In 2002, the Hawaii Legislature fell three votes shy of passing a bill to allow terminally ill, competent adults to obtain a prescription medication to end their lives.

Donna Mercado Kim and J. Kalani English were among the 14 senators opposed. Both voted for a similar measure, House Bill 2739, that passed the Senate overwhelmingly on Thursday.  Gov. David Ige has said he will sign it into law.

Views change over time, shaped by personal experiences, public opinion, conversations with constituents and stronger legislation, according to interviews with lawmakers and others who have been tracking the issue for years.

Senator Donna Mercado Kim during floor session.
Sen. Donna Mercado Kim, seen here on the Senate floor Tuesday, said she sees more people coming to support medical aid in dying as Hawaii’s population ages and more people face end-of-life decisions. Cory Lum/Civil Beat

“I think more and more people are coming to terms with it,” Kim said Wednesday. “As the population ages, they’ve been caregiving for their parents and relatives and just seeing all the technology to keep people alive, unlike before, and see people suffering.”

Sen. Will Espero also voted against the bill 16 years ago. At the time, he was a member of the House, which passed it 30-20. Now, he supports medical aid in dying.

The only person still in the Legislature whose views have not changed to support doctor aid in dying since the 2002 bill is Rep. Bob McDermott, a conservative Republican in the Democrat-dominated Legislature.

For Kim, it was the additional safeguards that won her over.

“I’ve kind of always been for it,” she said, adding that she voted against the 2002 measure because of concerns about misuse. “I don’t want to suffer and I don’t want anyone else to suffer. So this time around I asked the proponents to try to put more safeguards in it. It’s not perfect.”

For others, it’s been more of an “evolution.”

Rep. John Mizuno, who was elected in 2006, shepherded the measure this year as chair of the Health and Human Services Committee.

But he wasn’t always a supporter, let alone a staunch advocate.

“I think we’ve evolved, as a people,” he said Tuesday. “I evolved, I prayed upon it, I looked at the civil rights movement.”

Powerful Personal Stories

There were also two key conversations that led to his change of heart.

One was with John Radcliffe, a well-known lobbyist who became the self-described poster child for the issue last year. Radcliffe, who has terminal cancer, brought political weight and the tale of his own suffering, which include dozens of chemotherapy treatments.

Mizuno said he and Radcliffe are close, even if they have not always agreed over the years.

“He called me and used his beautiful adjectives: ‘You’re the blank-blank chair of the Health and Human Services Committee; you have the authority and ability to do this,’” Mizuno recalled. “He didn’t mince words. I truly respect John Radcliffe. He had a profound effect on me.”

Rep John Mizuno introduces guests in the gallery during floor session on March 21, 2018.
Rep. John Mizuno said conversations with constituents, family members and lobbyists led him to support medical aid in dying legislation. Cory Lum/Civil Beat

The other conversation was with Lucien Wong, a retired real estate development executive, who was a novice to the inner workings of the legislative process. 

Wong talked to Mizuno three years ago in his Capitol office soon after his wife died of cancer, sharing a powerful story about his wife Margaret’s dying wish “to go quickly.”

It was the only time they met, but it stuck with them both.

In 2015, Mizuno was vice speaker of the House and held no committee chairmanships. His focus was on keeping the Democratic caucus happy and putting out fires, which was little help to Wong’s newfound cause.

But Mizuno knew he had an opportunity to bring the issue forward this year when he was appointed as a committee chair. In January, he got the go-ahead from House Speaker Scott Saiki to hear a medical aid in dying bill this session.

Mizuno had introduced his own legislation, which he said went a little overboard with safeguards. He ultimately heard the bill put forward by Majority Leader Della Au Belatti, which he said would still provide more protections against abuse than the six other states that allow medically assisted death.

“We changed the whole mindset.” — Rep. John Mizuno

Last year, Belatti killed a similar measure when she was Health Committee chair. It had cleared the Senate by a 22-3 vote but she said there were concerns about insufficient safeguards.

This year’s bill adds more layers of protection, such as a consultation with a counselor and a longer waiting period between asking for the lethal medication and taking it.

‘A Matter Of Choice’

Mizuno, a devout Christian, represents Kalihi, which is predominantly Filipino and Catholic. Polls have showed both groups, which overlap to a large extent in his district, are more likely to oppose medical aid in dying than other ethnic groups or religions.

The Catholic Church has constantly opposed aid in dying measures and showed no signs of shifting its position this year. Church officials said it gives youth the wrong impression about suicide.

Mizuno has faced criticism over his position but said it’s been surprisingly minimal. Some angry emails and a “hate call” but nothing compared to the backlash lawmakers faced in 2013 when they passed the marriage equality bill. That’s another issue that many, including Kim, who voted against it, have come around to support.

Lucien Wong Lucien Wong

The name of the bill — Our Care, Our Choice — was deliberately chosen to help assuage criticism from certain sectors, Mizuno said.

Past bills have been labeled “physician-assisted suicide,” “euthanasia” and “death with dignity.” But each one eventually sputtered out, if it was taken up at all.

“We knew we had to brand it as civil rights,” Mizuno said, adding that otherwise lawmakers would get slaughtered by religious and disability groups. “We changed the whole mindset.”

He was influenced by the landmark 1954 segregation case, Brown v. Board of Education; the 1965 Voting Rights Act, about equal rights to the ballot box; and the 1973 abortion case, Roe v. Wade.

“Those are things that started to change the tide for me,” Mizuno said. “Nationally, this is a defining civil rights struggle. To my Christian brothers and sisters, I can defend it.”

He described the Catholics in his district and dozens, if not hundreds, of others who have come out against physician-assisted dying on religious grounds as “kind” and “loving” people. But he said even some Catholics are breaking with the church.

“I tried to look through scripture and even if you talk about Jesus suffering on the cross, the Lord took him early,” Mizuno said. “That’s compassionate care.”

Kim, a practicing Catholic, said there are a number of churches in her district, which includes portions of Kalihi, Aiea and Moanalua.

“As a legislator I’ve always said I have to put my personal beliefs aside,” she said, adding that she’s had several emails, but not a huge outpouring, from upset constituents.

Wong, who is Catholic, said he confronted that issue when his wife got sick with bile duct cancer, a side issue he’s pushing in the Legislature to try to secure research funding.

“I know the Catholics were very much opposed,” he said. “But I don’t know why they couldn’t see this as a matter of choice — and only with the safeguards.”

Wong said his wife’s final wish was to go quickly but that he could not legally do that. 

Still, Wong said he considered taking the matter into his own hands.

“My oldest daughter was with me and she said, ‘If you do, I’ll not only lose Mom but I’ll lose you. You’ll end up in jail,’” he said.

John Radcliffe seated SB1129 Death Dying measure in Capitol room 229. 15 feb 2017
John Radcliffe, testifying last year on a medical aid in dying bill, didn’t mince his words when urging Rep. John Mizuno to hear the bill this session. Cory Lum/Civil Beat

His wife’s next question was if she could not die quickly, how would she die? Wong said he knew the answer was by dehydration, by hunger or by another sickness since her immune system was compromised. But he did not have the heart to tell her. A doctor eventually did.

“She didn’t want me to sugarcoat it, which I probably would have,” Wong said. “It was this experience that launched me on my campaign to change the law in Hawaii.”

He’s still relatively new to the legislative process but not naive. He understands there are political undercurrents and other factors lawmakers are weighing in their votes.

“But if you have a cause, and you have a story to tell that’s believable and people on the other side are compassionate and willing to listen and educate themselves, I think there’s a good chance it will move,” Wong said.

Mizuno said he appreciates that people like Wong and Radcliffe help him and his colleagues better understand how these issues personally affect individuals.

He said his journey to supporting medical aid in dying ultimately led him to believe that government needed to get out of the way. Passing this bill was the way to do that.

“Who am I to stand between you and your god?” Mizuno said.

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