MEDIA focus, understandably, has been on the physician-assisted death recommendations of the Governor's Blue Ribbon Panel on Living and Dying With Dignity, on which I served. In terms of relieving suffering, however, our two key recommendations are for far more extensive use of hospice care by terminally ill patients and for universal pain control among the terminally ill. More people should
use hospice careThese can bring greater comfort to most of the 8,000 people who die in Hawaii every year. Too many dying people suffer needlessly -- on the order of perhaps a few thousand a year.
On the other hand, 300 would be a high figure for people to request and get physician-assisted death in any one year.
Oregon, where physicians now may prescribe fatal potions to terminally ill people, had two turbulent referenda to approve it -- the first in 1994, the second in 1997.
In the course of the multi-bucks fights, both the advocates and the foes of assisted suicide urged more use of hospice care. As a result, Oregonians now use hospice programs more than any other state. They so far have had only a few legal assisted suicides.
Hospice was brought to Hawaii in 1978 by Sister Maureen Keleher, then the head of St. Francis Hospital. She asked Sister Francine Gries to head a hospice program as an adjunct to the hospital. Sister Maureen has died but Sister Francine still is at her merciful task of helping people to die free of pain, reasonably at peace with their world, and saved from the indignity and body intrusions of surgery, radiation and chemotherapy carried past the point of reasonable hope for cure.
Each patient must determine when that point is -- when to stop the fight for cure and focus for the time remaining on achieving comfort and peace of mind plus peace of mind for those close to them. Hospice treatment usually is successful in achieving these.
I stress that "each patient" must decide when the time has come, not each physician. Many physicians still carry on "curing treatment" for too long, perhaps for an unwillingness to lose a life, perhaps for crass financial reasons. Many doctors also are delinquent in offering sufficient medication to relieve pain.
There are patients, too, who want to fight for a cure to their last breath. Informed, individual choice is paramount with heavy emphasis on "informed." My impression is that not enough people are fully informed about hospice care -- which most often can be at home.
Hawaii's hospices, now numbering eight, handled 1,465 patients last year and 1,196 deaths. That may be only one-fourth of the number of people who could have been assisted to a more upbeat exit.
Anecdotal evidence tells me that hospice care statewide is of good quality, administered by caring staff helped by caring volunteers. Talk of "beautiful deaths" is not uncommon. The late Msgr. Charles Kekumano certainly had one, with friends at his side and a smile on his face.
If we do achieve expanded use the governor's panel recommends it will be important to see that this essential element of caring is not sacrificed in a period of high growth.
St. Francis Hospice now has two homes dedicated just to hospice care patients, one in Nuuanu, one on the West Oahu campus of the St. Francis Medical System. Hospice Hawaii operates one on Windward Oahu and plans for a second in mid-Honolulu. These units are important but hospice is a treatment concept, not a place. Most patients prefer loving final care at home when circumstances permit it.
The governor's panel report includes detailed recommendations for expanding eligibility for hospice care and for more liberal insurance financing of it. Even today, however, it is available to most persons with private insurance or federal Medicare or Medicaid.
I am a strong advocate of permitting physician-assisted deaths under strict controls. I might want one myself one day, but hospice care would be this agnostic's preferred way to exit from life to whatever might lie beyond.
A.A. Smyser is the contributing editor
and former editor of the the Star-Bulletin
His column runs Tuesday and Thursday.