Editorial: Implement aid in dying, with care

Two years ago, in response to a medical-aid-in-dying question posed by the Legislature’s House Judiciary chairman, the state Attorney General’s Office offered an opinion that a physician who prescribes a lethal dosage of medication to a terminally ill patient at the patient’s request could be charged with manslaughter.

What’s more, the physician also could be sued for medical malpractice and face professional discipline. The opinion echoed the take of another issued years before, specifying that state law does not allow doctors help terminally-ill patients to die.

That was then. In the now, following a decades-long debate, Hawaii’s stance on the controversial matter of medical aid in dying has shifted dramatically. Taking effect this week is a new state law, “Our Care, Our Choice” Act, which allows terminally ill adult residents with six or fewer months to live, to obtain a lethal medication prescription.

As expected, longtime state political lobbyist John Radcliffe, a terminally ill cancer patient who pushed hard for the measure, on Wednesday became the first Hawaii patient to request such a prescription. The state Health Department projects as many as 40 to 70 patients will follow suit this year.

The law is rightly tethered to strict guidelines. Still, we can expect a potentially bumpy implementation as few doctors and pharmacists appear to be willing to prescribe the medication or fill orders, respectively. Such resistance is understandable.

Medical aid in dying’s supporters assert that the prescription is not tantamount to a suicide setup because death is shortly to be inevitable, and the drug serves as a compassionate ease to that end. Opponents counter there’s no way to know when death will come, and signing off on the prescription directly collides with health care’s do-no-harm Hippocratic Oath.

Discussion on the merits of what used to be commonly known as physician-assisted suicide will — and should — continue at the state Capitol and in Hawaii’s various communities. However, with the new law on the books, an immediate priority should be placed on implementation as specified by the measure.

Hawaii’s Health Department, which is now focused on developing guidance for families and pharmacies regarding safekeeping and storage of the prescription, is recommending that medical-aid-in-dying patients enroll in hospice care. That’s a sensible path as such facilities can help patients and others with medication-related issues and navigation of the law’s guidelines.

The prescription hinges on two doctors confirming the terminal illness and six-month prognosis as well as deeming the patient mentally capable and able to take the medication on his or her own. Also required is a written request overseen by two witnesses, one of whom is prohibited from being a beneficiary of the patient’s estate.

While most Hawaii health care facilities have adopted neutral policies — leaving it up to doctors on whether to participate — Hawaii Pacific Health and The Queen’s Medical Center pharmacies are opting to not take part. Notably opting in, through Kaiser — the state’s largest health maintenance organization — is Dr. Charles Miller, a director and past president of the Hawaii Society of Clinical Oncology.

In January 2017, Miller, Radcliffe and Compassion &Choices, a national nonprofit advocate organization for terminally ill patients, teamed up to launch legislative and lawsuit strategies that rallied support for the new law — and scrapping of the manslaughter charge in medical-aid-in-dying cases.

Hawaii is among seven states, along with Washington, D.C., that have enacted medical-aid-in-dying laws. Each rightly stresses that a patient must always be in control of his or her participation in the process.

Our state leaders and health care officials now have a duty to see to it that the law is effectively implemented while carefully monitoring its consequences.