State prepares for new medically assisted death law to take effect

Terminal cancer patient John Radcliffe would’ve ended his life four years ago had medical aid in dying been legal.

But the 76-year-old longtime lobbyist and poster child for Hawaii’s controversial Our Care, Our Choice Act, often referred to as “death with dignity,” is not yet feeling the painful effects he anticipated while fighting the disease.

“I’m really lucky to be alive, but I should be dead,” said Radcliffe, who was told he had six months or less to live in 2014 and just finished his 70th round of chemotherapy. “I’m not suffering. I should’ve had a lot more pain. I’m handling it pretty well. I’m just entirely grateful to be here.”

Still, the multiple-organ cancer patient is hoping to be the first to take advantage of the law that takes effect Jan. 1.

“The fact that I’m managing to stay alive shouldn’t be held against me too much. I’m a statistic. They all should have the right to choose,” he said.

The state Department of Health is urging health care organizations to prepare for the new law that permits terminally ill adult residents with six months or less to live to obtain a prescription for medication to end their lives. DOH officials said they are working to establish a process that assures “patients and their family members fully understand” alternative options such as palliative and hospice care.

At the start of the year, patients deemed mentally capable and able to take the medication on their own will be able to request a lethal prescription after two doctors confirm the terminal illness and six-month prognosis. Patients must make two separate appeals for medication, with a 20-day waiting period between the first and second requests. Also required is a written request overseen by two witnesses, one of whom is prohibited from being a beneficiary of the patient’s estate. It will be a criminal offense to tamper with a patient’s request or to coerce someone into medically assisted death.

Health care providers are gearing up for an increase in patients seeking the end-of-life option.

“The Queen’s Health Systems has been taking this very seriously,” said Dr. Daniel Fischberg, medical director of the hospital’s pain and palliative care department, which has assembled a team that has been meeting since May to draft policies, procedures and educational plans for staff “so that all patients may receive a prompt, skilled and compassionate response should they make a request.”

Dr. Chris Flanders, executive director of the physicians group Hawaii Medical Association, said most doctors are still reluctant to participate in the program.

“There’s some discomfort with the whole issue ethically and morally. It’s touchy with a lot of different groups either from a personal religious standpoint or from a physician’s philosophical standpoint,” he said. “It’s going to be the same as we experienced with the medical marijuana program. There’s going to be a handful of physicians who participate.”

Honolulu pain specialist Jeffrey Wang said he is not against the program for ethical reasons but will likely not get involved simply because he doesn’t “believe pain should be one of the reasons somebody wants to commit suicide.”

“Ethically and morally I don’t have an issue with physician-assisted suicide as long as the reasons for that is not that the patient’s in pain, because we have many ways to treat pain,” he said.

State Sen. Josh Green (D, Kona-Kau), a Big Island physician who is running for lieutenant governor, said the state must ensure safeguards.

“We’re being very careful to hopefully make it be a rare need in society but one that is available for the most heartbreaking cases. We’re trying to make sure there are safeguards, but there’s never a perfect system,” he said. “Just giving people the option tends to give them a lot of psychological relief. Many don’t end up taking the medicine. We have to balance that no one ever suffers and that we never make a mistake when someone has a better option. This is life or death.”

WHO IS ELIGIBLE FOR MEDICAL AID IN DYING UNDER HAWAII’S OUR CARE, OUR CHOICE ACT

>> An adult resident

>> Terminally ill

>> Given a prognosis of six months or less to live

>> Acting voluntarily and mentally capable of making their own health care decisions

>> Capable of self-administering the lethal drugs

How the 3-week process works:

>> A patient must make a total of three voluntary requests: two orally at least 20 days apart to their doctor and one written request.

>> Two Hawaii physicians must agree that the patient is eligible (one physician prescribes the medication; the other provides a consulting opinion).

>> A patient’s mental capacity must be confirmed by a psychiatrist, psychologist or licensed clinical social worker. The evaluation may be provided through telehealth (by phone or video).

>> A patient must prove residency in the state and give consent after being informed by their doctor of all other end-of-life options.

>> Qualified patients must also complete a final attestation form within 48 hours prior to ingesting the medication, reiterating the intent to take the drug.

>> A person may at any time withdraw the request or decide not to ingest the drug.