Those who advocated for Hawaii’s new medical aid in dying law — and those who opposed it — have been on a decades-long journey, finally ending in its enactment.

Laying the groundwork for implementation, however, has been the work of the past several months. That continued effort is what will spell success.

Effective Jan. 1, the Our Care, Our Choice Act will define an end-of-life option that remains controversial in some parts of the community, but one for which some patients and families have advocated.

The recent dispute over policies held by a Honolulu facility for elders has illuminated the real-life conflicts that are certain to arise.

In that instance, the ACLU Foundation of Hawai‘i and the ACLU Program on Freedom of Religion and Belief aired a complaint with the director of Kahala Nui, the senior residential property in East Honolulu with a ground lease owned by the Catholic Church.

The church had imposed a lease restriction barring activities “morally repugnant” to the church. And because of that condition, Kahala Nui management had issued a general memo to residents that exercising provisions of the new law is “not an option” for them.

The policy was later clarified to indicate the restriction would not affect the community’s 350 independent-living residents. The ACLU, which had argued the policy runs afoul of the federal Fair Housing Act, is reviewing it before determining whether the complaint still stands.

That likely won’t be the last upheaval in the implementation of the new law, given that the statute, passed as House Bill 2739, does allow health care providers to exclude medical aid in dying from their services.

Kat West is national director of policy and programs for Compassion &Choices, the advocacy group in the forefront of securing the passage of this bill and provisions like it legalizing medical aid in dying in six other states and the District of Columbia.

Hawaii’s statute — like that of Oregon, the first state to enact such a law — allows institutions, religious or otherwise, to enforce policies barring doctors from providing medical aid for patients seeking to end their lives.

She is part of a committee working on ensuring that patients have access to this legal option, she said. Members have been meeting with medical groups and institutions to make the case against blanket prohibitions.

There is a delicate balance to be struck here. Patients need to know about all their options — including the robust pain-management and comfort care of palliative services that remain a viable choice. They should be helped to find assistance on their chosen path.

At the same time, providers need to have the freedom to practice in accordance with their conscience or religious beliefs.

West said that over time, state leaders have discussed whether some of the restrictions in law are necessary and have amended them. For example, she said, some states have lessened the requirement for witnesses testifying to a patient’s sound mind, given that many lack any expertise in that area.

Granted, there may be room to revise Hawaii’s law at some point, but that remains some distance down the road. The state Department of Health is bound to gather data and issue a report on an annual basis and, next July, make an initial set of recommendations to the Legislature.

That process needs to go on undisturbed by any policy debates in this coming session.

But encouragingly, other, productive preparation work is underway. The Health Department is planning a major educational outreach for providers in February, just as the first requests are expected to start coming into the doctor’s office.

In addition, patients and their families would be wise to start learning more now about their options. They should be given ample opportunities to do so, well in advance of that most difficult decision.