The Our Care, Our Choice Act gives Hawaii’s terminally ill patients another option to avoid suffering and die peacefully on their own terms. The law authorizes medical aid in dying, or MAID, and now it’s easier to access.
Let’s back up a few years. The OCOCA took effect in 2019, making Hawaii one of the now 11 U.S. jurisdictions that authorize MAID.
MAID is a standard medical practice in which an adult with a prognosis of six months or less may obtain a prescription for life-ending medication they can take to end suffering at the time and place of their choosing.
Almost immediately, patients and providers realized that the OCOCA, with its 20-day waiting period and limited pool of providers, would be too difficult for dying people to access. According to Kaiser Permanente and Hawaii Pacific Health, 25% to 30% of their patients who wanted this option suffered and died during the waiting period. Patients in rural areas, or who were not affiliated with Kaiser or Hawaii Pacific Health, were having trouble finding a supportive provider at all.
Thankfully, lawmakers like state Sen. Joy San Buenaventura and state Rep. Della Au Belatti had the compassion and courage to pass an OCOCA improvement bill this session. It took effect immediately upon Gov. Josh Green’s signature on June 2.
Now, in addition to MDs, qualified advanced practice registered nurses can prescribe. The waiting period has gone from 20 days to five and can even be waived if the provider determines that the patient won’t survive it.
All eligibility requirements remain in place, and qualifying is still by no means an easy process. To use the OCOCA, a patient must be an adult resident, have a six-month prognosis, and be capable of making their own medical decisions.
They must be able to self-ingest the medication, which is what differentiates the practice from euthanasia. They must consult with three providers: an attending, a consulting, and a mental health provider. They must provide two oral requests and one written request, which must be signed by two witnesses, one of whom is not a beneficiary.
In short, no one will be making this decision lightly.
Most private insurance and Medicaid cover the cost of medication and provider consultations, which can be conducted via telehealth. Medicare and the VA do not cover MAID. Out-of-pocket costs can be $500 for medication alone.
There is no official list of providers — any Hawaii MD or authorized advanced practice registered nurse is legally allowed to support their patient wishing to access this end-of-life option. No special training is required, but if a provider would like to consult with an experienced prescriber, they can call Compassion &Choices’ “Doc-2-Doc” line at (800) 247-7241.
Medical aid in dying is not for everyone. In fact, of Hawaii’s approximately 11,000 annual deaths, only about 40 people per year elect to use MAID. Just knowing the option is available can be a great comfort. Even if you’re not terminally ill, if you think you might want this option for yourself someday, it’s important to start talking to your providers now.
For detailed information on the OCOCA, visit https://health.hawaii.gov/opppd/ococ/. For tips on how to talk to your provider about your end-of-life choices, visit www.compassionandchoices.org and click on “Resources.”
Aubrey Hawk is the Hawaii communications officer for Compassion &Choices.
This editorial is brought to you by Community First Hawaii a nonprofit serving as a convener and catalyst for solutions to improve health and access to health care. For more information, please visit our website at www.communityfirsthawaii.org or Facebook and Instagram pages, @communityfirsthawaii.