As the only physician outside Oahu to have written a prescription for a qualified patient under the Our Care, Our Choice Act (OCOCA), our state’s year-old medical aid-in-dying (MAID) law, I wish to share my perspective on amendments being proposed to improve access to the law.

I have been a practicing ER physician for the last 20 years, from the inner cities like Detroit to some of the most rural spots across our nation. I now live and practice on Hawaii island, where I also created a nonprofit to educate about all life matters, especially end-of-life.

Recently, I was approached by a terminal patient to help him with the medical aid-in-dying process. His primary and specialty physicians would not even speak to him about the issue. His first words to me were that he felt abandoned by the very professionals he trusted.

Unfortunately, this is the reality for many neighbor island patients. Access to basic primary care across our state is the largest medical need but limited on a level that our mainland friends — perhaps even some of our Honolulu neighbors — will rarely comprehend. I feel it every time I walk into my ER and struggle to get my patients the life-saving medical help they need.

It unfortunately does not surprise me that I am the only doctor on any island outside of Oahu that has participated in the MAID process. With such a shortage, end-of-life care is not a priority. Qualified terminal patients are suffering and dying while trying unsuccessfully to access the law.

That is why the Hawaii Department of Health has proposed amendments to the OCOCA to: 1) allow advanced practice registered nurses (APRNs) to prescribe the necessary medications, and 2) waive the mandatory minimum waiting period if the patient is unlikely to survive it. The DOH recommendations are based on local providers’ own experience with barriers they and their patient have faced in the process, as well as data collected here and nationally. Along with the DOH, I strongly support House Bill 2451 and Senate Bill 2582 and think they are crucial to removing unnecessary barriers in patient access to medical aid-in-dying.

I’d like to point out that my own primary and specialty care providers are APRNs — not just because I live in a rural community, but because they took the time to gain my trust and connect with me personally as their patient. Being an ER doctor, I have worked alongside some of the brightest APRNs for decades. As a patient and physician, I am not so arrogant as to believe that if we trust APRNs to care for our health, we can’t also trust them to care for our death.

Now back to that Hawaii island patient I mentioned. I listened to him and agreed to help him. His relief was palpable. He is an autonomous and private individual, but as we worked together on the MAID prescription process, I witnessed him become empowered to add other palliative modalities, including end-of-life doulas and hospice.

And what’s happened? With his medical aid-in-dying prescription in hand, his quality of life has soared, even as he declines physically. He is no longer afraid that he will suffer horribly at the end of his life and can now fully appreciate his final weeks. Being able to speak openly about death with a nonjudgmental provider, and to have access to all end-of-life options, has allowed him to fully live an extraordinary part of his life, despite prognosis.

This positive experience with the dying process — a natural part of life — should not be denied to so many qualified Hawaii patients simply because of their location or economic status. We must bring the OCOCA waiting period in line with other states, and we must allow APRNs to prescribe. This is not dangerous. It is simply humane.

Dr. Charlotte Charfen is a Hawaii island emergency medicine physician and co-founder of Life & Death Wellness in North Kohala.