In a text message to his oncologist, John Radcliffe on Wednesday initiated a historic request for a lethal prescription drug that will allow him to die in his sleep.

And with that, the longtime Honolulu lobbyist, who has an incurable cancer, became Hawaii’s first acknowledged medical aid in dying applicant.

“I consider it fulfilling a job — get the law passed and see if it works,” said Radcliffe, who aggressively lobbied state lawmakers to pass the landmark legislation in 2018. 

Already Radcliffe, 76, has lined up a required trio of medical professionals who will help him fulfill his request. And he plans to chronicle going through the rigamarole of paperwork and procedures required to receive a prescription for the lethal drug.

“I intend to go through the process and tell people as I go that it’s not difficult,” Radcliffe said at a press conference Wednesday organized by Compassion & Choices, the primary advocacy group behind the new law.

“Apart from gratitude for an absolutely gorgeous life, the biggest emotion I feel is a desire to be useful as long as I can.”

Law Beset By Hurdles

Modeled after Oregon’s 20-year-old “Death with Dignity Act,” Hawaii’s “Our Care, Our Choice Act” kicked into effect on New Year’s Day, allowing terminally ill patients a measure of control over their final days. Qualifying patients must be mentally competent and expected to live six months or less.

The law leaves room for individual doctors, nurses and pharmacists, as well as entire medical organizations, to decide based on their own moral values whether they wish to participate in fulfilling a patient’s request for aid in dying.

Although most medical facilities and hospice groups have indicated they will implement neutral policies around this end-of-life option, some have forbidden their staff from taking part in the new law. State health regulators and advocates are preparing to troubleshoot myriad barriers to patient access.

“Two weeks ago, my neighbor shot himself. He didn’t have this option yet.” — State Health Director Bruce Anderson

On paper, approval for a medical aid in dying application can be granted in as few as 21 days. But the process is expected to take much longer than that, at least at first, due to the current unavailability of the drug on the shelves of local pharmacies, a statewide shortage of psychiatric professionals available to conduct a required mental competency exam and other factors.

During the press conference, state Director of Health Bruce Anderson acknowledged problems with the law’s implementation. He asked the public and prospective patients to be patient as the system irons out the kinks in the process.

Then he flatly stated his case for the law’s importance.

“Two weeks ago, my neighbor shot himself,” he said. “He didn’t have this option yet. He had Stage 4 cancer. I wish he had hung in. He really needed to know about this law.”

‘A Done Deal’

It’s been more than four years since a fainting spell and unceasing exhaustion led Radcliffe to a Stage 4 colon cancer diagnosis.

Since then, the cancer has retreated from his colon, taking up residence in his liver and lungs.

He has endured 71 rounds of chemotherapy. It is impeding the disease’s progress, but for a hefty cost: nausea, anxiety, weight loss and countless days in bed at the Honolulu condominium he shares with his wife of 57 years.

In spite of his degrading health, Radcliffe last year successfully helped lobby state lawmakers to pass the controversial medical aid in dying legislation.

This was likely his last feat as a prominent fixture of the Capitol, first as a teachers’ union executive and more recently as a lobbyist for tobacco, liquor and gambling interests. 

Now he has become the first Hawaii resident to initiate the multi-step application process. That process, which state health regulators acknowledge to be imperfect, hinges on advanced coordination from doctors, nurses, psychologists, pharmacists and coroners. 

“I consider it fulfilling a job — get the law passed and see if it works.” — John Radcliffe 

Radcliffe said he doesn’t plan to end his life as soon as he receives the medication. Rather, he wishes to have it on hand so that he can assert a small amount of control over the suffering he expects to experience during his final days.

“The first question for me was, ‘Do you believe the doctor?’” he said. “Well, yeah, I do. Now the question is, ‘Do you want to suffer?’ And I don’t want to suffer. I’ve seen it, I’ve been doing it and I don’t like it.”

Radcliffe doesn’t want to die. But he’s accepted his doctors’ judgment that death is imminent.

His plan is simple: If the pain of his disease becomes too great to bear, he will swallow the pills.

“I know you’re supposed to go through the five stages of grief and all that,” Radcliffe said. “But I can’t remember going through negotiations with anybody over a done deal.”