Allowing life-ending medication is a compassionate choice

As governors of the state of Hawaii, we haven’t agreed on everything. But, as we watch the national effort to make medical aid in dying a legal practice, we do agree on this: A terminally ill person should be able to choose to end his or her own life in the Aloha State. A physician should be able to help a dying patient obtain a prescription for life-ending medication as part of the medical standard of care.

We stand with Compassion & Choices Hawaii and our respected colleague, Gov. Jerry Brown of California, who so eloquently expressed his support of the End of Life Options Act last year. The Act became law in June, tripling the percentage of terminally ill Americans who now have the option to choose medical aid in dying, from 4 percent to 16 percent.

As Brown stated in his letter to the California State Assembly:

“I have carefully read the thoughtful opposition materials presented by a number of doctors, religious leaders and those who champion disability rights. I have considered the theological and religious perspectives that any deliberate shortening of one’s life is sinful.

“I have also read the letters of those who support the bill, including Archbishop Desmond Tutu. I have discussed this matter with a Catholic Bishop, two of my own doctors, former classmates and friends who take varied, contradictory and nuanced positions.

“In the end I was left to reflect on what I would want in the face of my own death.

“I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to be able to consider the options afforded by [the End of Life Options Act]. And I wouldn’t deny that right to others.”

In addition to California, five other states authorize the option of medical aid in dying: Oregon, Washington, Montana, Vermont and Colorado.

In those states, medical aid in dying is available to adults who are terminally ill, with six months or less to live. They must be mentally capable of making their own health care decisions — and health providers, family and friends must not influence their decisions.

These eligibility requirements ensure that aid in dying is a safe and trusted medical practice.

The Journal of Palliative Medicine published clinical criteria for medical aid in dying which physicians use to ensure that the practice meets the highest standards of medical care.

With more than 30 years combined of practice in the authorized states, there has not been a single instance of documented abuse of medical aid in dying. Two decades of rigorously observed and documented experience in Oregon shows us the law has worked as intended, with none of the problems opponents had predicted.

In fact, in Oregon:

>> End-of-life care has improved overall since the law’s implementation, in large part due to the dialogue the law encourages between people and their doctors.

>> Hospice use is high and referrals are up, as is other use of palliative care. Some hospice programs reported a 20 percent increase in referrals since medical aid in dying was authorized.

>> In-hospital death rates are the lowest in the nation and at-home death rates are the highest in the nation. Violent suicide among hospice patients has virtually disappeared.

Local polls show the vast majority of kamaaina support medical aid in dying because they want this option to avoid unbearable suffering at the end of life. It is time to authorize the practice in Hawaii; we urge lawmakers to act in 2017.

This was signed by four Hawaii governors: George Ariyoshi (1974-1986), John Waihee (1987-1994), Benjamin Cayetano (1995-2002) and Neil Abercrombie (2010-2014).