When 2019 begins, so too will a new law authorizing health care providers to supply terminally ill patients with life-ending medication.
To prepare residents and health care providers for the new law, Compassion and Choices Hawaii — a nonprofit dedicated to raising awareness about end-of-life options — hosted a series of presentations around the Big Island this week.
Samantha Trad, access campaign director for Compassion and Choices, explained to dozens of gathered residents Wednesday what the Our Care, Our Choice Act — the name for House Bill 2739, which Gov. David Ige signed in April — will mean for those seeking end-of-life care.
“Show of hands, how many people here will die?” Trad asked the audience, most of whom raised their hands. “Now, how many of you would like to die peacefully?”
Trad explained the Our Care, Our Choice Act will provide medical aid in dying, a practice that allows terminally ill patients to choose to end their lives using a medical prescription that causes painless unconsciousness and death within one to two hours.
Medical aid in dying, Trad said, is legally distinct from euthanasia in that the final act is carried out by the patient, rather than another. It also is distinct from suicide or assisted suicide, as the choice is not between life and death, but between death and another, more painful death, she said.
Because only terminally ill patients with six months or less to live are eligible for medical aid in dying, their terminal disease is still officially recognized as their cause of death, Trad said, explaining that the patients only choose to die because of the disease that is guaranteed to kill them eventually anyway.
Of course, Trad said, the prescription “isn’t one you can pick up in an hour.”
The Our Care, Our Choice Act is modeled after a successful law in Oregon that legalized medical aid in dying 20 years ago — without any reported cases of abuse or coercion — but is actually more stringent in ensuring eligibility requirements.
Hawaii patients seeking medical aid in dying must submit two oral requests for aid at least 20 days apart, submit a written request signed by two witnesses testifying to the patient’s mental competence, obtain confirmation from two doctors that he or she is terminally ill with six months or less to live, obtain confirmation from a psychologist or psychiatrist of his or her mental competence, and must be able to self-administer the medication.
Two of those requirements — the 20-day wait limit and the psychologist examination — are unique to the Hawaii law, Trad said.
State Rep. Joy San Buenaventura, D-Puna, one of several lawmakers in attendance, said the state wants to ensure that Hawaii isn’t the first state to see a report of abuse or coercion in a medical aid in dying case.
Because of a prohibition on using federal funding on medical aid in dying, Medicare and Medicaid cannot be used to pay for life-ending medication. However, Trad said most private insurance providers can cover medical aid in dying, and added that there are two commonly used medications, one costing about $3,000 and the other costing $400.
Because the law has not yet gone into effect — it begins Jan. 1, 2019 — a full list of health care providers who will prescribe aid in dying medications has not been compiled, Trad said.
However, representatives of several Hawaii health care organizations, including North Hawaii Hospice and Hawaii Care Choices, were in attendance during the presentation and verbally confirmed their intentions to support patients seeking medical aid in dying.
Lorrin Kim, chief of the state Department of Health Office of Planning, Policy and Program Development, said his office is working with doctors throughout the state to educate them on how to operate with the law. Doctors are required by law to inform patients of all end-of-life options available to them, even if the doctors themselves decline to provide some of them.
“This definitely isn’t a standard practice,” Kim said, adding that his department has to put together necessary forms and educate law enforcement officials to not treat medical aid in dying cases as crime scenes.
However, Kim acknowledged that medical aid in dying cases likely will not be common in Hawaii.
Oregon, with a population of 4 million, sees roughly 2,000 prescriptions filled each year — which only about 65 percent of patients actually used, Trad said. Hawaii, with a much smaller population, might see a couple of hundred cases “if it’s a busy year,” Kim said.
Email Michael Brestovansky at mbrestovansky@hawaiitribune-herald.com.
