In a recent study conducted by researchers at Stanford University and published in the Journal of Palliative Medicine, 76.5 percent of Hawaii residents surveyed support physician-assisted death.
This year in the Legislature, incoming Sen. Karl Rhoadsplans to propose a bill to legalize this action and join six other states (California, Oregon, Montana, Washington, Vermont and New Mexico) that already allow doctors to prescribe lethal doses of medication for the express purpose of allowing patients to end their lives.
Seventy-six percent of Hawaii residents — this seems like a much different story than in 2002, the closest the measure ever came to passing in the islands when it failed by only three votes. Now, four former governors have petitioned publicly to have this bill passed.
Could 2017 be the year that Hawaii passes a death with dignity bill?
I thought I would do my own firsthand research during Christmas dinner (perfect timing). There were eight people present, all residents or former residents of Hawaii. Average age: 67. Three men, five women. Six of the eight agreed that this legislation should be passed with no hesitation. Two had reservations.
Everyone agreed that if they were the patient in a situation where their lives were limited by a terminal illness, then they would want to have the option to receive a prescription from their physician.
However, three main issues caused hesitation in the two dissenting opinions regarding a proposed death with dignity law. These focused on incorporating the concept of religious objections, potential abuses of the law and our definition of the value of life, even for those with a terminal illness.
Religious beliefs are a personal issue for many who might otherwise support the death with dignity laws. California Gov. Jerry Brown admitted in a message that accompanied his signature on the bill that he, too, struggled with the religious implications of taking one’s own life but in the end felt he could not impose his personalbeliefs on anyone else.
Potential abuses of the law seemed to be the bulk of the discussion with several people wondering about how Oregon has dealt with this possibility. Since its inception in 1997, 1,545 patients have had prescriptions written for lethal doses of medication under the state’s Death With Dignity Act, and 991 patients have died from ingesting this medication.
Most had cancer (77.1 percent), although other diagnoses such as progressive neurologic disease (8 percent), respiratory illnesses (4.5 percent), heart disease (2.6 percent) and other medical conditions have been the basis of the terminal diagnosis.
Many people may not realize, but 90.5 percent of these people were already enrolled in hospice and felt this additional option was necessary. As hospice organizations are recognized as critical to the care of those in their final stage of life, this consideration of a bill to legalize aid in dying does not replace or negate any of their excellent work.
One of my dinner guests said that this past year, he lost his wife, who was dying of a progressive neurologic condition and hospice was involved, and he was given a prescription for his wife of morphine, which he was allowed to administer for relief of pain and any observed suffering that she was experiencing. He felt that having the hospice organization involved was essential to providing comfort not only to his wife, but also to himself as he dealt with the loss of his beloved.
Oregon has not had one report of any misuse of its aid in dying law. The option has been used by only 0.17 percent of the almost 600,000 people who died from 1998 to 2016. So the number of people for whom this might be utilized is very small.
The third concern brought up in my small survey related to the value of life. Those who have aterminal diagnosis can still lead meaningful lives, and in some cases, live years beyond their projected time of death, but may not choose to do so if they are given medication to die early on in their disease.
No one can predict the future, and without any perfect way to project how someone will do, there are always outliers of the expected medical course of disease, those who miraculously get better or live longer than expected. Could they be cheating themselves and their loved ones of time spent together by taking medication to end their lives prematurely?
That’s an argument that really can’t be won, but it does focus the attention back onto the individual. Doctors don’t choose when someone dies. Hospice organizations don’t either. Shouldn’t patients choose for themselves?
As a physician, I have taken an oath to do no harm, but in my mind, alleviating unnecessary suffering is not harmful. Some may argue that giving doctors the right to prescribe a lethal dose of medication is the antithesis of healing, but to others, providing medication for pain and suffering of any degree is consistent with the profession of providing aid to those in need.
And remember, there would be no requirement that all doctors would have to participate in such a system.
This coming legislative session, the question will be proposed once more. Will doctors be able to legally provide a prescription for lethal medication to those who choose to end their lives?
Provided all of the provisions for terminal illness are met, and patients are of full capacity when they request the prescription, I would hope that the residents of Hawaii have their voices heard and the bill passes, making 2017 the year we join the rest of the West Coast and others to legalize aid in dying.
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