Hawaii rules physicians can provide aid in dying

Compassion&Choices, the nation’s oldest and largest nonprofit organization working to improve care and expand choice at the end of life, and the Hawaii Death With Dignity Society (HDWDS), a local organization with similar goals, today announced the findings of a panel discussion on aid in dying. Experts on Hawaii law, medicine, elder care, legislative, and end-of-life issues concluded Hawaii physicians may already provide aid in dying subject to professional best-practice standards.

“Hawaii law, through a number of statutory enactments, and a provision in a 1909 law unique to Hawaii, already empowers terminally-ill patients with significant freedom to determine their course of medical care at the end of life and affords protection to physicians who provide care,” said panelist and Compassion&Choices Director of Legal Affairs Kathryn Tucker.

“Most medical care is governed by professional scope of practice standards,” said panelist Robert “Nate” Nathanson, MD, a founder of Hospice Hawaii. “These standards accept other practices that may advance the time of death, such as withdrawal of life-sustaining treatment, voluntarily stopping eating and drinking, and palliative sedation.”

“Even with excellent pain and symptom management, some patients trapped in lingering decline ask their physician to prescribe medication the patient may ingest to bring about a peaceful death,” said panelist Deborah Zysman, MPH, president of the Hawaii Public Health Association, “This practice, known as aid in dying, is increasingly accepted not only by the American Public Health Association, but also the American Medical Women’s Association, the American Medical Student Association, and the American College of Legal Medicine.”

Representative Blake Oshiro, Hawaii House Majority Leader, chaired the panel, which also included former State Representative Ernest “Juggie” Heen; Dante Carpenter, Chair, Democratic Party of Hawaii; former State Representative Eve Anderson; Mitch Burns, an attorney of elder law; Hawaii community volunteer Laura Thompson; Pam Lichty, MPH, member of the board of the ACLU of Hawaii; Scott Foster, co-founder of HDWDS; and Robert Orfali, author of Death with Dignity.

Orfali wrote his book to help give others the choice his wife, Jeri, wished she’d had. In her 50s, she faced ovarian cancer. “When she became terminally ill, Jeri wanted some form of insurance at the end,” Orfali said, “She did not want to die in pain. She believed in aid in dying and wanted to have medication just in case.”

“The people of Hawaii strongly support the availability of aid in dying as an option for terminally ill, mentally competent adults,” said Representative Oshiro, “And it is good public policy. The experience in Oregon demonstrates that when aid in dying is available, hospice utilization increases dramatically, physicians seek more continuing medical education in treatment of pain and other distressing symptoms, and are more open to discussing end-of-life options with their patients.”

The lawyers and legislators concurred that nothing in Hawaii law currently prohibits aid in dying. Patients and their doctors may make decisions governed by best medical practice, allowing them the opportunity to explore a wider variety of patient-directed, end-of-life choices. Tucker, Compassion&Choices’ director of legal affairs, said, “We expect Hawaii residents will soon have the same broad range of end-of-life choices enjoyed by the people in Montana, Oregon, and Washington.”