April 6, 2018 -- A bill legalizing medically-assisted suicide in Hawaii was signed into law Thursday by Gov. David Ige.

The state joins California, Colorado, Oregon, Vermont, Washington state and the District of Columbia in allowing the practice, the Associated Press reported.

"It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace," Ige said.

The law permits doctors to prescribe life-ending medication to terminally ill patients, the AP reported.

Ige said "we know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind." </s> HONOLULU (AP) - Hawaii became the latest liberal-leaning state to legalize medically assisted suicide Thursday as the governor signed a measure into law allowing doctors to fulfill requests from terminally ill patients to prescribe life-ending medication.

"It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace," Gov. David Ige said.

Ige said the law was written to ensure the patient is in full control and it provides just one option available for end-of-life care, knowing assisted suicide is not for everyone.

"But we know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind," the governor said.

Hawaii's heavily Democratic lawmakers approved the legislation late last month. The state joins California, Colorado, Oregon, Vermont, Washington state and the District of Columbia in allowing the practice.

Critics say they are concerned that the option will lead to hasty decisions, misdiagnoses and waning support for palliative care, in which dying people can be sedated to relieve suffering.

The law has safeguards to prevent abuse. Two health care providers are required to confirm a patient's diagnosis, prognosis, ability to make decisions and that the request is voluntary.

A counselor also must determine that the patient isn't suffering from conditions that may interfere with decision-making, such as a lack of treatment of depression.

The patient must make two oral requests for the life-ending medication, with a 20-day waiting period in between, and sign a written request witnessed by two people, one of whom can't be a relative.

Criminal penalties will apply to anyone who tampers with a request or coerces a prescription for life-ending medication.

"The time was right for Hawaii to adopt this law," said Peg Sandeen, executive director of the Death with Dignity National Center, a nonprofit advocacy group. "The safeguards Hawaii state legislators have enacted into this law will ensure that patients are in control of this process and make their own decisions at every step of the way - as is their right."

Allowing medically assisted death has been a divisive issue in Hawaii. Last year, a similar measure passed the state Senate but was later tabled in the House. </s> John Radcliffe, right, who was diagnosed with cancer in 2014, watches as Hawaii Gov. David Ige signs a bill to legalize medically assisted suicide on Thursday, April 5, 2018 in Honolulu. Radcliffe testified in favor of the measure and said Thursday he was happy it passed. Doctors in the state can now fulfill requests from terminally ill patients to prescribe life-ending medication. Hawaii is the sixth U.S. state, plus Washington, D.C., to legalize the practice. (AP Photo/Sophia Yan)

John Radcliffe, right, who was diagnosed with cancer in 2014, watches as Hawaii Gov. David Ige signs a bill to legalize medically assisted suicide on Thursday, April 5, 2018 in Honolulu. Radcliffe testified in favor of the measure and said Thursday he was happy it passed. Doctors in the state can now fulfill requests from terminally ill patients to prescribe life-ending medication. Hawaii is the sixth U.S. state, plus Washington, D.C., to legalize the practice. (AP Photo/Sophia Yan)

HONOLULU (AP) — Hawaii became the latest liberal-leaning state to legalize medically assisted suicide Thursday as the governor signed a measure into law allowing doctors to fulfill requests from terminally ill patients to prescribe life-ending medication.

“It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace,” Gov. David Ige said.

Ige said the law was written to ensure the patient is in full control and it provides just one option available for end-of-life care, knowing assisted suicide is not for everyone.

“But we know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind,” the governor said.

Hawaii’s heavily Democratic lawmakers approved the legislation late last month. The state joins California, Colorado, Oregon, Vermont, Washington state and the District of Columbia in allowing the practice.

Critics say they are concerned that the option will lead to hasty decisions, misdiagnoses and waning support for palliative care, in which dying people can be sedated to relieve suffering.

The law has safeguards to prevent abuse. Two health care providers are required to confirm a patient’s diagnosis, prognosis, ability to make decisions and that the request is voluntary.

A counselor also must determine that the patient isn’t suffering from conditions that may interfere with decision-making, such as a lack of treatment of depression.

The patient must make two oral requests for the life-ending medication, with a 20-day waiting period in between, and sign a written request witnessed by two people, one of whom can’t be a relative.

Criminal penalties will apply to anyone who tampers with a request or coerces a prescription for life-ending medication.

“The time was right for Hawaii to adopt this law,” said Peg Sandeen, executive director of the Death with Dignity National Center, a nonprofit advocacy group. “The safeguards Hawaii state legislators have enacted into this law will ensure that patients are in control of this process and make their own decisions at every step of the way — as is their right.”

Allowing medically assisted death has been a divisive issue in Hawaii. Last year, a similar measure passed the state Senate but was later tabled in the House. </s> Hawaii has become the seventh state to legalize medically assisted suicide, a topic that has been deeply divisive in the medical community.

The practice that has come to be known as 'dying with dignity' involves prescribing life-ending medication to terminally ill patients.

Supporters say it's a compassionate choice to prevent suffering and critics say it's immoral and goes against the Hippocratic Oath which states: 'I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.'

Physician-assisted suicide is becoming increasingly common around the world and several other states including Massachusetts and Alaska have been considering its legalization.

Medically assisted suicide is also legal in California, Colorado, Oregon, Vermont, Montana, Washington state and the District of Columbia.

Critics of the practice say could lead to hasty decisions, misdiagnoses and decreasing support for palliative care, in which dying people can be sedated to relieve suffering.

Hawaii's new law was debated for several hours in the state Senate in late March.

In a hearing Democratic Senator Breene Harimoto said that allowing for the option of medically assisted suicide could create 'an environment of hopelessness' that would allow a doctor to help cause death.

The Hawaii Family Forum submitted a written testimony that the legislation may create subtle pressure on the elderly to end their lives early so they are not a burden to their families.

Senator Russell Ruderman countered those arguments saying the bill is about freedom.

'If you don't believe in it, don't do it. But there is no reason to deny to others the freedom to live and die as we choose,' he said.

The chamber's only doctor, Senator Josh Green, who works in an emergency room, voted for the bill but said he wished lawmakers would take more time to debate it.

When Governor David Ige signed the bill on Thursday he said: 'It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace.'

'We know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind.'

In order to be eligible for the option under Hawaii's new law, patients must be 18 or older and have fewer than six months to live.

To safeguard from potential abuse the law requires that two medical providers confirm the diagnosis and prognosis.

A counselor must also confirm that the patient isn't suffering from any conditions that may interfere with their ability to make decisions.

The patient has to make two oral requests for the life-ending medication with a 20-day waiting period in between.

They're then required to sign a written request witnessed by two people, one of whom cannot be a relative.

There will be criminal penalties for anyone who tampers with a request or coerces a prescription for life-ending medication.

'The safeguards Hawaii state legislators have enacted into this law will ensure that patients are in control of this process and make their own decisions at every step of the way — as is their right,' said Peg Sandeen, executive director of the Death with Dignity National Center, a nonprofit advocacy group. </s> With the governor’s signature on Thursday, Hawaii has given terminally ill patients the option to decide when they want to die.

The new law, known as the Our Care, Our Choice Act, will make Hawaii the sixth state in the U.S. and the seventh jurisdiction to legalize physician-assisted suicides. The law takes effect Jan. 1.

It will allow patients in Hawaii to request medication from their physicians that would end their lives. Patients eligible for this option, which has come to be known as “dying with dignity,” must be 18 or older and have less than six months to live.

“I do know that even within my own family there’s different opinions about whether there should be an option or not ... but we know that we have got to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind, if they so choose to,” he added.

Activists have been working with state lawmakers in Hawaii to pass the bill for 20 years, according to Kim Callinan, CEO of the nonprofit advocacy group Compassion & Choices.

“This has really been the building of a ground-up operation,” Callinan told HuffPost, adding that her organization has been working with the state since the beginning.

At least one group had started a petition before the bill’s signing, garnering more than 18,000 signatures from people who oppose it.

“We are very concerned that a lot of the concerns that were brought up by the medical community ... the disabled rights community, they were not taken into consideration,” Eva Andrade, the group’s president, said at the time.

Speaking to HuffPost on Thursday, Callinan said laws that legalize physician-assisted suicide are about more than giving people a chance to decide when they want to die ― it’s about giving terminally ill patients more options.

Like other legislation passed in other states, Hawaii’s Our Care, Our Choice Act requires that physicians tell patients who are considering this option about all of the other options that do not involve assisted suicide. Physicians are also required to let patients know that they are allowed to back out at any time after they are given a prescription for the medication that would end their lives.

“Patients see this law as a way for them to have autonomy at the end of life,” Callinan told HuffPost. “What they’re most worried about is that they’re going to die suffering and in pain.

“Most people don’t choose to use the medication, but they want it because it gives them a peace of mind to know that if their suffering becomes too great, they have the option to end it.” </s> There's not much good news for those with six months to live, but what if you could plan for your last moments to happen on a tropical island paradise?

You can. Yesterday Hawaii's governor signed a bill allowing for medically assisted suicide in the Aloha State. When the law takes effect next year, Hawaii will join five other states—California, Oregon, Colorado, Vermont, and Washington—and the District of Columbia in allowing terminally ill people to request and receive life-ending medication.

Mind you, people can't just fly into Hawaii, buy some pills, plop down on a beach, and end it all while watching the sun set over crystal blue waters. First of all, you have to establish yourself as a resident of the state. Then you must be diagnosed with a terminal disease that will kill you within six months. Then you must make two oral requests (20 days apart) and one written request (with witness signatures) for a prescription for life-ending medication. And you have to prove you're of sound mind. So don't expect a rush of suicide tourism to Hawaii.

It's good news whenever a state formally gives permission to treat people as though they own their bodies and can decide when to end their own suffering.

Assisted suicide is one of those issues—like marijuana legalization—where government policy has lagged significantly behind public polling. Surveys show that nearly three out of four Americans approve allowing terminally ill patients to end their own lives. Yet as Governing notes, New York's Supreme Court recently upheld a ban on assisted suicide, while 27 other state-level efforts just last year failed even to make it to a vote by lawmakers. In three of the five states where assisted suicide is legal, it took ballot initiatives from the citizens to force the state's hand.

So the struggles continue. Below, ReasonTV delved into a fight to bring assisted suicide to Montana back in 2013. Technically Montana is a sixth state that allows medically assisted suicide, but that's due to a state Supreme Court ruling and not an affirmative law. There have been efforts in Montana both to formally permit medically assisted suicide and to ban it entirely: </s> Ige signed the bill Thursday, making Hawaii the sixth liberal-leaning state plus Washington, D.C., to legalize the practice.

Ige said the measure gives full control to terminally ill patients. He says everyone knows their loved ones will eventually die, but they don’t need to suffer.

The law allows doctors to fulfil requests from terminally ill patients for prescription medication that will allow them to die. The legislation includes safeguards intended to prevent abuse.

The other states that allow medically assisted suicide are California, Colorado, Oregon, Vermont and Washington state.

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 life-ending medication as a defence against criminal charges. </s> Hawaii just made the mistake of becoming the eighth jurisdiction in the United States to allow assisted suicide.

We can learn a lot about the folly of this path if we look to other places here and abroad where assisted suicide already is legal. A quick survey turns up countless instances of the failures of these laws to safeguard the most vulnerable.

From Europe, there seems to be a constant stream of documented cases related to the practice of assisted suicide and euthanasia, which would give anyone pause.

In the Netherlands, the number of people with experience of mental illness being euthanized is rising by the day. There are known cases of such people being abused or coerced into death by people they should be able to trust. A whistle-blowing doctor in Belgium went to the Associated Press with the details of a dementia patient’s death by euthanasia – the patient had never formally asked to die.

A column in the Washington Post recounts another sad story of one case gone very wrong. In 2016, an otherwise healthy elderly woman with dementia, having made an ambiguous advanced directive to end her life “when the time was right,” was euthanized against her will at the request of her husband by a nursing home doctor whose assessment was that the patient’s suffering was “unbearable and incurable.” She prepared the lethal injection. The physician tried silencing the patient’s protests by slipping a sedative into her coffee. When the sedative failed, this doctor had the family of the patient restrain her so that she could administer the lethal injection.

The columnist rightly asks, “How many botched cases would it take to end euthanasia of the vulnerable?”

In January, a physically healthy 29-year-old suffering from depression was euthanized. The Daily Mail reported that in Holland in 2013, “a total of 42 people with ‘severe psychiatric problems’ were killed by lethal injection compared to 14 in 2012 and 13 in 2011.”

Are these abuses confined to Europe or are they the inevitable fruits of what is everywhere bad public policy? There is evidence for the latter.

In Oregon, Michael Freeland, who had a 40-year history of acute depression and suicidal ideation, not only received the lethal prescription but also was allowed to keep the drugs even when all other means of his taking his own life had been removed from his home.

Another Oregonian, Kate Cheney, who had been diagnosed with dementia, was first referred for the non-required psychiatric evaluation and denied the lethal dose. Her family shopped for a doctor until they found one who would sign off; the doctor’s report stated that her “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive.”

In fact, just this legislative session, there was a bill before the Delaware General Assembly that would sanction the assisted suicides of people with intellectual and developmental disabilities. This flies in the face of the central concerns of the disability rights community: Nothing in the proposed Delaware bill ensures that people actually have access to the pain relief, palliative care and home-based and community-based personal care services they need.

Moreover, just like all of the proposed bills and assisted suicide laws, the Delaware bill utterly fails to prevent coercion. Coercion to request lethal drugs, like any form of abuse, occurs behind closed doors.

Let’s all note how legalizing assisted suicide and euthanasia has led to the tragic death of vulnerable people. Whether in Europe, Canada, or even here in the U.S., this public policy push is unsuccessful at instituting any structures that would protect those who are most vulnerable from abuse and coercion.

We can avoid making the same mistake here by rejecting such laws and proposals altogether.

Matt Valliere is executive director of Patients Rights Action Fund, a national organization that opposes assisted suicide. </s> A 104-year old Australian man said he will travel to Switzerland with the goal of ending his life.

David Goodall, a scientist, plans to go to Basel for the purpose of assisted suicide in early May, according to Exit International, a group that advocates for end-of-life choice.

“I greatly regret having reached that age,” Goodall told the Australian Broadcasting Corporation. “I’m not happy. I want to die. It’s not sad particularly. What is sad is if one is prevented.”

The group refers to what is commonly called assisted suicide -- when a person chooses to end his or her life with the help of another person, often a doctor -- as “rational suicide” or “voluntary euthanasia.”

Victoria is the only state in Australia where assisted suicide is legal. The state passed the “Voluntary Assisted Dying Law” in November 2017, but it will not go into effect until June 2019. The law is limited to those whose death is expected in no longer than six months.

Goodall said he feels it should be his decision to choose to end his life.

“My feeling is that an old person like myself should have full citizenship rights including the right of assisted suicide,” Goodall added.

The Northern Territory -- in the central and central north of Australia -- briefly legalized assisted suicide in 1995, but the law was nullified in 1997, according to the Euthanasia Laws Act of 1997.

Although Exit International advocates for individuals to have the option of assisted suicide where they live, the organization said it will help Goodall, who will be accompanied by his long-time friend, Carol O'Neil, make the trip to Switzerland.

“A peaceful, dignified death is the entitlement of all who want it," the company said in a statement. "And a person should not be forced to leave home to achieve it.”

It is unclear when Goodall will travel to Switzerland.
Medically assisted suicide became legal in the state of Hawaii.