Column: Give nurses role in medical aid in dying
At least six Hawaii residents died in 2019 while waiting for approval or medication through the Our Care Our Choices Act (OCOCA), or medical aid in dying program.
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At least six Hawaii residents died in 2019 while waiting for approval or medication through the Our Care Our Choices Act (OCOCA), or medical aid in dying program. However, if Senate Bill 2582 passes, we may be able to reach future OCOCA participants before their time is up.
OCOCA allows terminally ill and mentally competent patients to ingest prescribed medication that will end their lives while they sleep. It includes a mandatory waiting period of 20 days between patients’ oral requests (they must make two) and written requests as well as a counseling consultation. The law establishes eligibility criteria and safeguards to ensure a secure, compassionate and patient-centered end-of-life process. There are regulatory requirements to address concerns about misuse.
However, because of the statewide physician shortage, patients can be unable to find providers who will support and guide them in the OCOCA process.
In 2019, the first year of OCOCA, the eligibility process from the first oral request to the date of receipt of the written prescription was an average of 34 days, according to the Department of Health Office of Planning, Policy and Program Development. The longest wait for one patient was 100 days, and the shortest was 20. Hawaii residents are dying while they wait.
SB 2582, which the Department of Health supports, would authorize advanced practice registered nurses (APRNs) to participate in OCOCA in accordance with their scope of practice and prescriptive authority. It would also reduce the mandatory waiting period from 20 days to 15 days and waive the period for patients who are likely to die while waiting. I have provided testimony before the Senate Committee on Commerce, Consumer Protection and Health in strong support of SB 2582.
As I testified, a large body of national evidence shows that APRNs provide high-quality, safe care for people of all ages, in accordance with their education, training, national certification and Hawaii licensure. All nursing practice holds at its core the delivery of high-quality, compassionate, holistic and patient-centered care — and this includes end-of-life care.
APRNs respect patient self-determination and provide nonjudgmental support for their end-of-life preferences and values, as they strive to prevent and alleviate suffering. We are educated to evaluate patients’ and families’ medical and psychosocial needs and, as the most trusted profession by the public, are in a pivotal position to evaluate requests for OCOCA in context of patient’s desires.
Access to care, especially in rural island settings, is a significant problem recognized by the Hawaii Legislature. Because of this, the Legislature has enacted more than 25 bills since 2009 that enable APRNs to practice to the full extent of their education. The result: an increase in the number of APRNs across all islands, with 100% of those on the islands of Hawaii, Maui and Kauai counties working in federally defined medically underserved areas.
More than 90% of APRNs in Hawaii hold prescriptive authority, and more than 88% care for Medicare or Medicaid patients in a typical week, according to the Hawaii State Center for Nursing.
APRNs have the education, the compassion and the capacity to serve as the solution for a literal life-or-death conundrum concerning patients dying while awaiting approval for OCOCA. Our geographically dispersed state puts already underserved patients at a disadvantage in accessing health care and in getting support for their end-of-life preferences. The changes proposed in SB 2582 will allow terminally ill persons, especially those outside of Oahu, to receive OCOCA care and family support by the APRN.
Mary G. Boland, Dr.P.H., R.N., is dean and professor at the University of Hawaii-Manoa School of Nursing and Dental Hygiene.