Changes Would Make Hawaii's Aid-In-Dying Law More Accessible

Feb 16, 2021

HILO — Proposed changes would make Hawaii's aid-in-dying law more accessible for terminally ill patients who want to end their lives.

The state House and the Senate are considering updates to the law that would change the length of waiting periods and expand the types of health care professionals who can consult on cases, the Hawaii Tribune-Herald reported  Monday.

The 2019 law allows Hawaii residents 18 and older who are diagnosed with a terminal illness and given a prognosis of six months or less to live to get prescriptions to end their lives.

The prescriptions can be obtained after two verbal requests to a doctor, a written request with two witnesses and a mental health evaluation to ensure those seeking assistance are capable of making their own medical decisions.

Proposed changes include allowing advanced-practice registered nurses to attend or consult medical providers and adding psychiatric mental health nurse practitioners to those who can provide counseling consultations.

The measures also would reduce the minimum waiting period between verbal requests from 20 to 15 days and allow medical providers to waive the waiting period if they believe patients will die before the 15 days lapse.

The proposed changes are in line with recommendations from the state Department of Health. Officials and advocates say people struggle to use the law on islands outside of Oahu.

"Access remains limited on the neighbor islands, particularly on Kauai where there are no participating attending providers," department spokeswoman Janice Okubo said.

Dr. Charlotte Charfen, co-founder of the nonprofit organization Life and Death Wellness, was one of two health care providers on the Big Island who wrote prescriptions under the law last year.

"At this point, I've now helped six people, written six prescriptions since the law was enacted, and each one came to me because they didn't have a physician to be able to help them," Charfen said.

Sam Trad, state director for Compassion and Choices, which advocates for end-of-life rights, said access has been an issue.

"It's very difficult, especially on the neighbor islands, to access the law and can be very difficult to find a provider, especially with the growing shortage of physicians," Trad said.

Many doctors had patients who met the requirements and wanted help ending their lives but died during the mandatory waiting period in ways they hoped to avoid, Trad said.

"It's not just for privileged people in Honolulu. It's for every dying resident of Hawaii who wants this compassionate end-of-life option," Trad said.