End-of-Life Choice, Palliative Care and Counseling

Dying with doctor’s assistance in Hawaii discussedby Jay

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By Ilima Loomis
The Maui News
February 26, 2012

KAHULUI – Hawaii could become a key state in the discussion over a patient’s right to ask for a physician’s help to die, according to a group seeking to expand awareness of the issue in the islands.

Barbara Coombs Lee, president of Compassion & Choices, said her group’s legal team believes that laws already on the books in Hawaii make it possible for a physician to legally prescribe a fatal dose of medication to a competent, terminally ill patient.

She said her organization was actively working to expand its reach in Hawaii, raise awareness about “aid-in-dying” and inform terminally ill patients about the resources available to them – including a network of five Hawaii physicians willing to write a prescription that could hasten their death.

“We want to build the visibility. We want to build the movement,” Coombs Lee said. “People need to know that they have choices.”

Coombs Lee spoke last week at the Maui Arts & Cultural Center as part of a presentation organized by Compassion & Choices, Hawaii, and the Hawaii Death With Dignity Society. The talk also featured physicians and advocates from Oregon speaking about the state’s 14-year-old Death With Dignity law.

Compassion & Choices made headlines in October when Honolulu physician Dr. Robert “Nate” Nathanson announced that he was working with the group and was prepared to prescribe medication to help a terminally ill patient die.

The state Department of the Attorney General responded with an opinion that a 1909 statute cited by the organizations did not authorize physician-assisted suicide.

Walter Yoshimitsu, director of Hawaii Catholic Conference, questioned why the issue was being raised again after it had been laid to rest.

“What perplexes me is that the attorney general said that it’s not legal,” Yoshimitsu said. “They’re going to be charged with manslaughter, and yet they’re attempting to resurrect it.”

But Coombs Lee disagreed. She said Compassion & Choices’ legal team had studied Hawaii’s laws and found a “constellation” of several laws already on the books that are supportive of patient autonomy and end-of-life choices. Those laws, combined with the fact that no law explicitly prohibits the practice, “creates a very hospitable legal environment for aid-in-dying,” she said.

She said her group believed that the chances of a physician-assisted suicide being prosecuted were “small,” and that, if it were, the physician’s defense would prevail.

While she acknowledged that Hawaii’s laws were “not as crystal clear” as Oregon, or other states where courts have upheld patients’ right to die, Coombs Lee said there were other options available to terminally ill patients that were indisputably legal.

Suffering patients who are being kept alive by medical intervention can hasten death by refusing any more treatment – such as stopping medication or turning off oxygen.

“Sometimes people don’t even realize that a peaceful death is within their grasp if they just have their pacemaker deactivated,” Coombs Lee said.

Some patients also choose to stop eating and drinking – “a perfectly legal option in every state of the union,” Coombs Lee said.

Even if a physician is unwilling to write a prescription for a lethal dose, Compassion & Choices can advise patients on how to gradually accumulate enough medication to cause a self-administered overdose, she said.

She said that when patients seek help from her group, counselors speak with them at length to talk through the situation and all the options available to them. Many clients who receive assistance choose never to take the medication, while others find comfort just in knowing that the option is available to them if their suffering ever becomes unbearable, she said.

Yoshimitsu said his group did not oppose terminally ill patients deciding to hasten their deaths by ending medication or treatment.

“The church’s objection is that one should respect the human dignity – the life of a person from conception to its natural end,” he said. “For someone to give you barbiturates to end your life before its natural end is not within church teaching.”

Coombs Lee argued that advances in medicine have allowed people to live for years with chronic and terminal illnesses – extending their lives but also prolonging the amount of time they suffer from diseases that a generation ago would have caused a fast death. She said that was one reason terminal patients were “calling out” for life-ending medication.

But Yoshimitsu didn’t accept the argument.

“Pain should no longer be an issue – for the same reason you talked about, the medical advances,” he said. “Pain can be alleviated. There’s palliative care. There’s hospice, and there’s other organizations that help you at the end times. But there’s no need to end your life, to give you something to help you die.”

Several Maui residents at Tuesday’s presentation said that they appreciated Compassion & Choices’ message.

“I’m all for it,” said Emily Bott, who said she once called the organization on behalf of a friend who wanted help.

She said terminally ill patients should be given options.

“They should be able to take control, if that’s what they want,” she said.

Ele Bloom, a Hospice volunteer caregiver, said the talk was “informative” and provoked many questions. She said Hawaii residents should be made aware of the options available to them at the end of life.

“I just feel more people should know about this,” she said. “We’re all going to leave this earth someday, and if it can be with a little more dignity, that’s the way it should be.”