Following a handful of impassioned floor speeches by lawmakers on both sides of the debate, the state Senate overwhelmingly passed a bill Thursday to allow terminally ill patients to request lethal medication, setting up Hawaii to become the sixth state to legalize medical aid in dying.

The Senate voted 23-2 in favor of House Bill 2739, known as the Our Care, Our Choice Act, capping a decades-long debate over the controversial practice. The House earlier this month passed the bill in a 39-12 vote.

The measure has been sent to Gov. David Ige, who has said he fully supports the bill and plans to sign it into law. It would take effect Jan. 1.

The bill allows mentally competent adult residents, who have been given six months or less to live, to request life-ending prescriptions to be self- administered.

Before Thursday’s vote Sen. Breene Harimoto — who along with Sen. Mike Gabbard voted against the bill — shared personal details about his battle with cancer, which he says strengthened his faith.

Harimoto (D, Pearl Harbor-Pearl City-Aiea) was diagnosed in 2015 with an aggressive form of pancreatic cancer. The cancer went into remission after eight months of radiation and chemotherapy.

“My faith in God, prayers and a sense of hope got me through this and through a lot of painful recovery,” he said on the Senate floor. “It was nothing short of a miracle. Because of this personal experience, I feel so strongly that we must always have hope and never give up.”

Harimoto disclosed that he was diagnosed last week with cancer in his lung and was scheduled to begin chemotherapy this week. The treatment had to be postponed, and Harimoto said he thanked God for the opportunity to be able to cast his “no” vote.

He said he’s been chided by some to leave religion out of the debate. “These people fail to understand that my faith forms the very foundation of who I am,” he said. “Should I really be required to check my religion at the door? This is not even possible.”

Sen. Russell Ruderman (D, Puna) spoke in support of the bill, arguing that people should be able to exercise their freedom of choice in end-of-life decisions.

“Freedom to live one’s life as we choose is the essence of this country’s laws,” Ruderman said. “Religions rightfully carry great respect in our society but must not dictate our laws. Why? Because interpretations differ, they change over time. And most importantly, I may not interpret the Bible the same as others. I may read a different Bible. I may choose not to follow a Bible. That right is enshrined in our Constitution.”

Sen. Josh Green, an emergency room physician, also spoke in support of HB 2739 but said he has “great conflict in my heart.”

“As a physician I swore to do no harm. But one might harm a patient by not relieving their suffering,” Green (D, Naalehu-Kailua-Kona) said. “I see them as a human being … and I can’t ignore that suffering. I can’t ignore that pain. I can’t look the other way.”

While some lawmakers contend Hawaii’s law will have some of the strongest safeguards in the nation to deter abuse and fraud, others worry the protections don’t go far enough.

Sen. Donna Mercado Kim said the bill is not perfect, but is a big improvement over a death-with-dignity bill she voted against 16 years ago over concerns about lacking safeguards.

“It’s not a perfect bill. We could do more, and I’m hoping that we do do more. But in the meantime people are suffering,” said Kim, who voted in support.

“We have seen our family members. We’ve been caregivers. We see our colleagues. It’s not an easy decision,” she said, her voice trembling with emotion. “People should have that right to decide.”

If signed into law, Hawaii would join California, Colorado, Oregon, Vermont and Washington state in legalizing medically assisted death. The District of Columbia also passed a law, while the Montana Supreme Court has ruled that physician- assisted death is legal under existing law.

In initial public hearings on the bill, lawmakers listened to hours of often emotional testimony in favor of and against the measure.

Supporters asserted that individuals of sound mind should have the option to end their lives peacefully and with dignity rather than suffer from crippling illnesses. Opponents argued that life should be respected and said pain relief is already available through hospice and palliative care.

Under HB 2739, patients would have to submit two verbal requests a minimum of 20 days apart and one written request to their attending physician for a prescription.

Two health care providers would need to confirm a patient’s diagnosis, prognosis, competence and that the request is voluntary. Before any medication is prescribed, a patient would need to receive mandatory counseling from a psychiatrist, psychologist or clinical social worker.

The bill calls for criminal penalties for tampering with a patient’s prescription request or coercing a patient to request a prescription.

Supporters cheered Thursday’s vote while opponents expressed disappointment.

“This has been 20 years in the making. We’re glad it came out of the Senate so strong — 23 to 2,” said Michael Golojuch Jr., grass roots coordinator for Compassion & Choices Hawaii. “This has been a group effort, community effort. It’s been decades in the making.”

He said the organization plans to shift its focus to helping patients access the law’s benefits. “We now look at access — ensuring that people have access to medical aid in dying if they choose to,” Golojuch said.

Eva Andrade, president of the Hawaii Family Forum, which opposed the measure, called the bill’s passage unfortunate.

“We’re very disappointed that a lot of the concerns that were addressed by the legal community, the medical community, people in the disability community were not addressed,” she said. “And even senators in their floor speeches acknowledged the bill was flawed. … We’re going to educate the community on exactly what this bill says.”

Star-Advertiser reporter Tyne Phillips contributed to this report.