Changes proposed for law on medical aid in dying

Lawmakers are considering modifying the state’s year-old physician-assisted death law to allow doctors to waive the mandatory waiting period for terminally ill patients and give them the drugs they need to end their lives immediately if they are within 15 days of dying.

Hawaii residents who are “capable” or lucid and have a prognosis of no more than six months to live can ask their physicians for lethal prescriptions under the state’s physician-assisted death law. Eight other states and the District of Columbia have similar physician- assisted death laws on the books.

Hawaii’s medical-aid-in-dying law, called the Our Care, Our Choice Act, took effect at the beginning of last year.  In all 27 patients received the lethal prescriptions, but five did not take the drugs.

The current law Opens in a new tab requires that patients who want to die must make two oral requests to a physician 20 days apart and must also make a written request for the drugs.

But Trad said in written testimony the Hawaii patients had to wait an average of 34 days before they received the drugs, and one patient was forced to wait 100 days.

“In fact, we know from local health care systems that over half a dozen eligible patients who wanted the option of medical aid in dying died during the mandatory waiting period, unable to have the peaceful end-of-life experience they wanted,” Trad wrote.

House Bill 2451 Opens in a new tab would revise the current law by reducing the 20-day waiting period to 15 days, and would allow doctors to waive the waiting period entirely when it is reasonably certain the patient will die within the 15 days.

The bill would also authorize advanced practice nurses with prescriptive authority to provide the life-ending drugs to terminally ill patients.

“The law is working well for those who are able to access it,” Trad told the House Committee on Health on Friday. “The only problem that we and others are finding are that dying patients who are eligible for the option face overwhelming roadblocks and barriers, especially on the neighbor islands.”

Part of the problem is the statewide physician shortage, according to supporters of the bill.

Trad described the case of a Hawaii island man “who spent his final weeks searching for a provider who would support him in the option of medical aid in dying,” she told the committee. “He lived in a rural area, he was eligible, he met all the qualifications, but by the time he found a physician to support him, it was too late and he did not survive the 20 days.”

But acute care nurse Carm Akim strongly disagreed, saying lawmakers should gather more data before allowing advanced practice nurses to prescribe lethal doses of medication. She also argued that reducing the wait time in the current law reduces the opportunity for patients to change their minds about ending their lives.

Dr. Daniel Fischberg, a Kailua physician, warned in written testimony that the proposed changes would dramatically change the law, taking it from what was touted as “the safest physician-assisted death legislation in the nation to the one most willing to sacrifice safety in the interests of expanding access.”

Rep. Nadine Nakamura (D, Hanalei-Princeville- Kapaa) suggested that if the bill passes, the advanced practice nurses should receive specialized training on the issue that includes the medical and legal issues surrounding the law.

The House Health Committee approved the bill with amendments Friday, with only Rep. Gene Ward (R, Kalama Valley-Queen’s Gate-Hawaii Kai) voting against it. The measure now goes to the House Consumer Protection and Judiciary committees for further consideration.