End-of-Life Choice, Palliative Care and Counseling

New Aid-in-Dying Service Getting Inquiriesby Sonja

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by Chad Blair
Honolulu Civil Beat
October 5, 2012

Compassion & Choices Hawaii, a nonprofit organization working to improve care and expand choice at the end of life, received 31 local inquiries in its first year of service.

The figure comes from an annual report released by the Physician Advisory Council for Aid in Dying, or PACAID, a group of local doctors that collaborates with Compassion & Choices Hawaii and can prescribe life-ending medication if necessary.

PACAID has a rigorous eligibility process that applicants must go through, and of those 31 inquiries only seven qualified to consult with a PACAID doctor.

Of the seven, four received a prescription for medication “which they could ingest to end their life and suffering in peace and dignity, at the time of their choosing,” according to a Compassion & Choices press release.

As of Thursday, two of the four patients died from natural causes and none had taken the medication.

“Terminally ill people get peace of mind from knowing they can request medication that will allow them to achieve a peaceful death,” Mary Steiner, campaign manager for Compassion & Choices Hawaii, said in a statement. “Some people get a prescription and don’t take the medication for weeks or months. They go on living their life.”

Steiner dismissed arguments from opponents of aid in dying that patients would use the medication prematurely.

“The report shows just the opposite, as we have seen in other states where the option is available,” she said. “Patients frequently say that the peace of mind and control they gain makes it easier to live out their remaining days.”

Growing Trend

As Civil Beat has reported, the aid-in-dying movement is gradually being accepted in a handful of other states, though it has faced obstacles from pro-life groups who favor palliative care rather than sanctioning a form of doctor-assisted suicide.

Locally, Death With Dignity legislation has been rejected several times by the Hawaii Legislature, with religious organizations leading the opposition.

What’s different about aid in dying is that supporters believe government does not have to enact new laws in order to allow people to end their own lives.

A spokesperson for Compassion & Choices Hawaii said he knew of no legal disputes regarding the seven patients who consulted with PACAID, describing all of them as “mentally competent adults making their own decisions.”

Compassion & Choices Hawaii said a year ago that an analysis of Hawaii law and policy “revealed a climate supportive of the option of aid in dying.”

The group said the new Hawaii data is consistent with data from Oregon, where “one in six terminally ill Oregonians talks with their family about aid in dying. One in 50 talks with their doctor. In the end, one in 500 ingests life-ending medication.”

Elevated Profile

In a related development, on Tuesday Compassion & Choices Hawaii said it wanted to participate as a “friend of the court” in a legal case involving a Queen’s Medical Center patient reported to have expressed an advanced directive regarding her life.

Karen Okada, 95, had given directions in 1998 to her brother that her life not be artificially prolonged, according to a Honolulu Star-Advertiser report last month. The newspaper said Okada “now is living a semi-comatose state at Queen’s Medical Center with a feeding tube.”

Compassion & Choices Hawaii wants Okada’s directive honored, and the group’s director of legal affairs, Kathryn Tucker, said appointing Okada’s brother as her agent does not mean he can ignore her instructions.

“Law in Hawaii is clear on this point,” said Kathryn Tucker, legal affairs director for the group. “The statute requires that: ‘An agent shall make a healthcare decision in accordance with the principal’s individual instructions.’”   The matter is pending in 1st Circuit Court, with a hearing set for Oct. 11.