Hawaii Passes Medically-Assisted Suicide Law

Hawaii is now the seventh state to legalize physician-assisted suicide, as Gov. David Ige signed a bill into law Thursday that would allow doctors to fulfill prescriptions for life-ending medication for terminally ill patients.

The state joined California, Colorado, Oregon, Vermont, Washington, and the District of Columbia as the only US territories to allow the practice. Hawaii’s leglislation requires at least 2 health care providers to confirm the patients’ diagnoses and requests for life-ending medication, while a counselor must confirm the patient is not suffering from any judging-interfering conditions such as depression.

The patient must also make 2 requests for the medication — with a 20-day wait period between each request — and sign a written request in front of 2 witnesses.

Hawaii legislators noted in the bill that palliative care, voluntary starvation and dehydration, or stopping artificial ventilation are all options taken upon dying individuals to progress their deaths. But these options are not always offered by physicians, and do not always result in the quick or peaceful death desired by patients.

Advances in technology mean that the process of dying can be extended even when no cure or likelihood of successful medical intervention exists,” legislators wrote. “This can often result in terminally ill patients undergoing unremitting pain, discomfort, and an irreversible reduction in their quality of life in their final days.”

Euthanasia and physician-assisted suicide are still very limited policies worldwide. A July 2016 study reported that just Belgium, Canada, Colombia, Luxembourg, the Netherlands, and Switzerland are the only countries to have legalized such practices.

The same study noted that, from 2005-2012, US public support for physician-assisted suicide for patients with incurable diseases decreased from 75% to 64% (as per a Gallup representative survey). When the survey question was changed to consider suicide for patients with “severe pain,” public support dropped by at least 10%.

In analysis of the practice itself, researchers found that physician-assisted suicide and euthanasia are increasingly being legalized, remain rare in incidence, and primarily involve patients with cancer. They could also not find existing data which indicated widespread abuse of either practice.

Switzerland became the first country to legalize physician-assisted suicide in 1942. In its 7 decades of practice, the procedure is apparently becoming more common. An April 2016 study reported that, in 2013, 58.7% of all sampled death certificates included at least 1 end-of-life decision by the patient — an increase from the 52% reported in 2001 (P < 0.001).

Physician-assisted suicide increased from 0.3% in 2001 to 1.1% in 2013 (P < 0.001), as did the method of continuous deep sedation until death. Sedation was practiced in 4.7% of all reported deaths in 2001, to 17.5% in 2013 (P < 0.001). It was combined with the forgoing of life-prolonging treatment in 62% of cases, and physician-assisted death in 3% of cases.

Researchers speculated the greater implementation of sedation may be in due part of the 2005 Swiss Association of Palliative Care guidelines on palliative sedation.