Hawaii's World

by A.A. Smyser

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It is timely because, by a U.S. appeals court decision, a window of opportunity for such deaths is open right now in Hawaii and eight other Western states. The U.S. Supreme Court conceivably could extend the opportunity nationally as early as next year by upholding the Western region decision.

The model act in many respects matches a law approved by Oregon voters in a 1994 referendum but meets several of the objections to that act raised by a federal district judge in Oregon.

The nine authors of the proposed law - two years in the drafting -are from the fields of law, medicine, philosophy and economics. Their spokesperson is Charles H. Baron, professor of law at Boston College. Their product is detailed in Volume 33, issued in January, of the Harvard Journal on Legislation.

They say they chose a long-form law, setting forth detailed procedures, instead of a short form, primarily protecting physicians from liability if the cases met certain criteria.

The long form, they acknowledge, is intrusive to the patient's privacy. It requires a request for assistance made on at least two separate occasions at least 14 days apart with no contrary expression in between.

It requires one verification in writing by another "responsible physician" and another by a licensed psychiatrist, clinical psychologist or psychiatric social worker. It requires that the patient be fully informed of other options such as hospice care and pain control.

All these records are to be filed with an appropriate state officer but considered confidential. They will not identify the patient except for a coded reference.

The argument for this intrusiveness is that it protects both physician and patients and guarantees against going down the "slippery slope" to casual suicide, even murder, that foes of assisted suicide say will be abused.

A distinction is made on "assisted suicide" in which a physician prescribes a potion and - preferably, say the authors -attends the death while the patient self-administers the potion. The model law does not approve the alternative of "euthanasia," in which the physician actively administers death.

All hospitals and health personnel who choose to abstain for reasons of conscience are protected, as are the people who help administer death so long as they meet the requirements of the law. Under the proposed law, life insurance could not be voided.

The privilege of physician-assisted death is limited to persons 18 or older suffering "intractable and unbearable illness." This is defined as "a bodily disorder (1) that cannot be cured or successfully palliated, and (2) that causes such severe suffering that a patient prefers death."

THIS definition split the commission, with the minority favoring limiting assisted suicide to the terminally ill. The broader definition, the report says, could cover cases "such as AIDS, advanced emphysema, some forms of cancer, amyotrophic lateral sclerosis, multiple sclerosis and many other debilitating conditions."

One of Hawaii's leading thinkers on medical ethics is Kenneth Kipnis, professor of philosophy at the University of Hawaii. He says we must decide soon how to handle assisted suicide, yet are woefully unprepared. The Harvard proposal could provide a starting point for a Hawaii blue ribbon committee to develop a recommendation for the 1997 Legislature.