Monday, February 1, 1999

Health coalition
presses for better
end-of-life care

An isle campaign to relieve
pain and tell people of their rights
and options gets under way
with a $450,000 grant

By Helen Altonn


Hawaii's hospices estimate there could be a potential 7,000 clients annually because of the state's death statistics.

Yet, they care for only about 1,400 people a year, said Barbara Shirland of Hospice Hawaii.

Making residents aware of hospices is just one of many end-of-life issues to be addressed in a new state program.

Health care professionals, policymakers, educators and social service workers have joined to improve care for the dying -- supported by a coalition of more than 85 organizations and individuals.

Pain management, patients' rights, advanced directives, regulatory and statutory barriers and increased education for professionals and the public are among key issues.

The Executive Office on Aging has received a three-year grant of $450,000 for the project from the Robert Wood Johnson Foundation. The state must provide an additional $150,000.

Seventeen grants were awarded to coalitions nationally, but only four, including Hawaii, received the full amount, said Marilyn Seely, Office on Aging director. Others received $75,000 planning grants.

Seely's office is contracting with the St. Francis Healthcare Systems, School of Public Health and Hospice Hawaii to work on objectives and help raise matching funds.

They will follow recommendations of Gov. Ben Cayetano's Blue Ribbon Panel on Living and Dying with Dignity but won't deal with physician-assisted suicide and death.

Seely said they will work with the clergy, who say they don't have all the information they need to counsel people at the end of their lives.

The clergy also can help reach minority groups, who are least likely to use advanced directives and hospices, Seely said.

An education campaign will be conducted to help people make better choices to save money on funerals and burials and understand their right to be pain-free, she said.

Dr. S.Y. Tan, a medical ethicist at St. Francis Medical Center, is working on an end-of-life care curriculum for students in social work, public health, medicine and nursing.

Scott Staub, associate vice president of the St. Francis Healthcare Foundation, said the group hopes to instill understanding among medical students and residents of pain control and a holistic approach to care involving the patient, family and loved ones.

"From a Catholic perspective, while we are adamantly opposed to physician-assisted suicide or death, we don't want to suggest we are switching to the other end of the spectrum to prolong life at any cost," he said. "The answer is no."

But appropriate pain management may hasten death, "because maybe an intervention isn't going to occur," Staub said. "Quality of life is maintained, and dignity is there."

Legislators are drafting bills related to the blue-ribbon panel's recommendations for pain management and hospice care, Seely said.

An administration bill seeks to consolidate and simplify the language for all advanced directives, including the living will, durable power of attorney for health care and surrogate decision-making.

Dr. Kathryn Braun, UH Center on Aging director, said research at the School of Public Health shows people know a lot about advanced directives. But they don't have them for various reasons, including "plain procrastination and denial that anything bad might happen," she said. "In organ donation, you hear, 'It's against my culture.' "

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