Column: Medical aid in dying shows progress

The Our Care, Our Choice Act (OCOCA) has been in effect only a few short months. Yet thanks to careful preparation by the state Department of Health (DOH) and a robust education campaign, Hawaii’s health-care providers are making tremendous progress implementing the new law, which gives eligible terminally ill patients the option of medication they can take to die peacefully in their sleep should their suffering become unbearable.

Perhaps not surprisingly though, in January we saw initial reports indicating that few doctors would support their patients who might decide to use the law; that no pharmacies were willing or able to fill the prescription; and that the medication itself was not available. Federally funded insurance (VA and Medicare) does not cover the cost of the medication, and it seemed uncertain whether Medicaid would cover it.

What a difference 20 weeks make. While the DOH’s first annual report is not due until July 1, anecdotal reports tell us that the law is being successfully accessed by patients statewide. Aid-in-dying medication is available and can be picked up at any of the participating compounding pharmacies, or sent via certified mail anywhere in the state to a registered recipient who has qualified. The state’s Med-QUEST program covers the cost of the medication as does most private insurance.

Most importantly, providers are increasingly supportive of their patients who wish to use the law. To date, we have given Continuing Education courses, webinars and one-on-one presentations to more than 200 Hawaii providers. Their engagement has been sincere and compassionate, increasingly so as people become aware that the dire predictions made by some who opposed the law have not come to pass.

As national medical director for Compassion & Choices (Dr. Grube), I have had many positive encounters with Hawaii physicians. One Honolulu oncologist expressed his concerns to me about how important it is that his medical group quickly develop a policy for OCOCA requests, and another palliative care specialist has been an outspoken advocate for educating patients about choice at end of life. Both of them recognize the palliative aspects of the Act, and the positive effects that more open end-of-life conversations will encumber.

Terminally ill patient John Radcliffe, who advocated tirelessly for Hawaii’s law and became the first person to request a prescription on Jan. 2, did not receive his prescription until March 2 due to hurdles faced in the qualifying process. This is too long for terminally ill patients seeking this option.

There is still work to be done. Sadly, we know of four patients who died before they could complete the lengthy qualification process. There are health-care systems and hospices that are hesitant to incorporate neutral policies allowing physicians to support their eligible patients in this compassionate option. However, they are moving toward making this end-of-life option more accessible as they hear from their patients who would like the option. In fact, it’s beginning to look like patients with supportive providers are now able to complete the process in a more compassionate timeframe, approaching the minimum 22 days.

As just one local prescribing physician (Dr. Miller), I am aware of at least 17 patients who have initiated the process. Three patients that I know of were able to use the medication to bring about a peaceful death when they deemed it necessary.

We’ve only just begun to build the foundation for responding to OCOCA patients. This is an evolutionary process: a physician may have just looked at the documentation for their first patient, a pharmacist may have just filled their first prescription. This evolution will include organizations changing policies as they work through actual experiences, professionals willing to share their experiences and mentor peers, even just more conversations around the dinner table.

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More information: Compassion & Choices Hawaii’s resources for patients and providers are free at www.compassionandchoices.org.

Dr. David Grube is national medical director of Compassion & Choices; Dr. Chuck Miller is a consultant for Hawaii Permanente Medical Group.