news archive

Below are articles, editorials, and letters to the editor from Hawai'i press.

Suicide bill: Weary of the post-mortems
The Honolulu Advertiser: EDITORIALS
Monday, March 15, 2004

As a death-with-dignity bill was shelved again this year, some Hawai'i lawmakers offered the excuse that physician-assisted suicide is an uncomfortable issue to take up in an election year.

Heck, it's an uncomfortable issue to take up in any year. But it has to be resolved for the sake of those terminally ill and aging Islanders who want to know whether they'll ever have the power to end unbearable suffering.

If not in Hawai'i, they may want to make other arrangements - like move to Oregon.

Oregon's assisted-suicide law allows terminally ill patients with less than six months to live to request a lethal dose of drugs after two doctors confirm the diagnosis and judge the patient mentally competent to make the request.

Since the law was enacted in 1998, at least 133 terminally ill people have used it to end their lives.

A report released last week found that 42 terminally ill patients killed themselves last year under Oregon's assisted-suicide law, a 10 percent increase from 2002.

With an average of 31,000 Oregon deaths each year, that's not a lot of suicides. And Hawai'i, with 9,170 deaths in 2003, would likely have far fewer.

As it is, a subtle form of assisted suicide is already practiced in hospitals when doctors and nurses halt life-sustaining treatments to let a terminally ill patient die. Moreover, as part of palliative care, narcotics administered to relieve pain can occasionally result in sufficient respiratory depression to kill a patient.

But for many terminally ill patients, that happens too late in the game. They want the ability to end their lives before they lose control of body and mind. It's not about martyrdom, but about dignity.

For that and other reasons, a death-with-dignity law is worth pursuing. In the meantime, we must improve palliative care and pain management so that the demand for physician-assisted suicide will be low.

Ultimately, the question of what kind of life is worth living can only be answered by the person living that life.

LETTERS & COMMENTARY
Don't despair over bill's rejection
The Honolulu Advertiser
Friday, March 12, 2004

I hope the thousands of supporters, many of whom worked tirelessly calling their representatives to voice support while urging their friends to do the same, will not view the re-committal of the death-with-dignity bill as a defeat.

We should be very proud of what we accomplished this year and the progress that has been made. We can take credit for many of the promises that were made by organizations such as the Hawai'i Medical Association, which proclaimed its commitment to working with its members to provide better pain management and educating its physicians about improved end-of-life care.

And I was encouraged that Hospice Hawai'i has both improved its already outstanding program and is working toward providing even better palliative care. As the Oregon Death with Dignity Act has shown, when quality hospice care is available, many of those initially considering a hastened death are satisfied with hospice as an alternative and go on to experience a "natural" death.

While I have always been the first to admit that improvements in pain management and better palliative care will reduce the desire for a hastened death, such alternatives will never entirely eliminate its need for those who are suffering intolerably and have exhausted every other reasonable option.

This year, as in the past, several of the testifiers offered exaggerated and fabricated stories as the "truth," but fortunately they were the exception rather than the rule. Most of those on both sides of the issue had honest and sincere differences of opinion.

For the first time many opponents admitted it was not assisted dying that they objected to, but rather their own fears about where such legislation could lead. Some had fallen easy prey to negative television and radio advertisements implying that if we allow dying people this dignified and humane option it would ultimately lead to the systematic elimination of our disabled, frail and elderly.

Yet the Sixth Annual Oregon Report, just released, again shows the law in that state is working well. As in the past, the majority of those exercising their legal option were elderly and suffering from cancer. As has been the case every year, loss of autonomy was cited as the primary reason for seeking a hastened death, with pain being one of the least significant concerns.

Despite what I view as progress, there were still victims - Hawai'i's dying who were counting on passage of this bill to offer them an option. Many admit they don't know if they would actually use it, but would still be comforted in knowing it was there. For them "maybe next year" is a hollow sentiment.

"Death with dignity" is not going to go away. Each year support among the public and healthcare community increases, and each year the gap between supporters and opponents narrows.

Who knows, next year may be our year.

- Roland L. Halpern, Executive Director
Compassion in Dying of Hawai'i

'Death with dignity' bill shelved
By Gordon Y.K. Pang and Lynda Arakawa
The Honolulu Advertiser
Wednesday, March 10, 2004

With election season coming, the House of Representatives rejected the controversial "death with dignity" measure that would have allowed terminally ill adults to get lethal doses of medication that would end their lives.

The House Democrats sent the measure back to the Judiciary Committee.

House Judiciary Vice Chairman Blake Oshiro, D-33rd (Halawa, 'Aiea, Pearlridge), among the main proponents, said the House members were divided and the Democrats believed it would be better to raise the issue again later, but not this session.

"People were a little uncomfortable about taking this up in an election year," he said.

The measure also faced an uphill fight in the Senate. Gov. Linda Lingle has stated her opposition.

The measure was one of only a few bills to go down yesterday, as the House and Senate pushed out several hundred bills during marathon floor sessions to meet tomorrow's internal deadline for the legislative bodies to exchange bills for further review. A bill must be approved by the House and Senate to go to the governor.

Other measures still alive this session include the revamped gasoline price cap measure, which the Senate moved out after heated debate. But major initiatives proposed by Lingle in the areas of public-school governance and workers' compensation reform were in tatters.

Two years ago, the House voted 30-20 to pass a similar assisted-suicide bill backed by then-Gov. Ben Cayetano. That measure failed in the Senate in the final days of session.

Rep. Helene Hale, D-4th (Puna), who turns 86 this month and is the oldest legislator, was one of the few lawmakers to raise strong objections to the decision not to vote on the bill.

"I don't want to be a burden on my family or my community," Hale said.

The bill would have prohibited mercy killings, lethal injections and active euthanasia and would have required informed consent by the patient receiving a lethal prescription.

The Senate voted 18-5 to approve an amended gasoline price-cap bill that alters the formula for figuring the top price by tying gas prices to a national average rather than the West Coast. The original law, passed in 2002, is set to take effect July 1.

Senate Bill 3193 would cap regular, mid-grade and premium gasoline wholesale prices as well as diesel fuel based on a national average of gasoline prices reported by the Oil Price Information Service. The original law capped retail as well as wholesale prices.

Senate Republicans said the bill would not reduce gas prices for consumers.

Senate Minority Leader Fred Hemmings, R-25th (Kailua, Waimanalo, Hawai'i Kai), said the bill was a political ploy to "curry favor with people who are being misled on the need for this bill and, more importantly, are being tremendously misled on the impact of this bill."

Senate Commerce, Consumer Protection and Housing Committee Chairman Ron Menor, D-17th (Mililani, Waipi'o), said that the bill will withstand legal challenges and that Hawai'i drivers "continue to pay the highest gasoline prices in the country without acceptable justification."

Menor said the bill targets wholesale prices because increased wholesale prices force many dealers to raise prices at the pump to maintain limited profit margins. Capping wholesale prices would give dealers more flexibility to lower prices to be competitive.

A state-commissioned study conducted in part by Irvine, Calif.-based Stillwater Associates and released last year predicted that price caps would lead to higher prices and possible shortages.

The latter part of the daylong House session was dominated by debate over a wide-ranging workers' compensation reform package offered by the administration in an attempt to address concerns raised by business interests about rising costs.

Administration officials say that of nine key components offered by the governor and Labor Director Nelson Befitel, only one remains alive after half the session. That remaining provision, contained in House Bill 1374, would entitle those investigating an occurrence of workers' compensation fraud to recoup medical and other care costs, attorneys' fees and other costs if a successful determination is made.

Opinion: VOLCANIC ASH
Raw issue handled with dignity
By David Shapiro
The Honolulu Advertiser
Wednesday, March 10, 2004

The Legislature's handling of "death-with-dignity" bills in the past three years has been defined by the dignity with which lawmakers have addressed this emotional issue.

The debate has been mostly high-minded and respectful as legislators consider whether terminally ill patients should have the right to physician assistance if they choose to end lives that have lost all quality to intolerable pain or disability.

Two years ago, the House voted to allow patients within six months of death to request lethal prescriptions under strict limitations, but the measure fell two votes short in the Senate.

The House Judiciary Committee revived the bill this year, passing it to the full House by a vote of 10 to 5. Whether it becomes law or not, the committee showed courage in standing up for an important matter of personal choice in a contentious climate of election-year politics.

The committee's vote, which followed four hours of divided public testimony, was absent of petty partisanship. The majority included two Republicans and the minority included three Democrats.

This legislation doesn't affect many people; fewer than 130 Oregon patients took advantage of that state's groundbreaking law in the four years after it passed. But it's a blessing for those who need it and a comfort for others who fear their day is coming.

Opponents include Gov. Linda Lingle, many advocates for the disabled, certain religious groups and segments of the medical community. They worry that physician-assisted suicide is a "slippery slope" that ultimately could lead to euthanasia and mercy killings.

The right to die, they fear, could become a duty to die for elderly and disabled people whose lives are wrongly deemed to be burdensome and without quality by those who would benefit from their death.

These are worthy concerns, but they don't address the legislation now before us.

This is not a euthanasia bill. Few advocates of physician-assisted suicide support mercy killings in which the decision to end life is made by anybody except informed individual patients.

Under the current legislation, lethal prescriptions could be obtained only by competent patients certified to be near death. Requests must be oral and in writing, and there's a 15-day waiting period before the prescription can be written.

Doctors must counsel patients on other alternatives for end-of-life care and screen for mental illness, treatable depression and factors such as outside pressure.

Physicians would have no role in administering the lethal medication; patients would have to do that themselves.

Under these guidelines, there's little chance elderly, disabled or mentally ill patients who can't competently speak for themselves could legally obtain lethal prescriptions.

Opponents are right that end-of-life care and pain management are getting better, but top care is not universally available and other options are needed for those who wish to end unbearable suffering on their own terms.

It comes down to rightful choice. When there is no clear truth on a matter so personal, the decision should rest with the individual, not the government.

Rep. Joe Souki of Maui recognized this when he said that even though his own religious faith opposes suicide, he has no right to impose his beliefs on others who feel differently.

Rep. Ezra Kanoho of Kaua'i was forthrightly honest in explaining his "yes" vote: "If the time comes for me, I would like to have this option at my disposal."

That's exactly the point. Deep down, it's a choice most of us would like to have for ourselves. How can we deny the comfort to those who need it now?

- David Shapiro can be reached at dave@volcanicash.net.

OUR OPINION
Terminally ill deserve the right to choice in dying
Honolulu Star-Bulletin: EDITORIALS
Monday, March 8, 2004

THE ISSUE

The House Judiciary Committee has approved a bill that would allow physicians to assist terminally ill patients wishing to end their lives.

SIX years have passed since a blue-ribbon panel appointed by then-Gov. Ben Cayetano recommended that physician-assisted death of terminally ill patients be permitted in Hawaii. The state House approved the measure two years ago but the Senate defeated it by two votes. The Legislature is considering the proposal in the current session and should not delay its enactment yet another year.

Like previous versions, the measure before the Legislature would allow a terminally ill, competent adult to obtain a lethal dose of medication for the purpose of ending his or her life. Opponents, including Governor Lingle, warn that enactment of such legislation would create a "slippery slope," but the bill specifically prohibits mercy killings, lethal objections and active euthanasia.

As pointed out in a Feb. 12 column on these pages by Roland L. Halpern, executive director of Compassion In Dying of Hawaii, the bill before the Legislature includes more than a dozen safeguards to prevent abuse. Doctors must counsel patients on alternative forms of treatment, the patients must be physically able to self-administer the lethal medication and the patients are subject to a mandatory waiting period.

The House Judiciary Committee approved the bill last week by a 10-5 vote and sent it to the full House. The proposal's chance of passage are promising in the House. As in 2002, a closer battle is expected in the Senate.
The bill is similar to Oregon's Death With Dignity Act, ratified by 60 percent of that state's voters in 1997. Since it became law, 129 Oregonians asked for a prescribed lethal dose through 2002, the most recent year in which data is presently available.

Far more patients have taken their own lives by refusing to eat or drink, according to a national survey last year of 1,902 doctors, nearly 400 of whom had been asked by terminally ill patients for assistance in dying. Doctors agreed to assist 80 patients in dying, even though Oregon is the only state where such aid is legal.

Medical advances have allowed people to live beyond their expectations and, in many cases, their desire. Rep. Marilyn Lee, a Judiciary Committee member who voted for the bill but with reservations, suggests that similar advances have led to medications that relieve pain and suffering. "Really," says Lee, a nurse for 35 years, "no one should be in constant pain in today's world."

However, Oregon patients who were ready to die cited their poor quality of life created by their terminal ailments, not pain and suffering. Such terminally ill patients should be allowed assistance in ending their lives with dignity.

Bill on assisted suicide advances
By Lynda Arakawa
The Honolulu Advertiser
Friday, March 5, 2004

A controversial bill allowing terminally ill patients to obtain a lethal prescription to end their lives passed the House Judiciary Committee yesterday and is headed for a full House vote.

The committee voted 10-5 to advance House Bill 862 after more than four hours of testimony that was sometimes emotional and largely divided on the issue.

But the chances of this controversial bill becoming law are unclear, particularly in an election year.

The state House in 2002 passed a similar assisted-suicide bill backed by then-Gov. Ben Cayetano by a 30-20 vote, but the measure failed in the Senate in the final days of session, with senators voting 14-11 to shelve it.

Senate President Robert Bunda, D-22nd (North Shore, Wahiawa), yesterday said the Senate would give the bill a fair shot, but that it's hard to say whether it would pass.

Also, Gov. Linda Lingle has said that she is against physician-assisted suicide, calling it a "slippery slope" that could lead to euthanasia.

The "death-with-dignity" bill would allow terminally ill, mentally competent patients to obtain a lethal dose of medication that they would take themselves. A doctor would determine the competency of the patient.

More than 150 people spoke before the committee or submitted written testimony, which underscored the divided opinions even within the healthcare community and religious organizations.

Those who supported the bill said terminally ill patients should be given the ability to choose how they die and that the proposed law has safeguards against abuse.

Opponents said allowing physician-assisted suicide would make patients feel they have an obligation to die and would hinder efforts to improve end-of-life care.

Kona resident Sammie Stanbro urged lawmakers to support the bill and talked about how her late 60-year-old husband, Phil, suffered from cancer that spread to his bones. She said he had tried unsuccessfully to take his own life by overdosing on his medicine.

Stanbro said her husband was paralyzed from the waist down, requiring family members to turn him in bed and change him. Despite hospice care and pain medication, he still suffered from bouts of pain, she said.

"He wanted to be able to end his life when he wanted to," she said.

But physician-assisted suicide will lead to uncontrollable abuse because the bill's safeguards are inadequate to protect people, particularly the elderly, from those who would benefit from their deaths, said Jackie Mishler, a registered nurse.

"I oppose physician-assisted suicide because we should treat pain and suffering, not avoid it by killing the sufferer," Mishler said. "That cheap and dirty fix will ultimately undermine real compassion, take away funding and interest in pain management, and create a host of new victims among the disabled, the underserved, and those who can't speak for themselves."

Chris Nienczyk, a graduate student who has cerebral palsy, said that allowing physician-assisted suicide is "frightening, especially for persons with disabilities" who have been dealing with medical conditions all of their lives.

Policymakers are talking about the terminally ill today, but tomorrow the discussion might turn to Alzheimer's patients or people with disabilities, he said.

Dr. Leonard Howard, past president of — and speaking for — the Hawaii Medical Association, said physician-assisted suicide is fundamentally inconsistent with a doctor's role as a healer. He said significant progress is being made to educate doctors and other healthcare professionals about pain management and end-of-life care.

Robert "Nate" Nathanson, a retired physician and founder of Hawaii Physicians for Assisted Dying, said doctors must respect a patient's right to self-determination in end-of-life choices when all other reasonable efforts to relieve suffering have failed. He said a small percentage of patients want help in hastening their death, but it is a "major blessing" for the few who do.

The Rev. John Heidel of Religious Leaders for Assisted Dying, made up of 15 leaders of Buddhist, Jewish and Christian faiths, said the issue is a matter of personal choice.

"Just as we should be free to worship according to our individual understanding of faith, we should have the freedom in making our own end-of-life choices," he said.

Oregon is the only state where terminally ill patients can legally obtain lethal prescriptions from their doctors.

The House bill prohibits mercy killings, lethal injections and euthanasia and requires physicians to counsel patients on alternatives, including comfort care, hospice care and pain control. Patients with mental illness would not be allowed to receive lethal medicine.

Qualified patients also would be required to make an oral request and a written request to their physicians and would also have to ask the physician again at least 15 days after their initial oral request.

The committee yesterday amended the bill to strengthen residency requirements to prevent people from coming here to take advantage of the law.

Before voting, committee members discussed their feelings about the issue.

Rep. Cynthia Thielen, R-50th (Kailua, Mokapu), choked up as she talked about caring for her mother, who had cancer.

"I don't know if she would have chosen to use death with dignity, but I strongly believe that she should have been afforded that choice," Thielen said.

Rep. Alex Sonson, D-35th (Waipahu, Crestview) said he was not convinced that safeguards were adequate.

Rep. Joe Souki, D-8th (Wailuku, Waiehu), said the faith he belongs to is against suicide. "But I cannot, in good faith, transfer the personal feelings that I have ... on other faiths and other people that may have different feelings."

Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or at 525-8070.

Death with dignity isn't going away
The Honolulu Advertiser: EDITORIALS
Thursday, March 4, 2004

Lawmakers don't reintroduce a death-with-dignity measure year after year just for the fun of it.

And this session is no different.

Since 1999, legislative hearings on physician-assisted suicide in Hawai'i have become increasingly filled with the terminally ill who are weary of pain and loss of control and fearful that they are overburdening the burned-out friends and relatives who take care of them.

There are also several organizations that lobby strongly in favor of death with dignity. Needless to say, many of their members are elderly.

And of course there's staunch opposition, ranging from religious to medical.

"I realize that it's an emotional issue, but there's a significant number of residents who support this legislation and they should be heard," said Rep. Scott Saiki, House majority leader.

Not only should they be heard at today's hearing before the House Judiciary Committee, but lawmakers should seriously consider advancing such legislation, despite Gov. Linda Lingle's objection that physician-assisted suicide is a "slippery slope."

This is not uncharted territory. Hawai'i's law would be modeled on Oregon's physician-assisted suicide law, which is chock full of safeguards. That law has survived a federal court challenge and a repeal effort, and was supported by a 1997 U.S. Supreme Court ruling in favor of states' rights to pass such a law.

Oregon is not deluged with suicides nor abuses of the law. On the contrary, physician-assisted suicides accounted for just 0.1 percent of all deaths in 2002, according to the most recent study available.

Importantly, experts say the law has forced Oregon's healthcare system to improve palliative care and pain management, which is a goal all in Hawai'i should share. If the death-with-dignity debate advances the quality of palliative care in the Islands, that alone would be a victory.

If physician-assisted suicide ever becomes law in Hawai'i, we'd bet that few will avail themselves of it. The will to live is more powerful than we know. But in the rare case when the will to die is stronger because of the magnitude of pain and lack of relief, compassion should be shown.

Hearing set on 'death-with-dignity' bill
By Lynda Arakawa
The Honolulu Advertiser
Wednesday, March 3, 2004

The House Judiciary Committee will hear a controversial bill tomorrow that would allow terminally ill patients to end their lives.

House Bill 862, which carried over from last session, would allow terminally ill, competent patients to obtain a lethal dose of medication that they would take themselves. It was introduced last year by Reps. Blake Oshiro, D-33rd (Halawa, 'Aiea, Pearlridge); Eric Hamakawa, D-3rd (Hilo, Kea'au, Mt. View); Scott Saiki, D-22nd (McCully, Pawa'a); Marcus Oshiro, D-39th (Wahiawa); and Sylvia Luke, D-26th (Punchbowl, Pacific Hts., Nu'uanu Valley).

The hearing will be held at 9 a.m. in the auditorium of the State Capitol.

"The death-with-dignity legislation raises multifaceted issues, and it may be a good time for the Legislature to publicly discuss those issues," said Saiki, House majority leader. "I realize that it's an emotional issue, but there are a significant number of residents who support this legislation and they should be heard."

But it's unclear whether this highly emotional and divisive bill has a chance of becoming law, particularly in an election year.

Saiki estimated the bill has a "50-50" chance of passing in the House, and that its chances in the Senate are probably lower.

Also, Gov. Linda Lingle said during the 2002 gubernatorial campaign that she is against physician-assisted suicide, calling it a "slippery slope" that could lead to euthanasia.

Supporters of the bill say patients have a right to end their lives with dignity and that it will improve end-of-life care. Opponents, however, say it will open the door to abuses and put pressure on patients to commit suicide.

Kane'ohe resident Ruth Nakagawa, who watched her 45-year-old son suffer from cancer before dying in 1993, supports the bill.

"He used to ask me, 'Oh, Mom, I wish Dr. Kevorkian was here to help me ease the pain,' " Nakagawa said."But there was nothing I could do. ... My son really went through pain."

Dr. Jack Kevorkian, who is serving a 10- to 25-year sentence for helping a terminally ill man die in 1998, has said that he has assisted in more than 130 suicides.

Nakagawa said policymakers should leave the decision up to patients and their doctors.

"It's not for somebody to dictate to us what should be done and what should not be done," she said.

But allowing for physician-assisted suicide would remove focus from improving end-of-life care, said Eva Andrade, Hawai'i Family Forum communications director, who added that there are better medical alternatives

"We believe that the practice of doctor-assisted suicide creates a duty to die," she said. "We think that death would become a reasonable substitute to treatment and care. ... With today's pain management techniques, we believe that up to 99 percent of patients can receive treatment so that they don't suffer needlessly. We also believe it would destroy the delicate relationship between a doctor and a patient."

Andrade also said such a law would open the door to abuses and that safeguards cited by proponents will not work.

The bill prohibits mercy killings, lethal injections and euthanasia and requires physicians to counsel patients on alternatives, including comfort care, hospice care and pain control.

Patients who also suffer from a mental illness would not be allowed to receive the lethal medicine.

Qualified patients also would be required to make an oral request and a written request to their physicians, and would also have to ask the physician again at least 15 days after their initial oral request.

Roland Halpern, executive director of Compassion in Dying of Hawai'i, said end-of-life care has improved in Oregon, the only state where terminally ill patients can legally obtain lethal prescriptions from their doctors. He said the House bill is modeled after Oregon's law.

The Oregon law has survived a federal court challenge and a repeal effort, and was supported by a 1997 U.S. Supreme Court ruling that said that there is no constitutional right to assisted suicide but that states have the authority to pass such a law.

The New England Journal of Medicine has reported that doctors wrote 58 prescriptions in 2002 for terminally ill patients who qualified under the voter-approved Oregon law, and 38 committed suicide. Most of those who ended their lives were older, well-educated cancer patients, and assisted suicides accounted for 0.1 percent of deaths that year.

The state House in 2002 passed a similar assisted suicide bill backed by then-Gov. Ben Cayetano but the measure failed in the Senate in the final days of the session.

Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or at 525-8070

Onstage suicide isn't death with dignity
The Honolulu Advertiser: EDITORIALS
Wednesday, October 1, 2003

We back the right of terminally ill patients to die with dignity, and have urged Hawai'i to pass legislation modeled on Oregon's physician-assisted suicide law.

But our support for allowing the dying diseased to end their lives on their own terms in no way sanctions a publicity stunt by a Mainland hard-rock band to "raise awareness that physician-assisted suicide be legalized in Florida."

The Tampa-based band had planned an onstage suicide at a show at the State Theater in St. Petersburg. It claimed a terminally ill person would kill himself during the show.

Not surprisingly, the theater's owner canceled the event, and the St. Petersburg City Council approved a ban on suicide for commercial or entertainment purposes. Meanwhile, a state judge granted a temporary injunction to prevent the band from advertising the show and allowing the suicide.

Undeterred, the band says it has moved the show to an undisclosed location on Saturday, and will show the suicide on the Internet. Sounds to us like a tasteless stunt and little else.

This is not the way to advocate for physician-assisted suicide. On the contrary, such exploitative exhibitionism demeans a serious issue and harms the cause of many committed people.

Where's the dignity in that?

Give terminally ill option of doctor's aid
The Honolulu Star-Bulletin: EDITORIALS
Saturday, July 26, 2003

THE ISSUE
Studies show doctors are illegally prescribing lethal doses to terminally ill patients, while other patients are speeding their own deaths.

OPPONENTS of physician-assisted suicide should not be under the illusion that terminally ill patients in Hawaii are not finding ways to die with dignity, or that physicians are not helping them to do so. National surveys indicate that a significant number of doctors are honoring requests for lethal prescriptions or injections, and many patients are bringing about their own deaths by refusing to eat or drink. Hawaii's lack of a "death with dignity" act means only that the terminally ill are denied the most humane method of bringing their suffering to an end.

Hawaii's House approved an assisted-suicide bill patterned after the Oregon law last year but the Senate defeated it by a single vote. Governor Lingle has opposed such legislation. As more is learned about the issue, Hawaii's Legislature and the governor should reconsider.

Of 1,902 doctors responding to a survey published this month in the Archives of Internal Medicine, nearly 400 said they had been asked by terminally ill patients for aid in dying, and more than half of those doctors told patients they would honor the requests under some conditions. One prominent condition was that the patient not be depressed at the time of the request. Eighty patients were assisted by their physicians in dying, even though it is illegal in all states except Oregon.

Although 129 patients in Oregon have been assisted by doctors in dying since that state's Death with Dignity Act went into effect three years ago, nearly twice as many terminally ill Oregonians are speeding their own deaths without physicians' help, according to a study published Thursday in the New England Journal of Medicine. One-third of the more than 300 nurses reported that they had cared for terminally ill patients who chose to stop eating or drinking to speed their deaths. Such patients usually die within two weeks of beginning their fasts.

In both physician-assisted suicides and those that are entirely self-induced, the patients are reported not only to be terminally ill but to have decided their quality of life was poor and they were ready to die, but they were not depressed. The Oregon law requires that the patient has been diagnosed to die within six months. Doctors are allowed to write lethal prescriptions but not administer the drug, which the patients swallow on their own.

And disappointments ...
The Honolulu Advertiser: EDITORIALS
Tuesday, April 29, 2003

That said, we're compelled to mourn the apparent death of several needed bills, including ones intended to bring about school, election and road safety reforms and to alleviate end-of-life suffering.

It has consistently been our contention that public schools could improve dramatically under the leadership of more autonomous and dynamic principals. This could be achieved by taking principals out of the union, paying them executive salaries and placing them on performance contracts. Alas, lawmakers killed a bill to abolish the principals' union so we won't have the opportunity to test that theory.

Also dead is a bill to give the student Board of Education member a vote, except on issues related to fiscal and personnel matters. Frankly, we fail to see the threat.

On the issue of campaign reform, we're sorry that the Legislature isn't ready to give publicly financed elections a shot. Gone is a proposal that would have provided alternative funding for candidates running for legislative seats who voluntarily stick to financial limits. The system would help remove the public perception that politicians are disproportionately influenced by special interests. Too bad it didn't fly.

As for road safety, it's a pity that red-light runners won't be monitored via traffic cameras, because they pose a huge threat. A Senate bill would have authorized the Department of Transportation to contract with a private vendor to set up such a photo enforcement system. Unfortunately, it looks as though the DOT's earlier failed traffic camera program to nab speeders poisoned the water for any future campaigns.

And last but not least, we lament the repeated rejection of physician-assisted suicide in Hawai'i. A Senate bill would have allowed a terminally ill, competent adult to obtain a lethal dose of medication to end his or her life. This is a matter of choice and compassion, and we will continue to rally in support of it.

Oregon not deluged with assisted suicides
The Honolulu Advertiser: EDITORIALS
Monday, March 10, 2003

A report just published in the New England Journal of Medicine suggests that Oregon's five-year-old "Death with Dignity" law has not - as critics predicted - opened the floodgates to abuse. On the contrary, physician-assisted suicides accounted for just 0.1 percent of all deaths.

If families, physicians and others were using the law to goad burdensome relatives or patients to end their lives, we'd presumably be seeing much higher numbers than the following:

A total of 129 terminally ill Oregonians have committed physician-assisted suicide since the law went into effect in 1998. Last year, 38 people died by way of prescribed lethal medications.

The numbers suggest to us that Oregonians who voted for the law did so not because they planned to end their lives, but because they wanted the comfort of knowing they had that choice. And experts have drawn similar conclusions.

"People say they want the option, but very few people are really interested in availing themselves of this option," says Dr. Steve Miles, director of the Center for Biomedical Ethics at the University of Minnesota Medical School.

Most Oregonians who opted for physician-assisted suicide were well-educated cancer and Lou Gehrig's disease patients. And most cited as their primary reasons: loss of independence, inability to participate in activities that make life enjoyable and loss of control of bodily functions.

According to Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania School of Medicine, the law has forced Oregon's healthcare system to improve palliative care and pain management. That's a positive side effect that must certainly play a role in Hawai'i's debate over physician-assisted suicide.

We're not saying that the drumbeat for physician-assisted suicide in Hawai'i would be entirely silenced if palliative care and pain management were vastly improved. But these areas certainly deserve attention, and bettering them would remove some of the incentives for terminally ill patients to end their lives.

Ideally, "Death with Dignity" in Hawai'i would work the same way as it does in Oregon, with few people opting for physician-assisted suicide yet having the comfort of choice.

Another undignified year for death with dignity
The Honolulu Star-Bulletin
Gathering Places
Friday, March 7, 2003

Last Friday I had the rather unpleasant task of contacting my clients to let them know that Hawai'i's Death with Dignity bill did not get a hearing this year. My clients, all of whom are dying, had been hoping that Hawai'i, like Oregon, would finally pass a law that allowed a competent and terminally ill adult the right to ask for a lethal dose of medication to hasten their death, and thus end what is often prolonged suffering.

When asked why, I couldn't answer other than to proffer that perhaps some legislators were swayed by pressure from right-to-life groups; or perhaps they simply felt there were more pressing issues than easing the suffering of a small number of people; or perhaps, as one rather curmudgeonly client I have grown fond of replied, "Dead people can't vote, so they don't give a damn about us."

Whatever the reasons, Hawai'i once again has failed to enact legislation that would help our terminally ill citizens -- and the failure isn't limited to assisted dying. The Legislature didn't pass a single bill aimed at correcting the other end-of-life problems identified in a national study in which Hawai'i received a negative rating for our failure to have adequate end-of-life pain-management policies.

What might have happened if the law had passed? Rather than speculate, we can look to Oregon. In its five years of experience with assisted dying there has not been a single documented case of abuse, nor did opponents' claims that Oregon would become a suicide haven ever materialize. What did occur was a tremendous improvement in end-of-life care. The terminally ill began receiving better treatment through increased utilization of pain medication, increased hospice referrals and the creation of more special care units.

Lifting the stigma of assisted dying made patients more comfortable in approaching their physicians about end-of-life concerns. Physicians reported that following the required counseling, which includes presenting patients with options such as hospice, palliative care and better pain management, roughly 46 percent of patients changed their minds about wanting a hastened death. Of those patients who received the medication, fewer than half used it, and many patients were comforted in knowing that if all else failed they had another option.

Following passage of the Oregon law, surveys showed that 88 percent of physicians reported that they had tried to improve their knowledge of the use of pain medication, 76 percent sought to improve their ability to recognize psychiatric illnesses such as depression, and 86 percent reported that their confidence in the use of pain medication had improved -- all numbers that the Hawai'i Medical Association can only envy.

For the second year in a row, polls conducted by QMark Research showed that more than 70 percent of Hawai'i's voters believe a competent, terminally ill adult should have the right to ask for a physician's assistance in hastening their death. And this year's poll was conducted after opponents of assisted dying had spent tens of thousands of dollars in negative television, radio and newspaper advertising. Perhaps if some legislators had watched less TV and instead listened to their constituents, things might have turned out differently.

But for now, many of our terminally ill must endure the pain or find some clandestine means to end their lives.

"There's always next year," I say, trying to reassure another client.

"I'll be dead by then," was his reply. He knows it, and I know it too. I can only hope that his death is a dignified and peaceful one, the kind of death he should have been legally entitled to.
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-Roland L. Halpern is executive director of Compassion in Dying of Hawai'i.

Letters to the Editor
The Honolulu Advertiser, Honolulu, HI
Monday, February 24, 2003

How to die should be a matter of choice

I was impressed by Yasmin Anwar's well-written piece on her father's death (Focus, Feb. 16). I want to thank her for being candid about her family and her own suffering as she had to deal with this issue.

How we are to die should be a matter of personal choice, and, since I am paraplegic, access and choice are important to me every day. They certainly will be just as, if not more, important to me as my time on this Earth draws to a close. Why should what little control I have worked so hard to achieve be so completely taken away from me as I face death?

It is not for me to deny a prolonged death to those who wish to follow their own religious beliefs, but neither is it for them to deny me a hastened death when "my spirit is barely flickering in the frail shell that once was my body."

I hope Hawai'i will soon show the way to the other states by being the first to follow Oregon. Hopefully, the citizens of this beautiful island state have spoken loudly enough in recent polls that legislators will have heard the voice of their own people over the din of negative campaigning and will vote to ensure this last, ultimate civil right.

-Paul A. Spiers
Chairman-elect, board of directors, The Hemlock Society & Foundation

'Death with dignity' foes misrepresent its aim

Much of the voiced opposition to a "death with dignity" bill here has misrepresented both the philosophy and the specifics of such legislation.

The bill "prohibits mercy killing, lethal injection and active euthanasia." Instead, it would allow a competent and terminally ill adult the right to request a prescription for medication to hasten death when all reasonable efforts to relieve pain and suffering have proved ineffective.

The Oregon experience, where assisted dying has been legal for more than five years, has identified no slippery slope of abuse of this law.

Typically, those who choose this option are at the very end of their lives. They do not want their few remaining days spent tethered to tubes and wires, often unable to eat, speak or go to the bathroom themselves. To palliate pain with extremely heavy drug dosage can reduce "life" to other physical miseries that are humiliating and degrading.

Death is inevitable. The ability of a terminally ill, mentally competent adult to make that decision is the ultimate civil liberty and should not be infringed upon by those who would not make that choice.

-Robert A. Wilcox
Kailua

Difficult decisions on dying
The Honolulu Advertiser, Honolulu, HI
Sunday, February 16, 2003

By the time my father, Makhdum Mohammad Anwar, was moribund, his mind was so feeble that my brother, Ralph, and I were forced to play an exhausting guessing game.

In his hospital room overlooking a courtyard where smokers gathered, we had to guess whether he wanted to eat or not, sleep or not, be touched or not.

We had to guess whether to play his old favorites, Miles Davis and Nina Simone, or the qawwali music of his native Pakistan.

We had to guess whether he wanted to be buried in a traditional cemetery or under a tree in a forest. Though born a Muslim, my father was not a religious man. He smoked, drank heavily and bristled at any kind of dogma.

But just to cover all the bases, we smothered his hospital room with icons and scriptures representing every spiritual practice on the planet. If there was a hell, we were going to do everything in our power to keep him out of there.

Each day, we had to decide anew how much effort the doctors should exert to keep him alive. And we had to endure the sheepish looks of physicians who saw our father as their failure rather than a once-brilliant yet stubborn man.

There came a point when our father could no longer tolerate a feeding tube. The nurses told us he was aspirating the food into his lungs. Should they keep trying or take the tube out? Again, we had to guess what he would want.

And so we played make-believe that our father miraculously became lucid. For five minutes, his sassy spirit seeped back into his body and he could communicate with us.

We explained to him the cruel barrage of ailments that were ravaging him: diabetes, chronic dementia, immobility, pneumonia, high blood pressure, a bed sore that refused to heal.

"Bloody hell, let me go in peace," he told us.

And so we let him go. No more tubes, no more cheerleading and lots of morphine. "Go to the light," the Filipina nurse called out a few days later as he faded into a well-deserved oblivion.

I bring this up because Hawai'i has been debating for some years the pros and cons of physician-assisted suicide, or "death with dignity." We've gathered reams of research on all its legal, medical and moral ramifications. But with both sides as polarized as abortion foes and supporters, we don't expect this issue to be resolved any time soon, let alone become a law.

It's true that top-notch palliative care can assuage those who see dying as the only alternative to pain and depression. Hospice provides comfort and dignity to the terminally ill, and can make their final days bittersweet.

But what about those whose spirits are barely flickering in the frail shells that once were their bodies? Shouldn't they have had the choice to pull the plug before the indignity of feeding tubes, diapers, fear, confusion and the inability to recognize the children they raised?

I don't know whether my father would have opted for physician-assisted suicide while he was still lucid. Perhaps he wouldn't have. The point is, he never had the choice.

Yasmin Anwar, an Advertiser editorial writer, can be reached via e-mail at yanwar@honoluluadvertiser.com.

Copyright 2003 The Honolulu Advertiser (Honolulu, HI). All Rights Reserved .

Poll says voters support death with dignity legislation
Pacific Business News, Honolulu, HI
Wednesday, February 13, 2003

About 71 percent of Hawai'i voters support proposed death with dignity legislation, according to a QMark Research & Polling survey.

A similar QMark study a year ago showed the same level of support when the bill was first introduced, the company said.

The question in the survey asked voters if they would support or oppose legislation allowing the terminally ill people with sound minds the right to have physicians assist them in dying if there were appropriate safeguards to protect against abuse.

"The strong support for death with dignity in the face of very vocal and well funded opposition has not eroded in the least," said Barbara Ankersmit, QMark president. "People in Hawai'i clearly want control over their end-of-life decisions and a full range of options to choose from, including a hastened death."

QMark polled 500 residents statewide from January 4 to February 1.

(c) 2003 American City Business Journals Inc.