End-of-Life Choice, Palliative Care and Counseling

Posts TaggedDr. Nate Nathanson

Tragedy Calls Out for Support at the End of Life

Kailua, HI – Compassion & Choices Hawaii, an affiliate of Compassion & Choices, the nation’s oldest and largest nonprofit organization working to improve care and expand choice at the end of life, today responded to the tragic death by gunshot of an elderly couple in Hawaii Kai. Complete facts about this tragedy have not come to light, but what we know fits an unfortunately common pattern. Too often the lives of a loving couple end in violence, as one shoots the other in despair. Unable to live with what they’ve done, they immediately turn the gun on themselves.

Many elders see few options as illness advances and bodily functions deteriorate. Yet options always exist that are preferable to violence and premature death. Death remains a taboo subject in our society, so elders feel they cannot speak openly about situations where they might deem death preferable to a deteriorating and declining quality of life.

“No one, no matter what their condition, should feel they have to resort to violence when confronting advanced illness,” said Dr. Robert “Nate” Nathanson of Waialua, Hawaii. “Patients and their caregivers need to feel safe talking about unbearable symptoms and their feelings of desperation.”

People in Hawaii have many options as they approach the end of life, if they contact a knowledgeable and sympathetic listener. “The fact is that an honest conversation can often prevent a tragedy,” said Dr. Nate, “by leading to respite care, hospice, pain control, counseling or other forms of support.”

Since 1993, Compassion & Choices’ End-of-Life Consultation program has served thousands of clients, helping them find alternatives to violence. Peaceful, gentle means always exist to end life in a way that honors the life lived. The purpose of Compassion & Choices’ End-of-Life Consultation program is to ensure excellent end-of-life care and, if that care does not relieve unbearable suffering, provide information on a client’s options for a peaceful, dignified death. Individuals seeking information about end-of-life decisions can access Compassion & Choices Hawaii’s End-of-Life Consultation service by calling 1-800-247-7421.

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.”

New Poll: Hawaii Voters Strongly Support Aid in Dying

77% of Voters Favor End-of-Life Choice for Terminally Ill,
Near the Highest Level of Support in Nation;
Near-Unanimous (90%) Support for Patient’s Right
s

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, today released a poll finding 77% of Hawaii voters support access to aid in dying. The survey showed overwhelming majorities believe self-determination at the end of life is their right, and trust individuals and doctors – not the government – to make decisions about this medical practice. Seventy-seven percent (77%) favor or strongly favor allowing mentally competent adults dying of a terminal disease to ask their doctors to prescribe medication that gives them the peace of mind they can achieve a peaceful death. This level of support is among the highest of any state in the nation.

Former State Representative Ernest “Juggie” Heen, who is suffering from incurable liver and pancreatic cancer, told the news conference, “I am part of the 77% who believe in choice, and hope for some measure of control at the end of life. I have sought treatment, but there is no cure for my cancer. Chemotherapy might offer a few weeks or months, but the cancer is incurable. I have lived a full life and want to achieve a peaceful death. When the time comes, a prescription for medication I could take myself to achieve a peaceful death would greatly ease my anxiety about pain and suffering.”

Hawaii pollster Barbara Ankersmit, president of QMark Research, conducted the poll and presented the findings at a Honolulu news conference. “More than three out of four favor allowing a mentally competent adult who is terminally ill the right to bring about their own peaceful death with the aid and consultation of their physician. Nearly all Hawaii voters believe that terminally ill individuals, not government, should make end-of-life decisions, control end-of-life options, and trust doctors to establish guidelines and respond appropriately.”

These are highlights of the poll:

•    77% favor allowing those who are dying of a terminal disease the choice to request and receive medication from their physician to bring about their peaceful death;
•    90% agree the decision about aid in dying is a personal one between patient and doctor;
•    87% believe people in the final stages of a terminal disease should have the right to bring about their peaceful death;
•    83% say the medical community rather than the government should establish proper guidelines and safeguards; and
•    81% 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 seen below. A PDF is available here.

Robert “Nate” Nathanson, M.D., a founder of Hospice Hawaii, believes that aid in dying is in line with current standards of medical care: “Most medical care is governed by practice standards. These include many practices that may advance the time of death,such as withdrawal of life-sustaining treatment and palliative sedation. Patients make these difficult decisions every day in consultation with their doctors, their loved ones and their own consciences. Aid in dying is no different.”

Experts on Hawaii law, medicine, elder care, legislative and end-of-life issues have concluded Hawaii physicians may already provide aid in dying subject to professional best-practice standards.

For more information visit CompassionAndChoicesHI.org.