Hawaii is about to pass doctor-assisted suicide, while other states face starts and stops

Hawaii is poised to become the first state this year to pass a law that would allow terminally ill patients to request prescriptions from doctors to end their lives, making it the seventh state to have such a law on the books.

Advocates are hoping New Jersey and Delaware will follow suit later this year, said Khalid Pagan, senior communications associate for Compassion and Choices, a nonprofit supporting the practice, which the group calls "aid-in-dying."

Hawaii's Our Care Our Choice Act had broad support from the legislature after decades of advocacy by proponents, and Democratic Gov. David Ige has said he would sign it into law.

“Mentally competent, terminally ill people who are in pain and who are suffering should be given the choice to end their lives with grace, dignity and peace,” Ige said in a statement in late February as the bill was moving through the legislature.

Hawaii will join California, Colorado, Oregon, Vermont, Washington state, and the District of Columbia in legalizing the practice. Montana doesn't have a specific law on the books, but the state Supreme Court ruled in 2009 that doctors could use a patient's request for fatal medication as a defense against criminal charges. Hawaii's law is set to go into effect Jan. 1, 2019.

Still, no laws were passed in 2017, even though lawmakers in 29 states introduced bills that would have allowed for it.

According to the Patients Rights Action Fund, an advocacy group that opposes the legislation, at least 25 states have introduced bills this session, but seven have been defeated or languished after inaction. On March 29, the same day that the bill advanced in Hawaii, a Massachusetts health committee dropped its aid-in-dying bill from consideration.

Opponents of the practice, who use the term "physician-assisted suicide," have said that they worry about people in poverty or with disabilities being taken advantage of, and have raised concerns about patients with a terminal illness being pressured to end their lives so they do not become a burden to their families.

"Assisted suicide is dangerous public policy with potentially deadly consequences for everyone, but especially people with disabilities, the sick, the poor and the elderly," said Matt Valliere, executive director of Patients Rights Action Fund. "We should prioritize protecting these vulnerable members of society instead of adding to the challenges they face.”

Anti-abortion advocates have come out strongly against the laws as well. Catherine Glenn Foster, president and CEO of Americans United for Life, said she was “disappointed” by Hawaii lawmakers’ decision.

"America’s most vulnerable citizens ... are worthy of life and equal protection under the law," she said.

Supporters say the laws give patients the option to control when and how they die and help them avoid pain at the end of their life. They note that some patients turn to firearms or other violent means when they have received a fatal diagnosis.

Public support has moved up and down during the past two decades, with last year's Gallup poll on the issue finding that 57 percent of the public agrees with the statement that “doctor-assisted suicide is morally acceptable."

But even states that have laws on the books do not open the option to everyone who would want access to fatal medications. People who have a degenerative illness, such as Alzheimer's disease, are not permitted to participate. Data from Oregon, which has allowed the practice since 1997, show that most patients who participate have cancer, while others have diseases such as amyotrophic lateral sclerosis, or Lou Gehrig’s disease, a painful illness that breaks down a person's muscles.

State laws allowing doctors to prescribe fatal medications generally require that two healthcare providers confirm that a patient would otherwise die within six months and that the patient is able to make his own decisions. A counselor has to sign off that a patient does not have depression.

The laws require that patients ingest the medications themselves. They cannot be administered by a doctor, as they are in Belgium and the Netherlands. Critics have pointed to those countries as evidence of the dangers of such policies snowballing into troubling territory. Their laws allow for euthanasia for patients with mental illness.

Compassion and Choices and Death with Dignity National Center, two of the largest advocates for expanding aid in dying in the U.S., have said they do not support moves in that direction and have stressed that terminally ill patients must be able to make the choice to die themselves.

They maintained that position even as Oregon state Rep. Mitch Greenlick, a Democrat and chairman of the health committee, pressed for the law to expand access to people facing a diagnosis of up to one year and planned to introduce a bill that would expand the practice to patients with dementia.

"An important part of our advocacy is that the dying person is in charge of their death," Pagan said. "We don't advocate for aid in dying for people with severe dementia because they are not mentally capable of making healthcare decisions for themselves. That's a core piece of the safeguards of the laws."

Instead, they have been focused on passing laws similar to Oregon's across the country and seeking to expand access in states where the practice is already legal.

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