Hawaii is latest state to approve medical aid-in-dying; obstacles to implementation elsewhere

Hawaii is the seventh U.S. state to legalize medical aid-in-dying for terminally ill patients. But implementing similar laws hasn't been without obstacles everywhere. 

Hawaii Gov. David Ige last week signed the Our Care, Our Choice Act that gives mentally capable, terminally ill adults in the state the option of medical aid-in-dying, according to Compassion & Choices. Ige signed the new law after the state’s legislature approved the bill last month. The law takes effect after nine months, on Jan. 1, 2019.

“This legislation has been written to ensure that the patient is in full control,” Ige said, an announcement from the advocacy group. “When I think about this law it is impossible not to think of friends and family who have struggled through a difficult prognosis. … We know that our loved ones will eventually die but they don’t need to suffer.”

Hawaii joins Oregon, Washington, Montana, Vermont, California and Colorado, as well as Washington, D.C., in authorizing medical aid-in-dying, which was is also referred to as physician-assisted suicide. The laws allow physicians to prescribe a lethal dose of medication that patients can use to end their lives.

However, the implementation of the laws has not been without stumbling blocks. While Washington, D.C., passed a law via legislative action in 2016, regulatory barriers have prevented anyone from using the new law, according to Compassion & Choices.

The group organized what it called a day of compassion last week in which about 20 D.C. residents urged councilmembers and staff to eliminate those barriers that have prevented terminally ill patients from using the Death with Dignity Act since it took effect more than a year ago. The district’s health department issued administrative rules last June that exceed the law’s requirements, the group said.

“I still cannot find a physician who is willing to take over my care and write a prescription for medical aid-in-dying,” Mary Klein, a cancer patient, said in the announcement.

And despite Colorado voters passing the End of Life Options Act in 2016, there are few or no options for those seeking medical aid-in-dying in Pueblo and the southern part of the state, according to the Associated Press.

Only two doctors in that area of the state are known to have prescribed medications and only to cancer patients with a terminal diagnosis who have requested the medication. Other doctors and pharmacies have been deterred from participating because of religious or moral implications, the news agency said. The two major hospitals in Pueblo, Parkview and St. Mary-Corwin, have barred their physicians from performing any such services on hospital grounds, the AP said.

Medical aid-in-dying is controversial and laws make it optional for physicians to participate. Some doctors are not comfortable with the idea on ethical grounds.

Efforts to legalize medical aid-in-dying in Massachusetts were tabled in late March when a committee sent proposed legislation for further study. It was at least the fifth consecutive legislation session that failed to act on legislation, according to The Lowell Sun.

Advocates were optimistic that Massachusetts would approve a law to medical aid-in-dying after the Massachusetts Medical Society last year dropped its long-standing opposition and took a neutral stance.