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The people of Hawaii overwhelmingly support medical aid in dying. This is the 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.
Kamaaina have been striving for access to medical aid in dying for more than 20 years, beginning with Gov. Ben Cayetano’s Blue Ribbon Panel on Living and Dying with Dignity in 1996. Six U.S. states now authorize the option, giving access to 18 percent of the nation’s terminally ill adults.
Meanwhile, local support has grown steadily. The most recent poll of Hawaii voters, in December 2016, shows a supermajority 80 percent in favor of the option across all demographics including ethnicity, age, economic status and religion.
In an unprecedented show of solidarity, that same month four former Hawaii governors — Neil Abercrombie, Ben Cayetano, John Waihee and George Ariyoshi — together authored an opinion piece published in this newspaper urging lawmakers to pass a medical aid in dying law this session (“Allowing life-ending medication is a compassionate choice,” Island Voices, Dec. 15, 2016).
In over 30 combined years of medical aid in dying in the authorized states, there has not been a single instance of documented abuse. Almost two decades of rigorously observed and documented experience in Oregon demonstrates the law has worked as intended, with none of the problems opponents had predicted.
Hospice and Palliative Care – The Gold Standard
Five bills on assisted-death are before this Legislature. Only Senate Bill 1129 has received a hearing so far and is advancing:
>> SB 1129: Would establish a death with dignity act in which a terminally ill adult resident may obtain a prescription for medication to end life. Licensed physicians would be allowed to prescribe a lethal dose of medication to terminally ill, competent adults diagnosed with six or fewer months to live.
>> HB 201: Would let a terminally ill adult with the capacity to make an informed healthcare decision to request a prescription for aid in dying medication from physician.
>> HB 550: Would authorize terminally ill adults seeking to end their life to request lethal doses of medication from medical and osteopathic physicians.
>> HB 150: Establishes a persons ability to choose the End of Life Option when afflicted with a terminal illness.
>> SB 357: Authorizes a terminally ill adult with the capacity to make an informed health care decision to request a prescription for aid in dying medication from their physician.
While palliative care and hospice programs provide extraordinary comfort to patients and work wonders for many dying people and their loved ones, there are times when even the best palliative options cannot alleviate pain and suffering. Studies have shown that 10 percent of cancer patients experience breakthrough pain and although variable, the prevalence is high (33–95 percent). Patients may also suffer from physical and emotional agony, a loss of autonomy and inability to engage in enjoyable activities. Other symptoms, like fatigue, breathlessness, nausea, vomiting, rashes and open sores and wounds may be untreatable.
Additionally, some kamaaina don’t wish to be subjected to what’s euphemistically known as “terminal sedation,” addled by massive doses of morphine until they lose consciousness and eventually stop breathing. Only the dying person can decide whether their pain and suffering is too great to withstand. Medical aid in dying puts the decision-making power where it belongs: with the dying person.
Honoring ‘Ohana, Caring for Kupuna
Across the islands, we have in common deep family bonds and respect and love for our kupuna. Should they, or any adult family member, become terminally ill with a prognosis of six months or less to live, being able to honor their wishes for a peaceful death, free of suffering and surrounded by loved ones, is the ultimate gift.
Shockingly, opponents of medical aid in dying have said, “If you want to kill yourself, move to Oregon.” It is the height of cruelty to propose that terminally ill island residents should uproot themselves from their home and family at this stage in their life, at their most ill and vulnerable time.
Medical Aid in Dying is Not Suicide
Society evolves and definitions change. We must make it very clear that medical aid in dying is not suicide. Suicidal ideation indicates a mental illness, involving people who are so severely depressed that they no longer want to live. Medical aid in dying involves individuals who would love to live, but can’t. They’re dying — and soon. These people request medical aid in dying not out of despair or depression, but to maintain some dignity and comfort in their final days, to ease their pain and suffering, and to help them die peacefully.
Medical aid in dying is a safe and trusted, compassionate and palliative practice. The law provides a safe, proven option for those whose terminal disease has exhausted all hope for further curative treatment, and who are facing only increasing suffering before certain death. We should always provide quality end-of-life care for people who are suffering from an incurable and irreversible terminal illness. That quality care should include the option to end pain and suffering on one’s own terms when the time comes.
Mary Steiner is campaign manager of Compassion & Choices Hawaii. Chuck Miller is a retired oncologist board-certified in internal medicine, medical oncology and hematology.
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