Column: Lower barriers to medical aid in dying

As a Hawaii physician who has helped many terminally ill patients through the arduous process of getting a prescription for medical aid-in-dying medication under the Our Care, Our Choice Act, I was very interested to hear that California has just made things a little bit less cumbersome for their dying residents.

On Oct. 5, Gov. Gavin Newsom signed a bill that streamlines California’s process of approving requests by terminally ill patients to end their suffering and die peacefully on their own terms.

Starting Jan. 1, California’s End of Life Option Act waiting period required between a patient’s two separate oral requests for medication will drop to 48 hours, down from the current minimum 15 days. Earlier this year, New Mexico passed a medical aid-in-dying law with a waiting period of 48 hours, and in 2019 Oregon amended its 25-year-old Death With Dignity law to eliminate a waiting period for patients deemed too ill to survive it.

As decades of data have shown, the 15-day waiting period that was inserted into our country’s first medical aid-in-dying laws in the 1990s has turned out to be not a safeguard, but an arbitrarily extended suffering period and a barrier to compassionate care.

A 2018 study by Kaiser Permanente Southern California found that roughly one-third of nearly 400 terminally ill people who requested medical aid-in-dying medication died during the 15-day waiting period. In Hawaii, 2019-2020 data from Kaiser and Hawaii Pacific Health show similar numbers.

Except here, our law requires that the dying patient endure not 15 but 20 days between the two mandatory verbal requests — the longest waiting period in the nation.

I have helped about a dozen eligible Hawaii residents access the Our Care, Our Choice Act. Without exception, these individuals had carefully considered the option before coming to me, and most had already suffered the disappointment, fear and hopelessness of their own providers declining to support them in their wishes. On top of all this, they still had to struggle through the 16 steps the process requires. I practice on Oahu. In rural Hawaii, it’s often just plain impossible for a patient to use the law.

By making it so difficult to access the end-of-life option these suffering human beings desire and are legally entitled to, we are failing our most vulnerable. We are doing harm.

To my colleagues in the health-care profession, we must ask ourselves: Do we fundamentally believe that patients and families should drive the decision-making around end of life? If yes, then we must support them.

Thankfully, it does seem that more providers are taking the time to educate themselves on the Our Care, Our Choice Act. They are realizing that it’s not as scary as it sounds to let patients drive this most personal decision. I’m hopeful about the future, because the psychiatric residents I have the honor of teaching today demonstrate both a passion for healing and a willingness to accept the inevitability of death.

One psychiatric resident who accompanied me to a patient’s planned death (with patient’s permission) began weeping after the event, not out of sadness or frustration at not beating the illness, but in awe of the beauty and dignity of the passing.

These doctors are less inclined to see death as a failure that must be avoided at all costs (even if it means utter destruction of a patient’s quality of life), but as a natural conclusion to a well-lived life. These will not be the doctors who throw up their hands and abandon a patient to his or her own devices when death is inevitable.

We must make it less burdensome for terminally ill patients to access the Our Care, Our Choice Act. Next legislative session, I hope our lawmakers can show the courage and wisdom demonstrated by their colleagues.

Pablo Stewart, M.D., is a clinical professor in the Department of Psychiatry, University of Hawaii, John A. Burns School of Medicine.