Death can be calm, quick and peaceful, or painful, extended and torturous. End-of-life care can drain a family's bank account, leaving debt and hardship in its wake. During Hawaii's last legislative session, a physician-assisted suicide bill passed the House and came within two votes of passage in the Senate. The "Price of Paradise" asks: Should Hawaii have "Death with Dignity?"
Choice is essential | No dignity in such death
A physician-assisted suicide law came within two votes of passing during the last legislative session. The issue isn't likely to go away and Sen. David Matsuura, who tried to kill the bill in committee, failed in his re-election bid. Should Hawaii legalize doctor-assisted suicide? 'Price of Paradise' on the radio
Who: Guests: Kelly Rosati of the Hawaii Family Forum and Andi van der Voort of Hemlock Hawaii. Host: John Flanagan.
When: 8 p.m. today
Where: KKEA, 1420-AM
Join in: Call 296-1420 or toll-free from the neighbor islands, 1-866-400-1420 during the show. Cell phones: Star-1420 or Pound-1420.
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WHEN I graduated with a nursing degree 46 years ago, health care was less sophisticated. Today's miracle drugs and heroic life support systems were non-existent. People got sick and died at home surrounded by loved ones. Everyone should
be able to choose
a humane deathBy Andi van der Voort
Advances in medicine and technology have increased our life expectancy since then, but in so doing have exposed us to diseases that were practically unknown just half a century ago. While we can now prolong life almost indefinitely, the quality of that life has to be examined.
Those wishing to avoid the pain and suffering of a prolonged life often turn to suicide, which is not against the law anywhere in the United States.
Taking one's own life in the prime of health is a horrendously selfish act. On the other hand, an autonomous choice to take one's own life when dying of a terminal illness that causes indescribable suffering is, I believe, a brave and unselfish act.
YEARS ago, laws were enacted making assisted suicide a felony to discourage greedy heirs who would profit from encouraging a person's death. Today, we still have archaic laws governing physician-assisted death, which is different.
Through the years I have seen many people die. Some died quietly, without struggle, and some fought to live until their last breath. However, the saddest, and the most frequent, are those who suffer needlessly, begging to have the burden of suffering lifted.
I believe that a person should be able to choose how to end such a torturous death. I joined the Hemlock Society because I believe I shouldn't be forced to continue living if I'm ever in that situation.
I don't like pain. I don't like the diapers, the tubes, the stoned feeling from being drugged or the procedures that go with a painful death.
It should be my choice not to endure such indignities. However, present laws don't allow me any choice except to keep on dying until my ticker finally gives up. That's fine for some, and they have that right, but it's not for me.
We need to catch up with the current century. We need to protect physicians, pharmacists and loved ones who would help end a patient's suffering. We need to change our archaic, barbaric laws.
Five years ago, Oregon passed a law to allow for aiding humane death. The medical and legal scholars who authored the Death with Dignity Act knew that some day they, too, might be desperate to exit this Earth quietly and gently with a physician's help.
Statistics show that seven out of 10 people suffer in their dying. Hospice units, although they provide excellent care, will tell you they cannot relieve the pain of 5 to 8 percent of patients and can only use heavy sedation for days or weeks until the patient dies. To me, this is as barbaric as starving to death.
It is physically impossible for a dying patient to jump off a bridge, fire a pistol or hang from the rafters. It is not gentle or dignified.
We should have the right to request terminal help from caring physicians, and doctors should be protected when they act in the best interest of the patient at the patient's request.
Since enacting its law, Oregon has become a model state for end-of-life care, not just for assisted dying. In Oregon, pain management improved and physicians are better prepared to aid the dying. More people are dying at home in the care of their loved ones and more are seeking the services of hospice.
It's a win-win situation for everyone. Only 1 percent of the population request terminal help from a physician and receive it -- only 1 percent. However, 100 percent of Oregonians are benefiting from their laws. Hawaii needs the same compassionate care, and I ask you to tell your legislators.
For a copy of Oregon's Death with Dignity Bill, send a self-addressed stamped envelope to Hemlock Hawaii, P.O. Box 11508, Honolulu, HI. 96828, or go to the Oregon Death with Dignity Web site at www.dwd.org.
Polling results show that 72 percent of the residents of Hawaii want this legislation. We should respect the will of the people.
Andi van der Voort is a registered nurse and president
of the board of Hemlock Hawaii, the local chapter of the
non-profit Hemlock Society USA, which promotes
access to a full range of end-of-life choices.
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WE ALL hope to die with dignity, but we needn't support physician-assisted suicide to support death with dignity. Nothing is dignified about
physician-assisted suicideBy Kelly Rosati
The bill before the Legislature during the last session may have been titled "Death with Dignity," but it was actually about legalizing physician-assisted suicide (PAS) -- conduct currently classified as manslaughter under Hawaii's penal code.
Legalizing PAS would be terrible public policy. Any so-called "right to die" granted by the Legislature would lead to a "duty to die" for the most vulnerable among us. It would subject many elderly and disabled people to the risks of abuse and coercion and would transform the very nature of the physician-patient relationship.
It's hard to break through the confusion about this legislation to discuss its very real dangers. Before elaborating on those dangers, it's important to clarify two common misconceptions.
FIRST, physician-assisted suicide is not the same as the right to refuse unwanted medical treatment. That legal right already exists.
People concerned about "being hooked up to machines" should talk to their family members, complete an advance directive or designate someone to make health-care decisions if they are incapacitated. In this way, they can retain control.
Second, there is no medical reason to suffer unmanaged pain. Aggressive pain management is something all patients deserve. If you or someone you love is suffering, tell your doctor and, if he or she is unresponsive, find a new doctor. Also, check out www.painfoundation.org.
TO PROTECT Hawaii's patients, a diverse coalition of health-care, disability-rights and educational organizations has joined forces to stop the legalization of PAS and improve Hawaii's end-of-life care. This coalition includes Hawaii physicians, nurses, psychiatrists, hospitals, hospices, disability rights' advocates, religious leaders and others.
PAS opponents are Democratic, Republican and Green Party members. Opposition to PAS does not come from any one segment of society, and for good reason.
Think about it. Who among us wants to be a burden to our friends and loved ones? Anyone who has been a caregiver knows the toll it can take, and so do sick and dying patients.
Who wouldn't feel a subtle pressure to get out of the way so others can get on with their lives? But people facing the end of their lives need compassionate care, not the tools of death. They need to be surrounded by loved ones, not abandoned to suicide.
Because they know "safeguards" just don't work, 11 national disability rights organ- izations strongly oppose PAS. Abuse and coercion issues are real.
One patient who killed herself under Oregon's assisted-suicide law was first denied the lethal prescription. Her psychiatrist was concerned about dementia and the patient's daughter's influence. A second psychi- atrist noted this somewhat coercive daughter, but prescribed the lethal dose anyway.
How voluntary was this patient's choice? We can't know now. Mistakes are irreversible. Do we really need to take this risk? Can't we do better than suicide?
The proposed law applies to people with less than six months to live, but doctors are frequently wrong about such diagnoses. In particular, disabilities are often misdiagnosed as terminal illnesses.
PAS proponents sometimes talk about the "indignities" of needing assistance with daily living. Since when did needing help render someone undignified? People need support and options, not an open door to suicide.
Finally, what will physician-assisted suicide do to the practice of medicine? The American Medical Association's vice president for ethical standards said, "This is a defining moment in medicine. If doctors are allowed to kill patients, the doctor-patient relationship will never be the same again. If killing you is an option, how can I expect you to trust me?"
There are better solutions than suicide. Let's treat pain and depression. Let's provide compassionate care. Let's offer real choices.
Support death with dignity? Of course. Support physician-assisted suicide? Never.
Kelly M. Rosati is an attorney, executive director of
Hawaii Family Forum, a local non-profit, pro-family
education organization and coordinator of Hawaii's
Partnership for Appropriate and Compassionate Care,
which opposes legalizing physician-assisted suicide.
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The Price of Paradise appears each week in the Sunday Insight section. The mission of POP is to contribute lively and informed dialog about public issues, particularly those having to do with our pocketbooks. Reader responses appear later in the week. If you have thoughts to share about today's POP articles, please send them, with your name and daytime phone number, to pop@starbulletin.com, or write to Price of Paradise, Honolulu Star-Bulletin, 7 Waterfront Plaza, Suite 210, 500 Ala Moana, Honolulu, HI 96813.
John Flanagan
Contributing Editor
