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‘Death with Dignity’: Legislation would give terminally ill option to end life with medication

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This could be the year Hawaii legislators pass a “death with dignity” bill, several told the Tribune-Herald.

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This could be the year Hawaii legislators pass a “death with dignity” bill, several told the Tribune-Herald.

Such legislation would give people diagnosed with terminal illness the option of getting a prescription for an “aid-in-dying drug” to help them die peacefully, rather than suffer a prolonged, painful death.

“This is the first time in 25 years that I’ve worked with this issue that I’m saying, yes, it’s very possible,” said Scott Foster, co-founder of the Hawaii Death with Dignity Society.

A 2016 survey for advocacy group Compassion and Choices Hawaii revealed 80 percent of registered Hawaii voters support physician-prescribed life-ending medication as an option for terminally ill people.

“Those are the highest numbers in the country,” Foster said. “We’re very pleased with that.”

Oregon, Washington, Vermont, California and Colorado have enacted laws that allow physicians to prescribe life-ending medications. Those laws allow prescriptions for terminally ill patients with less than six months to live — and who are medically able to make decisions.

Montana’s Supreme Court ruled physicians already could legally write such prescriptions, meaning the practice is legal in six states.

Multiple legislatures nationwide are considering similar measures this year.

Bill details

At lease five death with dignity bills have been submitted for consideration so far in Hawaii.

House Bill 150 includes a provision specifying that a request for a life-ending drug can’t come from a power of attorney, friend or spouse. Instead, it must “be made solely by (an) individual” — an adult with the ability to make medical decisions.

HB 201 specifically bans euthanasia, stating, “nothing in this chapter shall be construed as to authorize a health care provider to end an individual’s life by euthanasia.”

HB 550 requires physicians to verify an individual “is making an informed decision.” Also, the physician “shall recommend that the patient notify the next of kin.” A person who declines or can’t find family, though, won’t be denied access.

Senate Bill 357 notes “medical aid in dying” should follow standard “medical practice defined by established standards of care.” Those standards, as they apply to end of life, spring from Oregon’s experience. According to the bill, Oregon’s law has demonstrated that “in contrast to the fears of opponents, the elderly, disabled and uninsured have not been negatively impacted.”

SB 1129 prevents insurance companies from charging more if a policyholder requests the drug and requires the companies to pay benefits if the policyholder dies from taking it (most life insurance policies include exemptions that benefits won’t be paid if the policyholder commits suicide). The bill also assesses penalties if someone alters a qualified person’s request, or forges the person’s signature.

Foster said the inclusion of protections, such as euthanasia bans, helps allay the fears of critics who worry about the “slippery slope.” That argument suggests nonconsenting individuals might be killed by family members, doctors, nurses, guardians, friends or acquaintances.

Data

Hawaii legislators have Oregon’s death with dignity data to help them consider the various bills. Residents there, in 1997, were given the right to “end their lives through the voluntary self-administration of lethal medications.”

A total of 1,545 people were given prescriptions for life-ending medication between 1998 and 2015, according to Oregon Department of Health online data. Of those, 991, or 64 percent, actually took the medicine and died as a result.

State Sen. Russell Ruderman, D-Puna, said he thinks people should have such a choice.

“For those that want it, it should be available,” he said.

Ruderman plans to review final versions of the bills and thinks one will pass because of longtime lobbyist John Radcliffe, who is terminally ill and supports death with dignity legislation.

“I think him being the most powerful lobbyist the past 10 or 12 years will have an effect,” Ruderman said.

In 2002, similar legislation lost by three votes in the Senate.

Sen. Lorraine Inouye, D-Hilo, said she sponsored SB 357 because, “for me, personally, I believe that we need to give people a choice.”

Inouye said her good friend, Sandy Song, died of cancer.

“Many of us suffered with her,” Inouye said. “It was just horrible and no matter how much they gave her, in terms of morphine, it wasn’t enough.”

Inouye said she and other legislators already have been getting lots of calls and emails and approached by lobbyists.

“I feel confident that a version will pass, yes, and there’s deep support. For me, it’s ‘the Sandy bill,’” Inouye said.

State Rep. Joy San Buenaventura, D-Puna, said she’s “generally for the right of well-informed people to make the decisions for their own bodies.”

She wants to make sure people who request life-ending medicine can change their minds and that protections for doctors are included.

“If we pass it, this allows more open discussion,” she said.

Critics

Foster said critics of such legislation typically view it from a religious perspective.

Suicide is considered a mortal sin in Catholic teaching, for example.

But proponents of death with dignity laws bristle at the term “assisted suicide” because suicide is specifically ruled out as a qualifier for a physician-prescribed life-ending drug.

Pastor Wilbert Laroga of St. Joseph Church in Hilo said, for Catholics, the issue is about moral values.

He said the Catholic Church believes in “a natural death from the moment of conception” until the time a person naturally dies.

Advocates say individuals for whom the bills are intended actually desperately want to live but their illness makes clear they will not survive.

Thus, advocates say, those who would benefit from the legislation are not suicidal. Rather, they are taking control of their illness.

Chances of passage

Because of the amount of work put in by advocates, the mood is positive that some form of legislation will indeed pass.

“I’m really confident that we can pass a bill this year,” said Mary Steiner, campaign manager for Compassion and Choice Hawaii. “Of course, it really comes down to the Legislature. We seem to be at a place we haven’t been at since 2002.”

Steiner said Oregon’s experience suggests many safeguards initially believed necessary have actually proven unneeded. Now those safeguards have become barriers to access, Steiner said, and her organization supports HB 201.

Requiring a second physician’s approval for an end of life prescription, she said, might be especially difficult on the Big Island, where there are fewer doctors than there is demand.

State Rep. Chris Todd, D-Hilo, said he supports the death with dignity concept.

“I think this is something we need to provide for those not facing a very comfortable future,” he said.

He noted, “we want to do everything possible to make sure that the intent of the bill stays intact.” He wants to make sure the legislation can’t be used nefariously against people with disabilities or others.

But he also said, “I know if I were in this position, I would definitely want this.” Todd didn’t predict if a bill will pass. But noted, “it does feel like this is something that is picking up momentum nationwide.”

A national laboratory

Radiation oncologist Dr. Kevin Wilcox of the Hawaii Pacific Oncology Center said Oregon served as the nation’s laboratory for developing a functional version of end of life care that includes an option for physician prescriptions.

When he began cancer care in 1969, he worried patients would ask him to help them die. But he was surprised by how few made the request.

Correctly used narcotics can address most pain to the point of having good quality of life, he said, and he’s comfortable with an end of life bill.

“I have no ethical problem with it, putting it into place,” said Wilcox, who also is a member of the Hospice of Hilo board of directors. But he might not participate himself. Physicians are trained to fight for patients’ lives, he said, and it’s hard for them to consider death with dignity legislation.

State Sen. Karl Rhoads, D-Oahu, who proposed SB 1129, calls it “basically Oregon’s law.”

“I didn’t think there was a reason to reinvent the wheel,” he said.

But he said his personal opinion is “there should be some hoops to jump over before you take a life — even your own. Not too many people are going to use this, I don’t think.”

Rhoads said no one close to him has died painfully and slowly.

“I hope to never want to use it. But I’d like to know it’s there if things get bad,” he said.

An almost overlooked aspect of the recent Hawaii survey, Rhoads said, is the percentage of people who do not want the government making decisions for them when they’re dying — 92 percent.

But Rhoads put the chances of passage in the Legislature in context.

“It’s hard to pass bills,” he said.

“That’s why 3,000 get introduced every year, and 300 get passed. (The Capitol is) a complicated building.”

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Even so, he said, “I think the building is way behind public opinion on this.”

Email Jeff Hansel at jhansel@hawaiitribune-herald.com.