At 95, Karen Okada lay Thursday in a hospital bed at the Queen’s Medical Center, seemingly unaware that a Circuit Court judge will hear arguments today over whether Queen’s doctors can remove her feeding tube and hasten her death.
Okada’s eyes opened slowly, but she did not speak in response to prodding from her daughter, granddaughter and daughter-in-law. They insisted, however, that Okada’s eyes well up with tears and she squeezes their hands whenever they end their hospital visits.
Okada’s daughter, Joy Rodrigues, sat at her mother’s bedside and said the family is ready to help Okada die — when the time is right, which is not now.
"We don’t think she’s nearing it," Rodrigues said. "If she had a chance to get better, she would want to get better."
At stake in today’s hearing before Judge Patrick Border is whether Okada’s 1998 written desire to not have her life artifically prolonged should supercede the current wishes of her brother, former Honolulu City Council Chairman George "Scotty" Koga, whom Okada gave the authority to make health care decisions on her behalf.
Queen’s attorney William Hunt argued in his court filing that Okada executed and signed a "Death with Dignity Declaration" — or advance health-care directive stating that she did not want her "‘dying’ be artifically prolonged … and that her instructions ‘shall prevail even if they create a conflict with the desires of my relatives, hospital policies, or the principles of those providing (her) care.’"
On Aug. 15 the Queen’s Ethics Committee found that "continuing to provide antibiotic treatment and nutritional supplementation is in violation of Ms. Okada’s instructions … and such treatment should be discontinued," Hunt said in his court filing.
Okada stuffered a stroke in 2011 that left her, after a tracheotomy, with a breathing tube in her throat, and a bout of pneumonia on Aug. 8 initially required antibiotics. It is unclear when the feeding tube was inserted.
The family members now want to move Okada from Queen’s to a hospice.
"The family would like to take her to a more comfortable environment," said their lawyer, Scott Makuakane. "She’s not terminal at this point. She’s not dying at this point."
But the family said Queen’s doctors will allow Okada to be relocated only if they first remove a surgically implanted feeding tube. The family said the hospice facility is not equipped to surgically insert a new feeding tube, so the move would hasten her death.
Attorneys for Queen’s did not respond to requests to confirm or clarify that position.
In his filing, Hunt did not address the issue of removing Okada’s feeding tube as a condition of moving her to a hospice.
Makuakane said the hospice would take Okada with or without the feeding tube.
Dr. Jim Pietsch, director of the University of Hawaii’s Elder Law Program and an adjunct professor of geriatric medicine and psychiatry at UH’s medical school, said it’s "not very common" to see court cases in Hawaii pitting a patient’s family’s wishes against the patient’s written desire not to prolong her or his life artificially.
"It’s not an uncommon occurrence that there will be a family conflict," Pietsch said. "They just don’t pursue it in court."
Pietsch serves on Queen’s Ethics Committee but told the Star-Advertiser he was unaware of Okada’s case and did not participate in the committee’s deliberations about her.
Meanwhile, Makuakane said Thursday he was having difficulty finding a doctor in Hawaii to testify today on the family’s behalf.
He said the doctors he contacted either had privileges at Queen’s or did not want to testify against the medical center.
So Makuakane said he likely will have to rely on the emotional testimony from Okada’s family.
In general, Pietsch said, Hawaii judges give great weight to the testimony of medical professionals.
But Okada’s family plans to argue today that the doctors are wrong.
"She’s strong-willed and she’s a fighter," said Rodrigues. "The time’s not right."
