End-of-Life Choice, Palliative Care and Counseling

Three out of Four Hawai’i Doctors Want Aid in Dying as a Medical Practiceby Jay


Leading Hawai’i physicians today announced formation of the Physician
Advisory Council for Aid in Dying (PACAID) and released survey results showing
overwhelming support by Hawai’i doctors to incorporate the practice into end-of-life care.
A January survey by QMark Research of Hawai’i found 76% of doctors agree people in the
final stages of a terminal disease should have the right and the choice to bring about their
peaceful death. The PACAID members will adopt best-practice guidelines for aid in dying,
advocate supportive policies at medical organizations, and consult with patients and their
physicians. They will provide peace of mind to terminally ill, mentally competent adults by
prescribing life-ending medication that patients may self-administer if suffering becomes

Charles F. Miller, MD, FACP; Robert “Nate” Nathanson, MD; and the late Max Botticelli,
MD, founded PACAID with the primary goal of helping physicians empower their
terminally ill patients. By having personal control of their end-of-life options patients have
the ability to achieve peace of mind, reduce suffering and have a higher level of satisfaction
at the end of life. Clifton S. Otto, MD, and John Samuel Spangler, MD, joined PACAID,
bringing the core group of physicians to five before Dr Botticelli’s untimely death.

The physician-members of PACAID will develop, lead and support a larger Physician
Coalition for Aid in Dying, a network of supportive physicians. “Nearly nine in ten doctors
agree the medical community – not government – should establish practice guidelines to
prevent abuse,” said Hawai’i pollster Barbara Ankersmit, president of QMark Research.
Fifty-seven percent of doctors agreed specifically they favor allowing their terminally ill
patients the choice to request and receive aid in dying.

“Aid in dying will be gradually implemented and incorporated in end-of-life care in
Hawai’i,” said Dr. Miller. “Dying patients will talk to their doctors, doctors will respond,
hospice will work well with information we have provided, and aid in dying will be
available along with, not instead of, hospice care.”

PACAID members will provide information, guidance and emotional support to hospice
workers in cooperation with Compassion & Choices Hawai’i End-of-Life Consultation
(EOLC) program. EOLC uses the power of choice and comfort to restore hope to
individuals and their loved ones at the end of life. Individuals seeking information about
end-of-life decisions can access Compassion & Choices Hawai’i’s End-of-Life Consultation
service by calling 1-800-247-7421.

“Most medical care is governed by professional scope of practice standards,” said Dr.
Nathanson, a founder of Hospice Hawai’i. “Medical practice standards routinely govern
other practices that may advance the time of death, such as withdrawal of life-sustaining
treatment, voluntarily stopping eating and drinking, and palliative sedation.”

In addition to leading the development of practice standards and building the coalition of
supportive physicians, PACAID will advise physicians who receive aid-in-dying requests
from patients and shepherd affirmative policy through local medical organizations.
Members of PACAID with current licenses and prescribing privileges for controlled
substances can serve a consulting role to patients and their doctors, and write a prescription
for life-ending medication if the primary physician declines to do so for personal or moral

Last October, experts on Hawai’i law, medicine, elder care and policy-making for end-oflife
issues concluded Hawai’i physicians may provide aid in dying, subject to professional
best-practice standards. Based on the experience of professionals in other states, the
physicians of PACAID aim to lend their expertise and leadership in developing those
standards. Dr. Miller served for 30 years in the U.S. Army Medical Department, was chief
consultant to the Surgeon General and spent nine years as chief of hematology-oncology at
Kaiser Medical Center, Honolulu. Dr. Nathanson co-founded Hospice Hawai’i in 1979 and
served in general practice for 37 years. Dr. Botticelli, one of the founders of PACAID
before his unexpected death earlier this month, joined the University of Hawaii’s John A.
Burns School of Medicine in 1971 and became chair of the Department of Internal
Medicine in 1992. He also served as director, from 1986 to 1994, of the Queen Emma
Clinic, operated by The Queen’s Medical Center in collaboration with the College of Health
Sciences of the University of Hawai’i.

To interview Dr. Miller or Dr. Nathanson, please contact Steve Hopcraft or Scott Foster at
the above phone or e-mail.