By Chris Haring

Hawai’i legislators are poised to expand its five-year-old medical aid-in-dying law with shorter waiting periods and more provider options.

Hawai’ian patients living with terminal illnesses are a step closer to better access to medical aid in dying, as HB650 was allowed to bypass its conference committee stage on April 25. As Ben Angarone wrote for Honolulu Civil Beat, the bill would shorten the waiting period for end-of-life prescriptions “from 20 days to five and could be waived if providers agree that the patient would die before it elapses.” Additionally, medical aid-in-dying prescriptions “could be made by advanced practice registered nurses, rather than just physicians,” and “licensed marriage and family therapists could fill the role of counselor to evaluate a patient’s mental capacity,” he wrote. While the state’s initial legislation was passed in 2018, some disagreements on specifics have delayed the expansion of its right-to-die law.  

Hawaii’s Medically Assisted Suicide Program Is Poised To Be Expanded

Patients may soon have shorter waiting periods and more provider options.

By Ben Angarone / April 26, 2023

For years, advocates have argued that patients face too many obstacles to take advantage of Hawaii’s law allowing medically assisted death. The procedure will likely become more accessible after a bill got a boost on Tuesday to bypass the Legislature’s chaotic conference committee stage.

If House Bill 650 is signed into law, the waiting period would immediately shorten from 20 days to five, and could be waived if providers agree that the patient would die before it elapses.

Prescriptions for life-ending medication could be made by advanced practice registered nurses, rather than just physicians. Licensed marriage and family therapists could fill the role of counselor to evaluate a patient’s mental capacity. 

Charles Miller, an oncologist who leads the Medical Aid in Dying program at Kaiser Permanente Hawaii, was happy to hear the news.

Not many people die from medically assisted death, he said. “But for that 1%, it’s the most important thing in their life,” he added.

Medically assisted death was legalized in Hawaii in 2018 with the Our Care Our Choice Act, propelled by lobbyist John Radcliffe, who battled terminal cancer for several years and eventually ended his own life with prescribed medication.

Under Our Care Our Choice, medically assisted death is not considered suicide. “The death certificate shall list the terminal disease as the immediate cause of death,” the law reads.

That bill sailed through the Legislature and was the second to be signed into law by then-Gov. David Ige that year.

But the effort to expand the existing program took a longer path. A similar bill introduced last year made it to conference committee before failing when the House and Senate ran out of time without reaching agreement. 

Many steps are required in order to participate in the program, but put simply, an attending provider must certify that the patient has a terminal illness and six months or less to live. After receiving two requests separated by the waiting period – and after a counselor determines that the patient is of sound mind – the provider prescribes medication for the patient to self-administer.

Barriers were put into place to allay fears of abuse. The original draft’s waiting period was amended from 15 days to 20, and advanced practice registered nurses were struck from the bill as potential attending providers. 

Advocates argued that those barriers have proven to be too high, and since the program started, every annual report to the Legislature has agreed with this assessment.

With the longest waiting period in the country, some patients die before the waiting period is up

Neighbor island patients also lack provider options. Doctors are legally allowed to opt out of providing the service, and many do. As of the most recent report, which covered 2021, Kauai only had one provider who wrote a prescription.

The report recommended expanding the pool of providers and shortening the waiting period.

“That’s really what we focused on this time around,” said Aubrey Hawk, an advocate for Compassion & Choices Hawaii who has lobbied for medically assisted death since 2012.

Asked whether APRNs would also opt out of Our Care Our Choice, Miller pointed out that many statewide medical associations have remained officially neutral while allowing their members to decide for themselves where they stand. 

But on this bill, he said, the Hawaii Association of Professional Nurses testified in strong support, which he sees as a positive sign. Hawk said that her organization has seen in their surveys that many nurses would be willing to participate. 

Prior to Tuesday, the House and the Senate had each passed a version of the expansion but disagreed on specifics regarding whether licensed marriage and family therapists could count as counselors as well as the timing for when to waive the waiting period. 

The two chambers would have needed to try to hash out those disagreements in conference committee ahead of the May 4 end of session.

But the House switched course and decided to agree to the Senate amendments on Tuesday, setting it up for a full chamber vote before heading to Gov. Josh Green’s desk for a signature.