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Hawaii likes to take its time resolving big social issues. It took 15 years, for instance, for it to legalize medical marijuana dispensaries and grow operations after first approving medical marijuana in 2000.
Likewise, marriage equality. Hawaii’s Supreme Court became the first court in America to declare a state ban on same-sex marriage unconstitutional, but it took two more decades before a state law passed guaranteeing gay and lesbian couples the right to marry.
Now comes another important issue, one under consideration in Hawaii since 1996 and being prepared for action in the 2017 legislative session: medical aid in dying.
Five states now legally sanction medical doctors putting lethal medication in the hands of terminally ill patients who have expressed their wish to avoid spending their remaining days in agony, as the process of dying runs its final course.
California became the most recent of those earlier this month; its law goes into effect in June. But it is a testament to the ongoing controversy of what was once called “physician assisted suicide” that after passing their legislation in March, California legislators had to call a special session just to agree on the new law’s enactment date.
Oregon was the first state to approve medical aid in dying. After the enactment of its law in 1997, 12 more years passed before Washington, via public initiative, and Montana, via court ruling, followed suit. Vermont’s legislature passed its measure in 2013.
Twelve states and Canada are now looking at some version of legislation to do the same: Alaska, Arizona, Massachusetts, Minnesota, Nebraska, New Hampshire, New Jersey, New York, Rhode Island, Tennessee, Utah and Wisconsin.
If this feels like momentum, there may be at least two reasons why.
• Oregon’s Growing Example. Oregon’s 19 years of experience with its groundbreaking law have been widely studied by academics, policy experts, physicians, patient advocates, journalists and others.
Perhaps the biggest takeaway is the fact that the option is used sparingly: Through the end of last year, a total of 1,545 terminally ill patients had been prescribed life-ending medication, but only 991 had used it, accounting for an average of 55 deaths a year. But patients who had received prescriptions felt more in control, less fearful and more at peace for their final passage, according to a study in the New England Journal of Medicine.
Isn’t that what each of us would wish if we were diagnosed with a degenerative illness that promises a slow, painful death for ourselves and agony for our families and friends — peace at life’s end?
• Brittany Maynard. The young California teacher was diagnosed with a malignant brain tumor in early 2014, less than a year and a half after she and her husband married. Facing terrible odds and the certainty of a horrible death, she and her family moved to Oregon to take advantage of its law.
Along the way, she resolved to be an advocate for medical aid in dying.
That advocacy included sharing her story publicly, and as she did so in the fall of that year, the reaction was enormous and largely positive. A People magazine profile drew 16 million unique visitors. Her YouTube videos totaled more than 17 million views. Those and many other retellings of her story helped grow a consensus in California that its residents deserved better than the choices that state had provided Maynard.
Perhaps the biggest challenge in fostering reasonable consideration of medical aid in dying laws is helping the public and lawmakers understand exactly what the process is — and isn’t.
Often confused with euthanasia — the act of killing someone painlessly to prevent suffering — or “pulling the plug,” the crass term for stopping life support measures for a patient who in a persistent and irreversible vegetative state, medical aid in dying is characterized by multiple safeguards to ensure the patient’s condition is hopelessly terminal and his or her wishes are certain.
Such laws only apply to mentally competent individuals with terminal illnesses and a prognosis of six months or less to live. They require patients to be fully informed of all options, and they must request their life-ending medicine themselves from their physicians, free of coercion or undue influence. They also must be able to take the medicine themselves, without assistance.
The laws require the physician to provide multiple opportunities for the patient to change his or her mind. And at least two witnesses must attest that the patient’s request is voluntary.
Those thoughtful requirements have created a new environment around end-of-life considerations in the states that have them, none more so than Oregon. Research shows that violent suicide among terminal patients in that state has all but disappeared. The state’s in-hospital death rates are the nation’s lowest, and its at-home death rates, the highest, according to the chief advocacy group for medical aid in dying, Compassion and Choices.
Those are benefits that might have accrued to patients and families in Hawaii, had the recommendation of a blue ribbon panel created by Gov. Ben Cayetano in 1996 been followed. The group’s report was issued only a few months after Oregon’s medical aid in dying law went into effect.
All but one of the Cayetano panel’s recommendations to improve end-of-life decisions in our state have been implemented. Medical aid in dying has been considered in numerous legislative sessions, coming as close as three votes shy of passage in 2002. But despite state and national polls indicating strong majority support for such legislation, staunch opposition from some faith-based groups has consistently stopped the measures cold.
Advocates say supportive legislators believe 2017 bodes well for the cause, and education efforts are underway in the community to create an environment of support. Compassion and Choices’ Hawaii chapter will hold a discussion Tuesday in concert with the Interfaith Alliance, for instance, to give religious leaders an opportunity to talk story, raise concerns and have questions answered.
Twenty years after the matter was first seriously raised in Hawaii, this is a conversation that feels ready to be brought to fruition. Legislators and candidates for the House and Senate should be prepared to move this matter forward come January.
Those in the remaining pockets of opposition, meanwhile, should consider perhaps the most relevant question left in this debate: Though medical aid in dying might not be an option they’d consider for themselves, shouldn’t it be available for those terminally ill patients, whose consultations with physicians, clergy and family make clear that it’s the best choice for them?