A controversial proposal to legalize medically assisted death for terminally ill patients is headed for a vote by the full House of Representatives for the first time in nearly two decades.

Lawmakers in the House are scheduled to vote Tuesday on House Bill 2739, which would give patients with less than six months to live the option of requesting prescriptions for lethal doses of medication.

Two House committees advanced the measure Wednesday, setting up next week’s floor vote, which is expected to be contentious.

The House Health and Human Services Committee voted 4-1 in favor of the bill, while the House Judiciary Committee voted 7-1 in favor. Republican Reps. Andria Tupola and Bob McDermott cast the two “no” votes.

The last time the full Hawaii Legislature took up the idea was in 2002, when the House approved a death-with-dignity bill but the Senate fell three votes short of passing it. Last legislative session, a similar bill cleared the full Senate but stalled in a House committee and never advanced to a floor vote.

The bill’s supporters include terminally ill patients and relatives along with health care workers who contend that mentally competent individuals should have the option to end their lives peacefully rather than suffer from painful and debilitating illnesses.

Opponents, meanwhile, include individuals of various faiths who argue that life should be treated as a gift and who equate medically assisted death with suicide. Some health care workers also oppose the practice and have warned that patients may end their lives prematurely. Others say pain relief is already available through hospice and palliative care.

Rep. John Mizuno, chairman of the House Health and Human Services Committee, said the bill has the strongest protections of any state after amendments were made following a five-hour public hearing Tuesday. Medical aid in dying is legal in the District of Columbia and five states — California, Colorado, Oregon, Vermont and Washington.

Mizuno said one of the biggest changes made to HB 2739 is a requirement for mandatory counseling from a psychiatrist, psychologist or clinical social worker after two physicians confirm the patient’s diagnosis, prognosis and competence. To support residents living in rural areas, the counseling can occur via telehealth.

“We wanted to make it extra safe so we put in mandatory counseling, and no other state has that,” Mizuno said. “You will hear people, even the advocates, say it’s an overprotection. However, at the end of the day, we didn’t want to take a chance.”

The bill also was amended to remove advanced practice registered nurses as eligible to provide a lethal prescription. Under the current version of the bill, only licensed physicians would be able to prescribe the medication to be self-administered by the patient.

House Judiciary Chairman Rep. Scott Nishimoto said the bill balances access with safeguards.

House Majority Leader Della Au Belatti, who as then-chairwoman of the House Health Committee tabled last year’s bill, is the lead sponsor of the current bill.

“The Legislature has carefully examined this issue over the past two decades,” Belatti said in a statement. “During the interim, we looked closely at what other states have done and heard the public’s concerns. This bill provides strong protections for terminally ill patients and their families while allowing patients to exercise their end-of-life choices.”

Under the procedures set out in the current bill, patients would have to submit two verbal requests a minimum of 20 days apart and one written request to their attending physician for a prescription.

The written request would need to be signed by at least two witnesses who can attest the patient is of sound mind, is acting voluntarily and is not being coerced. One of the witnesses cannot be a relative and one witness cannot be someone who stands to inherit anything upon the patient’s death.

A patient would have the right to rescind a request at any time and in any manner, and the bill calls for criminal penalties for tampering with a patient’s prescription request or coercing a patient to request a prescription.

Scott Foster, co-founder of the Hawaii Death With Dignity Society, said he’s been advocating for legislation for the last 25 years. He called Wednesday’s affirmative committee votes “absolutely astounding and surreal.”

“But it’s not over yet,” Foster said.

If the House approves the bill, it would cross over to the Senate, where it’s expected to be warmly received. Gov. David Ige has said he would sign the measure into law.

“It’s time for this bill to become law,” Ige said in a statement. “Mentally competent, terminally ill people who are in pain and who are suffering should be given the choice to end their lives with grace, dignity and peace. I would be proud and honored to sign this bill into law if our state legislators pass this measure this session.”