Gathering Places


Friday, March 7, 2003

Another undignified year
for death with dignity

Last Friday I had the rather unpleasant task of contacting my clients to let them know that Hawaii's Death with Dignity bill did not get a hearing this year. My clients, all of whom are dying, had been hoping that Hawaii, 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, Hawaii 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 Hawaii 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 Hawaii Medical Association can only envy.

For the second year in a row, polls conducted by QMark Research showed that more than 70 percent of Hawaii'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.

Roland L. Halpern is executive director of Compassion In Dying of Hawaii.

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