Like other states, Hawaii is ready for medical aid in dying

As a registered nurse who has practiced for over 30 years in Oregon and seven in Hawaii, I have been extremely engaged in the discussion about Senate Bill 1129, our state’s medical aid in dying bill. The legislation is modeled after Oregon’s Death with Dignity Act.

Medical aid in dying is an end-of-life medical practice in which a terminally ill, mentally capable individual who has a prognosis of six months or less to live requests, obtains and — if his or her suffering becomes unbearable — self-administers medication that brings about a peaceful death.

Understandably, debates about medical aid in dying are passionate. But these debates must be based on facts, not on speculation and myth.

Medical aid in dying is authorized in six states and Washington, D.C., for a combined total of more than 30 years of safe practice. The law works as intended. In fact, a study by the Portland Veterans Affairs Medical Center and the Oregon Health & Science University found that “Oregon physicians were responding in a careful and prudent manner when patients requested aid in dying.” Predictions of a “slippery slope” or abuse have not come to pass.

The legislation also protects vulnerable people such as those with disabilities, as evidenced by this letter from Disability Rights Oregon: “DRO has not received a complaint of exploitation or coercion of an individual with disabilities in the use of Oregon’s Death with Dignity Act.”

My own experience supports this evidence. I have cared for hundreds of patients in their last months and weeks of life; most of these were in Oregon. I have personally seen the benefits of access to medical aid in dying. In fact, many patients report a sense of peace and control by having this option, even when they go no further than discussing it with their physician.

I have also seen the needless suffering that can happen when access to this personal choice is not available.

I’d like to share two stories from my nursing experience in Oregon that illustrate this.

In 1995, when medical aid in dying was not yet available in Oregon, I had a patient with AIDS whose progressive symptoms of weight loss, incontinence, infected bedsores, pain and immobility, along with her loss of autonomy and dignity, brought her great suffering. Home hospice helped, but could not successfully treat her main symptoms. Desperate, she tried to end her life with street drugs but failed, leaving her in a comatose condition. She spent her last week in a nursing home, attended by strangers — her worst nightmare come true.

The Oregon Death with Dignity Act became law in 1997. Two years later, another patient, a man with terminal metastatic cancer and a 4-month prognosis, requested and, after proper screening, received life-ending medications. He wanted to die when he still had enough quality of life left to be with his friends and family for a final week of loving celebration. This is indeed what happened. He took the medication, went to sleep and died peacefully at home. By connecting with loved ones, and by choosing the time, place and manner of his passing, he embraced both life and death in his last days.

Some express concern that medical aid in dying will lead to a “culture of suicide.” This is not true. Suicide is when severely depressed people choose death over life. Medical aid in dying is an option for those whose terminal disease has advanced beyond all hope of a cure — they are already dying. When death is inevitable, with only the prospect of increasing suffering ahead, people should be able to make end-of-life choices according to their own values and priorities.

It is time for the Hawaii Legislature to protect our human right to autonomy in health care, including a legal option for medical aid in dying.

Malachy Grange is a retired registered nurse and Hawaii hospice volunteer.