We may not like to think about it, but one day, each of us will die. Thanks to the tools of modern medicine, we’re living longer than ever, but the fact remains that death is an essential part of life.
So, is it possible to have a good death? What would that look like to you?
The great majority of us would define a good death as painless and peaceful. We’d prefer to die at home, surrounded by loved ones. We want to be conscious until almost the very end, “with it” enough to make amends, say a loving farewell. Importantly, we’d like our survivors’ bereavement to be free from confusion, doubt and guilt.
Despite this, today in the U.S., 80% of us will die in acute care hospitals or nursing homes, often attached to machines or surrounded by bright lights and loud noises, having “lost our battle” with a terminal illness. Rather than allowing us to savor our last precious time on Earth, those same miracles of modern medicine that prolong our lives can needlessly extend suffering, resulting in final days of fear and pain.
Thankfully, end-of-life care is evolving. Hospice and palliative care are becoming more widely used in Hawaii, with excellent pain-management tools to address both physical and existential suffering. The field is increasingly focused on patient-directed care that honors family values and individual beliefs.
But while hospice may take away pain and anxiety and help people come to terms with death, it may not always succeed in preserving someone’s personal sense of autonomy and dignity.
This is when medical aid in dying (MAID) may be an option. Under the Our Care, Our Choice Act, MAID has been authorized in Hawaii since 2019. It gives terminally ill adults (six months or less to live) the ability to request a prescription for medication they can ingest to end their suffering peacefully, in their sleep, at the time of their choosing.
MAID is authorized in 11 U.S. jurisdictions, making it available to about 20% of Americans. It’s not for everyone — only a tiny fraction of dying people will ever end up using it. But for those who do, even just having the prescription on hand can bring peace of mind, enabling dying people to relax and live out their days to the fullest.
Accessing the Our Care, Our Choice Act is not easy. A qualified patient must make two verbal requests to their doctor, noted in their medical record and separated by a 20-day waiting period (the longest waiting period in the nation). A second doctor must attest that the patient is qualified, and a third practitioner must certify that the patient is able to make their own medical decisions and is not suffering from any untreated mental health issues.
While patients of Kaiser and Hawaii Pacific Health have an easier time thanks to those systems’ supportive policies, in rural Hawaii, including Hawaii Island, it’s still hard to find a provider willing to support a patient with MAID.
Compassion & Choices, the nation’s largest nonprofit advocating for greater end-of-life options, recommends talking to your providers now, before you become terminally ill, if you think you may ever want to consider MAID.
You can find excellent resources on how to initiate this conversation at https://www.compassionandchoices.org/.
Aubrey Hawk is communications officer for Compassion & Choices Hawaii.
This editorial is brought to you by Community First a 501 (c) 3 nonprofit founded by the late Barry Taniguchi. For more information, please visit our website at www.communityfirsthawaii.org or Facebook and Instagram pages at @communityfirsthawaii.
