End-of-Life Choice, Palliative Care and Counseling

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Legal Interpretations Differ but Public Opinion United

Trust Doctors, not Government to Guide Aid in Dying

HONOLULU – Compassion & Choices Hawaii, the local affiliate of the nation’s oldest and largest nonprofit organization working to improve care and expand choice at the end of life, and the Hawai’i Death with Dignity Society today responded to an opinion on “assistance with dying” by Hawaii’s attorney general. The organization joined attorneys and physicians in expressing confidence that when the time comes, patients can request, and doctors will provide, aid in dying. Terminally ill, mentally competent Hawaii patients can request a prescription that gives them the peace of mind of knowing they could achieve a peaceful death in their homes, with their families and loved ones.

“Almost everyone in Hawaii agrees that terminally ill individuals, not government, should make end-of-life decisions and control end-of-life options,” said Robert “Nate” Nathanson, M.D., a founder of Hospice Hawaii. “The people of Hawaii overwhelmingly trust doctors to establish guidelines and respond appropriately to requests for medication to bring about a peaceful death if suffering becomes unbearable.” The results of a recent poll bear out Dr. Nathanson’s assertion. In the poll, 90% agreed the decision about aid in dying is a personal one between patient and doctor. Eighty-one percent (81%) said they trust their doctors to respond appropriately to a request for medication to bring about a peaceful death if suffering became unbearable. A complete summary of poll results can be found at CompassionAndChoicesHI.org.

The reasoning of the attorney general’s opinion is flawed. Focusing narrowly on a single 1909 statute, the opinion failed to appreciate how a constellation of Hawaii laws vests its citizens with broad autonomy over end-of-life decision-making. It does not mention findings in other states, including the persuasive authority of Baxter v. Montana or the recognition by Georgia’s attorney general that his state’s law against “assisting a suicide” does not cover aid in dying.

“The palliative benefits of aid in dying are very significant,”said Dr. Nathanson. “It offers relief for terminal pain and anxiety. And it lets some patients live longer and with peace of mind during their last days. This is comfort care at its best. When doctors cannot cure, at best they can provide relief.”

Chaired Professor at NYU Law School, frequent visiting Professor at Richardson and resident of Kailua Sylvia Law said, “Legal opinion differ and change over time. Hawaii has many laws which offer patients autonomy in end-of-life care and pain management. The state does not outlaw aid in dying with the sort of specificity required of a criminal prohibition. So it is reasonable to conclude Hawaii physicians can respond to these requests subject to best practices, without fear of prosecution.”