The Legislation Would Improve the Existing Law
The Our Care, Our Choice Act (OCOCA) took effect on Jan. 1, 2019. Under the law, terminally ill, mentally capable adults with six months or less to live are able to request and, should they decide to, self-ingest medication that allows them to peacefully end their suffering. As required by the OCOCA, the Hawai’i Department of Health reports to the legislature annually on outcomes from the law. Each year a report has been issued, there have been recommendations to remove unnecessary roadblocks in the law, so that all eligible patients can access the compassionate option of medical aid in dying.
Findings from the annual reports indicate that, while the OCOCA works for patients who can access it, doctors, patients and families agree that there are barriers to access. Based on the Hawai‘i Department of Health’s recommendations to the legislature, these bills would improve1 the Our Care Our Choice Act by:
- Including Advanced Practice Registered Nurses (APRNs) with prescriptive authority in the definitions of attending and consulting providers and psychiatric nurse practitioners in the definition of counseling providers, in alignment with their scope of practice. Hawai’i is one of 24 jurisdictions that give APRNs authority to independently carry out all medical acts consistent with their education and training, including prescribing all forms of medication, including controlled substances. Allowing APRNs to participate as providers under the Our Care, Our Choice Act is consistent with their scope of practice and would help address the disparity in access to participating providers, particularly in rural areas and on the neighbor islands.
- Allowing attending providers to waive the mandatory waiting period if the patient is unlikely to survive and meets all other qualifications. Two of the largest healthcare systems found that a significant number of eligible patients die in exactly the way they do not want to during the mandatory minimum waiting period. This bill will allow a qualified patient’s attending provider to waive the waiting period if, in their medical judgment, the patient is unlikely to survive that waiting period.
- Reducing the 20-day waiting period between the first and second oral requests to five days. Of the 11 authorized U.S. jurisdictions, Hawai’i has the longest mandatory waiting period (20 days) between the first and second oral requests for medical aid in dying. Rather than a safety feature, the additional waiting period required under the Our Care, Our Choice Act has proven to be a barrier for individuals seeking this option. These bills will reduce the waiting period between oral requests to five days.
For more information:
Hawai’i State Director, Compassion & Choices