I was pleased to join a panel discussion about aid in dying on Oct. 5 in Honolulu. Experts on Hawaii law, medicine, elder care, legislative process and end-of-life policy all concluded Hawaii physicians may provide aid in dying subject to professional best-practice standards. The analysis by the panel was thorough and thought-provoking, as are the questions that now arise about the way forward.
The panel recognized that requests for aid in dying are akin to other already permissible end-of-life choices, included in the autonomy protected under the Uniform Health Care Decisions Act. This law allows patients to specify if and when they wish to refuse or withdraw life-sustaining medical care. Additionally, in 2004 Hawaii enacted the Pain Patient’s Bill of Rights, and in doing so recognized that patients are empowered to request and receive as much pain medication as necessary to get relief.
In addition, a 1909 provision gives terminally ill patients significant freedom to determine their course of medical care at the end of life and protection to physicians who provide the chosen care:
"(W)hen a duly licensed physician or osteopathic physician pronounces a person affected with any disease hopeless and beyond recovery and gives a written certificate to that effect to the person affected or the person’s attendant nothing herein shall forbid any person from giving or furnishing any remedial agent or measure when so requested by or on behalf of the afflicted person."
Moreover, Hawaii’s Constitution protects medical decision making and bodily autonomy.
The lawyers and legislators on the panel concurred that nothing in Hawaii law currently prohibits aid in dying, which brings us to the questions:
What does this mean for terminally ill patients and their doctors?
BY HELPING PATIENTS gain release from the agonies of extended dying, physicians can stay with their patients and give good end-of-life care.
Patients, knowing they can talk with their doctors about peaceful dying after cures are exhausted, can talk about all the options available to them. Informed patients are better able to direct their end-of-life care, and gain great comfort from knowing they will not have to suffer unbearably.
In Hawaii there is no prohibition against aid in dying. Patients and their doctors can make decisions that are governed by best medical practice, allowing them the opportunity to explore a wider variety of patient-directed end-of-life choices.
Will opponents of choice at life’s end seek to limit access to aid in dying as an option for terminally ill, mentally competent adults?
Polls indicate over 70 percent of the people of Hawaii support the availability of aid in dying. And it is good public policy.
Many years of experience in Oregon demonstrates that when aid in dying is available, hospice utilization increases dramatically, physicians are more likely to seek continuing medical education in palliative treatments, and are more open to discussing end-of-life options. But the people must ensure opponents do not take away this important end-of-life choice.
What will it take for aid in dying to become integrated into best practices for end-of-life care?
We must inform the public that existing law empowers terminally ill patients to choose from a full range of options at the end of life.
Doctors must learn that current law allows them to respond openly to requests for aid in dying. As individuals, we must become consumer advocates and ask our doctors, "Should the time come, would you support my request for aid in dying?"
Over time, medical providers in Hawaii will integrate aid in dying into excellent end-of-life care, one option among many available to dying patients. Practices in Oregon, Washington and Montana offer physicians guidance on aid in dying.
The immediate future will depend on how the people of Hawaii respond to this newly recognized freedom. We expect and hope they will soon have the same broad range of end-of-life choices enjoyed by the people in Montana, Oregon and Washington.
