More terminally ill patients are choosing aid-in-dying, but experts say obstacles remain

HONOLULU (HawaiiNewsNow) - Hawaii’s “Our Care, Our Choice” Act went into effect on Jan. 1, 2019, giving terminally ill patients the right to use prescribed end-of-life medications. Twenty-eight people died that year after being prescribed the medications.

In 2020, the figure was 34.

And in 2021, according to new state numbers, there were 49.

While the number of people seeking the end-of-life medications continues to increase, advocates say there aren’t enough doctors to help patients. And those patients who can navigate the system have to complete Hawaii’s mandatory 20-day waiting period because securing pills. It’s longest in the nation among states where medical aid in dying is legalized.

“It requires a lot of energy to get through. So sometimes it’s not that they don’t want to utilize the law, it’s that it’s just takes too much work,” said Joy Rodriguez, who identifies herself as an end-of-life doula.

Lesa Griffith’s mother, Ramona Chiya, went through the process of seeking an end-of-life prescription.

“She told me one morning, ‘you know, I don’t want to suffer, I’m starting to suffer.’ I think that was her sign to me to get ready,” Griffith said.

Chiya was a popular fabric designer and artist who saw a lot of beauty in the world.

“Words like inspirational, creative, brave, I think they really painted a portrait of a woman who lived on her own terms and died on her own terms,” Griffith said.

Chiya was diagnosed with Stage 4 lung cancer and it became hard for her to get around.

Last month, as the suffering got worse, she decided to end her life through medical aid-in-dying.

“When you talk about unconditional love from a parent she had that in spades,” Griffith said, adding she wants other people to know that there are options for terminally ill loved ones who are suffering.

And Aubrey Hawk, with Compassion and Choices, says more people could benefit from the law if it was more accessible.

“It’s a 17-step process that a patient has to go through,” she said.

“The patient must make one oral request, wait 20 days and make a second oral request to the doctor who will be prescribing. In between there is another doctor consultation. There’s a mental health consultation. There’s a written request.”

This past year, the average time it took after the first oral request to get a prescription was 41 days.

Rodriguez, an “end of life doula” for Burden Lifters, has assisted around 50 patients with the medical aid-in-dying process. She says she sees many patients die before getting the end of life prescription.

“It requires a lot of energy to get through. So sometimes it’s not that they don’t want to utilize the law, it’s that it’s just takes too much work,” she said.

Rodriguez added that another issue is accessibility.

Twenty-one doctors wrote prescriptions for those 49 patients last year. Fourteen were on Oahu, three on the Big Island, three on Maui, and only one on Kauai.

“Unfortunately, I’m one of the few providers that is willing to do this work. So I’ve had a lot of experience,” said Dr. Pablo Stewart, of the Queen’s Medical Center.

Advocates and some lawmakers have tried to fix some of the issues.

A bill that would decrease the waiting period to 15 days, allow doctors to wave it for patients who might not make it that long, and allow advanced practice registered nurses and physician assistants to help died in the last legislative session.

“During the conference process, we tried,” said state Rep. Ryan Yamane, of the House Health Committee.

“We tried hard to work with each others to address the various issues to see if we could come up with common language. But unfortunately, for this year, we weren’t able to address that by the voting period.”

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