This could be the year for the Hawaii Legislature to legalize medical aid in dying for terminally ill adults after more than 20 years of advocates urging lawmakers to take action.
Two House committees passed a bill to do so Wednesday, which sends it to a vote by the full House next week — the first time all 51 members will have taken it up since 2002. From there the measure would head to the Senate, which passed a similar bill with overwhelming support last year. Gov. David Ige has signaled his intention to sign it into law if it reaches his desk.
Republican Reps. Bob McDermott and Andria Tupola cast the lone “no” votes. McDermott said he was not even provided a copy of the amendments prior to the vote.
The Judiciary Committee passed it 7-1, with “aye” votes from Chair Scott Nishimoto and Reps. Joy San Buenaventura, Tom Brower, Chris Lee, Dee Morikawa, Gregg Takayama and Cynthia Thielen, the only other Republican on the committees.
The Health and Human Services Committee voted 4-1. Chair John Mizuno and Reps. Bert Kobayashi, Della Au Belatti and Lei Learmont voted in support.
House Bill 2739 Safeguards
Must be a Hawaii resident
Prognosis of six months or less to live
Diagnosis of a terminal illness
Mentally capable of deciding
Confirmation by two health care providers of the diagnosis, prognosis, medical competence and voluntariness of the patient’s request
Two oral requests, separated by 20 days
One written request, witnessed by two people (one not related to the patient)
One counseling session with qualified person (telehealth allowed, such as by phone or Internet technologies)
Patient must self-administer the lethal drugs
48-hour waiting period between written request and making the prescription available
Belatti did the “heavy lifting” on the bill, Mizuno said, amending it in a way that the committee members would pass. The changes included additional safeguards to protect against abuse.
“We’ve come up with a bill that I believe is balanced,” Nishimoto said. “It’s one that I’m extremely comfortable with.”
The full House is expected to vote on the bill Tuesday, Mizuno said.
Retired nurse Malachy Grange, wearing a yellow shirt in solidarity with supporters, said lawmakers were “very wise” to pass the bill and he was fine with the changes.
“People have looked at this for a while and come to the conclusion that this is a choice that should be available to all people,” Grange said, adding that as a hospice volunteer in Oregon he saw firsthand the benefits of such a law.
Nanakuli resident Tarita Tehotu said she was happy more safeguards were added, but was still opposed.
She said as a kanaka maoli, a native of Hawaii, she rejected people from other states like Oregon or California — whose laws were used as a model for Hawaii’s bill — coming in and pushing for the legislation.
“What message are we going to give our next generation?” Tehotu said, likening medical aid in dying to suicide. “This is to me another form of annihilation of our people.”
“We look forward to working with the Legislature to expand end-of-life care options for terminally ill kamaaina to give them and their families peace of mind,” said Aubrey Hawk, spokeswoman for Compassion & Choices Hawaii.
Last year, Civil Beat called all House members asking where they stood on the issue but most would not say. Lawmakers have said privately that they expect the bill to clear the House next week, but there will be opposition.
Mizuno said this is one of the most controversial issues he’s seen the House take up in an election year. All 51 House posts are up for election this fall, though many seats have historically been easy for incumbents to keep with little or no opposition.
Hawaii would join the District of Columbia and five other states — California, Colorado, Oregon, Vermont and Washington — in legalizing some form of doctor-assisted death.
Mizuno said Hawaii’s law would be one of the most stringent. The changes to the bill included removing a provision that would have allowed nurses to prescribe the fatal drugs and a section that would have let doctors help administer it. Under the amended version, the patient must self-administer the lethal dose.
Mizuno said allowing doctors or others to help administer the fatal drugs is a “slippery slope” and difficult to handle legally. Doing so is technically manslaughter so the law would have to make an exemption, he said.
The committees also added another hurdle before a patient could receive the prescription. Aside from needing two medical providers confirming the terminal diagnoses, the six-months-or-less-to-live prognosis and medical competence, the patient must also undergo counseling by a doctor, psychologist or psychiatrist, but could do so by phone.
Hawaii would be the first state to require counseling, Mizuno said. He added that the tele-health provision would help make it easier for residents in Hawaii to comply with the counseling requirement, recognizing that some live in rural areas far from doctors.
The committees also lengthened the time the patient must wait between making two verbal requests for medically assisted death. Instead of 14 days, the amended version now calls for 20 days. One signed written request, witnessed by two people (one unrelated to the patient), is also required.
McDermott, one of the two committee members to vote against the bill, was not provided a copy of the amendments prior to the hearing.
“I don’t know what we’re voting on,” he said as Nishimoto called for the vote.
Nishimoto said that given the time constraints, working on changes to the bill up until 15 minutes before the hearing started, he did not have an opportunity to give McDermott a copy.
“Pass it then read it,” a member of the public shouted out sarcastically.
Tehotu said after the hearing that she found it “heartbreaking” that McDermott had to vote on something without even seeing a draft.
Belatti read quickly through the amendments at the beginning of the hearing but copies were not distributed. Civil Beat has requested a copy.
Tupola said in a release after the hearing that she was too was frustrated by not receiving the amended version before the vote. She said during the hearing that she appreciated all the changes made to the bill, but still opposed it.
“This is a work in progress,” Kobayashi said. “We’ve tried our best I think within a certain time limit. If it goes over to the Senate, they will look at it and agree or perhaps improve what we have given them.”
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