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Hawaii’s World

By A.A. Smyser

Tuesday, January 9, 2001

Doctors must support
physician-assisted death

For 80 years I have enjoyed PAL -- Physician-Assisted Living. I hope to enjoy still more. But the time could come when I will want PAD -- Physician-Assisted Death. Most likely my demise will come some other way. Hospice is an attractive option. But I would like the security blanket of knowing PAD is available if I want it and meet such conditions as:

Bullet My physician and I agree that I face unremitting and unbearable suffering, even if I am not terminally ill.

Bullet We jointly agree there is no reasonable alternative acceptable to me.

Bullet He/she consults with another doctor who has examined me.

These conditions are those just made the national law of the Netherlands by a 140-40 vote of its lower house.

They are quite close to the recommendations made for Hawaii in 1998 by Governor Cayetano's Blue Ribbon Committee for Living and Dying with Dignity. I was part of the 11-7 majority for PAD on that committee. Our recommendation so far has gone nowhere in the state Legislature, not even a committee vote supporting us.

We face an uphill battle. Public opinion polls show 60 percent or more support. But organizations such as the Catholic Church are strongly opposed and have been influential with key committee chairmen in the Legislature.

Governor Cayetano is for us. So is Honolulu Mayor Harris. But we need still more horsepower, particularly from physicians, to get past the legislative roadblock.

The Catholic Church was key to the 51.5 to 48.5 percent defeat of a PAD initiative by Maine voters on Nov. 7. The proposal earlier had public support but a high-intensity, final weeks campaign defeated it.

Oregon's Gov. John Kitzhaber, an emergency room physician, taped a powerful TV commercial saying PAD is working well in his state -- but the Maine foes said it isn't and narrowly prevailed. Oregon now faces the threat of Congress passing a law preventing physicians from using the medications necessary to have a peaceful, successful PAD.

The Hemlock Society, the key national organization supporting PAD in America, now is debating where to go next. Its founder, Derek Humphry, sees physicians as the key to future success. They are a cautious lot, he says, and we've got to bring them around. Three of four physicians on Governor Cayetano's panel voted with the majority favoring PAD.

The Netherlands vote late last year gave final approval to a practice its judiciary has permitted since 1973 under certain conditions. The overwhelming vote in the parliament shows how successful this has been in terms of public support.

Switzerland also permits PAD under informal rules but has not officially legalized it. Other countries allow refusal of life-extending treatment.

In the United States more attention is going to options short of PAD. These include terminal sedation which may hasten death. There are organizations whose representatives will instruct those who want to die yet avoid committing any illegal act themselves. Suicide is legal in all 50 states. But assisting a suicide may be prosecuted by a zealous prosecutor. Thus great care must be taken by those who only give advice.

Another option is the patient refusing all fluids and food, even through tubes. Death by dehydration can take 10 days to two weeks but there is little discomfort after the first couple of days, according to the Hemlock Society, which describes but does not recommend it as an alternative to legalizing PAD. Prosecutions could be a possibility here, too. We must end this need for stealth.

A.A. Smyser is the contributing editor
and former editor of the the Star-Bulletin
His column runs Tuesday and Thursday.

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