Civil Beat recently published a Community Voices article by Dr. Charles Miller called “Aid-in-Dying is Not Assisted Suicide.” In his article, Dr. Miller, founder of the Physician Advisory Council for Aid in Dying (PACAID), promotes what he euphemistically calls “aid-in-dying” in lieu of the generally accepted term “assisted suicide.”

Groups like PACAID attempt to obfuscate the moral and legal issues surrounding assisted suicide in Hawaii by using the euphemism “aid-in-dying.” However, the real meaning of this term becomes clear by an understanding of the group’s mission, which is to promote physician involvement in hastening patients’ deaths, such as through issuing a prescription for lethal drugs.

Discontinuing care that would otherwise extend a patient’s life is vastly different than taking affirmative steps to end life. Patients legitimately have the right to make end of life decisions such as when certain medical interventions are no longer appropriate. This is legal and presents no ethical dilemma. As a skilled home health and hospice caregiver, the notion that any care provider has a role to play in helping people take their own lives is offensive.

The primary purpose of a caregiver is to offer “safe” and specialized comfort care, working with patients and their healthcare teams to ensure pain control is managed with the utmost attention and effort. The solution is expanding and improving pain alleviation that enhances quality of life. My many years of experience show that virtually everyone who expresses a desire to die (which is a very small number) wants to live once the care team delivers exceptional, compassionate care.

Allowing or even requiring care providers to comply with requests for suicide opens the door to abuses of the worst kind and creates a bioethical dilemma for those who pledge to respect human life and dignity. It fails to address the underlying cause of suicidal ideation, which is clinical depression. Giving up on depressed people, even those at the end of life, is not, as Dr. Miller states, “an extension of compassionate medical care.”

It is absurd to think we can devalue vulnerable people like the elderly, disabled, or seriously ill because of any underlying condition by conveniently taking away their right to complete their lives naturally. I have witnessed hospice patients who recovered and returned home with family. The fact is that many people have lived years after they’ve been given a terminal illness. So far, state law has prevented them from being coerced into choosing death over life at a time when they would be susceptible to pressure or persuasion.

Dr. Miller’s article implies that “achieving a peaceful death” means taking action intended to cause patient death. I believe that achieving a peaceful and dignified end means delivering loving, compassionate, and appropriate care that addresses a patient’s physical, emotional, and spiritual needs until the natural end of life. It means collaborating with patients and their loved ones to respect their end of life decisions, including the decision to withhold care that would artificially prolong life and the choice to take only comfort care.

In today’s climate of unprecedented public debt, economic uncertainty, and the ever-present threat of budget cuts, legalization of assisted suicide (aka “aid-in-dying”) in Hawaii would create a climate in which vulnerable people succumb to real or perceived pressure of a duty to die. Choice quickly becomes illusory. Rather than looking for ways to artificially hasten death, let us take the moral high ground and show true compassion by redoubling our efforts to provide to the dying the reassurance of caring human companionship and a safe harbor of benevolent care until the natural conclusion of life.


About the author: Janet Grace has been a private certified nurse assistant in Hawaii for the past 15 years and is skilled in advanced home health care. She was a volunteer member of the “Peg’s Legs” caregiving team to late Hawaii artist Peggy Chun.

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