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Physician-assisted suicide, death with dignity, medical aid in dying. Whatever it’s called, the Hawaii Legislature has tried and failed for two decades to pass legislation that would give terminally ill adults the legal ability to end their lives with drugs prescribed by a doctor.
After coming close last session, supporters are prepared to try again. They have popular opinion on their side, the experiences of other states to learn from and new bills with new names — “voluntary assisted dying” and “our care, our choice” — that were introduced earlier this month.
“It’s time,” said Sen. Karl Rhoads, who introduced a measure last year that sailed through the Senate but stalled in the House. “We’re behind the electorate on this issue.”
The traditional thinking would be that it’s too controversial to pass in an election year. All 51 seats in the House are up this fall along with half of the 25-member Senate, which is entirely Democratic. There are five Republicans in the House.
But with recent polls showing nearly two-thirds of Hawaii voters in favor of medical aid in dying, advocates and some lawmakers said this could be the year.
“The political risk is not passing it, especially if you’re a Democrat and you have a primary,” Rhoads said.
If approved, Hawaii would become the seventh state to legalize it. Two dozen other states are considering similar legislation.
The bill Rhoads introduced last session, which is still alive, was modeled after Oregon’s law. It fizzled in the House health committee, chaired at the time by Rep. Della Au Belatti, who had concerns about sufficient safeguards.
The decision to defer the measure spared the full House from having to vote on it. Most members remained silent last year when Civil Beat called to find out where they stood on the issue.
But Belatti, now majority leader, has put forward a new measure this year, modeled after California’s law. It’s basically the same as the amended version of Rhoads’ bill.
It requires confirmation by two health care providers of the patient’s diagnosis, prognosis, medical competence and voluntariness; two oral requests by the patient, at least 15 days apart; one written request, signed by two witnesses, at least one of whom is unrelated; and a 48-hour waiting period after making the written request. The patient also must have fewer than six months to live in order to qualify.
One key difference is the “form of final attestation,” which the patient must sign when the provider writes the prescription for the lethal drugs. The form acknowledges the diagnosis, prognosis and nature of the medicine being prescribed. It requires patients to initial whether they have informed their family or not, and must be completed at least 48 hours before self-administering the drugs.
Rhoads’ bill requires a similar form to be signed by the patient, but it is part of the initial written request.
Aside from that difference, Belatti said Tuesday that some of the safeguards contemplated in her bill include better record-keeping by the Department of Health.
She said the other thing that’s changed from last year is California has had a year’s experience with its end-of-life options act, giving Hawaii lawmakers an opportunity to learn more from that experience.
Advocates aren’t sure why lawmakers don’t just pick up where they left off last session with Rhoads’ bill. They point at how it could be amended, if necessary, and then moved to the House floor for a final vote. The Senate could then just agree to any of the changes or negotiate the differences in conference committee.
Belatti said the House decided it wanted several options on the table.
“We wanted to make sure all of our bases were covered,” she said, adding that there is a new house health committee chair and new Senate judiciary committee chair who will be reviewing the bills.
Rep. John Mizuno, the new health committee chair and de facto gatekeeper of the medical-aid-in dying measures this session, introduced a similar bill but with more restrictions. His legislation requires a 20-day waiting period between the oral requests, and the patient could have only three months or less to live.
Both bills were referred jointly to Mizuno’s health committee and Rep. Scott Nishimoto’s House judiciary committee. That could be an indicator that the House wants the bill to make it to the floor for a vote sooner rather than later since it would take longer to go through each committee separately.
Belatti’s bill is expected to be the vehicle, though. There are concerns from advocates about Mizuno’s bill being overly prescriptive, to the point it would make it difficult for some people to take advantage of the law. Belatti’s bill has support from Nishimoto and House leaders, including Speaker Scott Saiki and Finance Chair Sylvia Luke. It’s also co-sponsored by Reps. Mark Hashem, Nicole Lowen, Dee Morikawa, Gregg Tayayama, Chris Todd and Nishimoto.
Aubrey Hawk, communications officer for Compassion & Choices Hawaii, said the nonprofit advocacy group will push for a bill that it thinks provides transparency and has sufficient safeguards based on the experiences of the several other states that have already had this law in place.
“While there are different bills introduced, as well as those from last session still around, we want to see the Legislature keeps its options open because there are different ways in which to approach this issue and we would like to have a full discussion take place,” she said.
Belatti said it’s too early in the session to know when the bill might get a hearing or its chances of passage.
“We’ve got a lot of bills to consider,” she said.
Saiki said it was important for the House to address concerns from last year about the safeguards.
“We’ll see what happens,” he said, giving the measure a 50-50 chance of passage. “My style is I really don’t want to create false expectations because I know this is an important topic for the general public. I’ve asked that we not rush on this issue because the consequences of bad legislation are very significant.”
Rep. Richard Creagan, a physician who co-introduced a separate “voluntary assisted dying” measure with Rep. Cindy Evans and 14 other House members, said he does not have a preference on which bill passes so long as the Legislature finally acts this year.
He said the Hawaii Medical Association’s neutrality on the issue is important, noting how a similar shift in California’s chapter helped create that law.
Doctors’ views in general have shifted, rising to 57 percent in support in 2016 from 46 percent in 2010, according to a Medscape survey.
Creagan estimated about three-fourths of the House supports medical aid in dying. He gave the Legislature an 80 percent chance of passing it this year.
“This isn’t suicide,” he said. “This is wanting to leave this Earth peacefully. We don’t want to make people shoot themselves if they want to die.”
Walter Yoshimitsu, executive director of the Hawaii Catholic Conference, the public policy voice of the Roman Catholic Church in the state, said additional safeguards will not change the church’s opposition.
He said he was surprised when he heard lawmakers were going to take up the issue again this year and sees it as a political gamble.
Yoshimitsu said lawmakers can call it whatever they want, it’s still physician-assisted suicide. And he views that as inconsistent with the state’s efforts to reduce suicide in Hawaii.
“It gives the wrong message to the young people and others that it is OK,” he said.
A Civil Beat Poll in late November found 63 percent of Hawaii voters supported legalizing medical aid in dying, with 22 percent opposed, 9 percent unsure and 6 percent not caring either way.
Support was weakest among Hawaii’s predominantly Catholic Filipino population, which polled at 47 percent in favor, 24 percent opposed and 21 percent unsure. Caucasians and Japanese, two other large population segments in Hawaii, each had at least 70 percent support.
The Hawaii Catholic Conference was one of several faith-based and conservative groups to testify against the bill last year. The Hawaii Family Forum, headed by Eva Andrade, strongly pushed for the bill’s defeat, calling suicide “contagious” and questioning the record-keeping and transparency in the reporting by physicians.
There were hundreds of pages of testimony throughout the process, including impassioned pleas from liberal groups and the Democratic Party. John Radcliffe, a longtime lobbyist who is dying of cancer, became a key supporter.
Peg Sandeen, executive director of Death with Dignity, a national nonprofit that advocates for medical-aid-in-dying laws, said Hawaii will be among the next few states to pass a bill.
“We’re exceedingly excited about Hawaii,” she said. “There’s so much public support.”
Like others, she was a bit flummoxed by lawmakers introducing new measures this session when they have a bill in the House that’s already cleared the Senate.
“They all accomplish the same thing,” Sandeen said, noting how they have narrow standards for people to qualify, adequate safeguards and protections for people from coercion.
Politically, she said Vermont was in a similar position as Hawaii before it passed a death-with-dignity bill in 2013. Public support was strong and it became a campaign issue for Democrats in the primary.
Sandeen, and other advocates and lawmakers, said that could be why Hawaii is seeing new bills introduced this session as lawmakers look to take credit for writing the law and supporting its passage.
Rhoads said his preference would just be to pick up where lawmakers left off last session as the most expedient way to pass the bill. But he said if the House sends over a new bill to the Senate, he expects it to pass.
“This doesn’t cost anything. It’s something very popular. So why not do it?” he said.