A 73-year-old man with Lou Gehrig’s disease and a 75-year-old man with prostate cancer used Hawaii’s new aid-in-dying law to end their lives with lethal medication in the first five months of this year.
That’s according to a state report issued Monday on the Our Care, Our Choices Act, which allows terminally ill patients to end their lives on their own terms with prescribed drugs. The law took effect Jan. 1, and the report runs through May 31.
Six other patients qualified to obtain the lethal prescriptions during that time, one of whom died of lung cancer without ingesting the drug. The others have not used the drugs.
Just having the medication on hand — without using it — can help patients feel better, according to Dr. Charles Miller, a physician who used to head Kaiser Permanente’s oncology department and now oversees its medical aid-in-dying requests.
“For most of them it’s so stress-relieving,” he said. “You can just see the tension, the anxiety, it just goes away. Sometimes that’s enough.”
Miller is one of four attending physicians who have written such prescriptions so far, and has flown to Maui and the Big Island to meet with patients at their homes.
“In my experience, the patients who make this request are very clear in their own minds why they want to do this,” he said. “They want to have control. They want to live but they can’t. So what they do want to do is to control how, when, where and with whom they end their lives.”
The state doesn’t track how many people make an initial request for medical aid-in-dying but do not obtain a prescription because they don’t qualify or change their mind. Kaiser, the state’s second-largest health insurer, has received 18 requests for prescriptions so far, according to Miller.
There are about 10,500 deaths annually in Hawaii.
The law restricts medical aid-in-dying to Hawaii residents age 18 and up with terminal illnesses and a life expectancy of up to six months. Patients must be able to take the prescribed medication themselves. Three health care professionals, including a mental health provider, must deem them qualified.
Various other hurdles must be met, and there is a 20-day waiting period before a prescription can be filled. For the eight Hawaii patients, it took roughly 37 days on average to obtain their prescriptions, the report said. Miller said two of his patients died before qualifying for prescriptions.
“Hawaii has the most stringent medical aid-in-dying law of all the authorized states,” said Samantha Trad, state director of Compassion & Choices. “The waiting period is five days longer than most of the other states.”
Under the Our Care, Our Choices Act, patients must be educated on the whole range of care options, including “feasible alternatives or additional treatment opportunities, including but not limited to comfort care, hospice care and pain control.”
“This has been a collaborative effort and the dedication of Hawaii’s healthcare providers to help patients and their families navigate the system has played a critical role in successfully implementing the law,” Lorrin Kim, the Department of Health’s chief policy officer, said in a statement. “There is more discussion in the community about supportive care alternatives when curative treatment is no longer viable.”
Compassion & Choices’ website shows that 10 states have aid-in-dying laws. The nonprofit encourages health care systems to let their physicians decide whether they want to prescribe such drugs as an option for end-of-life care for their patients.
“Hawaii Pacific Health and Kaiser have really gone out of their way to support patient-directed care at end of life,” Trad said.
The American Society of Clinical Oncology recommends that cancer patients with metastatic disease be referred for palliative care at the same time they start any treatment, according to Miller.
Trad said that sometimes people don’t even realize that stopping treatment is always an option.
“I would just encourage people to start having end-of-life conversations now with their families and their physicians because it makes a huge difference knowing that you’re going to be supported in your choices,” Trad said.
“These conversations can be hard,” she added, “but they are so necessary.”
To learn more about Our Care, Our Choices, visit the Health Department’s website at 808ne.ws/caresupport.