that morning, was a reminder of what she was risking -- that if a seizure or a stroke occurs as her symptoms get worse, if she loses the ability to self-administer, if she suffers a stroke and she loses the ability to stand, walk or swallow, all of a sudden she's now trapped in her own body, and she's trapped dying the very way she was trying to avoid.

"It was around 4 o'clock in the afternoon," Diaz remembered. "She wrote a final passage in her Facebook, kind of a letter to all her friends and loved ones, and within five minutes of taking that medication, Brittany fell asleep, just like I've seen her do a thousand times before. In 30 minutes, the medication slows brain function, including the parts that control breathing, so her respirations drop to a point where she passed away. That was the gentle passing that Brittany had, and that's not the gentle passing that she would have had if the brain tumor would have continued to run its course."