Data on First Two Years of Hawaii’s Medical Aid in Dying Act Released

The Department of Health maintains its prior recommendation to reduce the waiting period, currently the longest of any authorized state, and to allow advanced practice registered nurses to prescribe for patients.
August 18, 2021

Samantha Trad, far left, with Hawai’i supporters

The Department of Health (DOH) has released its annual report detailing the use of medical aid in dying during the first two years of Hawaii’s Our Care, Our Choice Act (OCOCA). The state’s 2020 data show the following: 37 prescriptions for aid-in-dying medication were written by 14 unique doctors (of these, 11 were located on Oahu, two on Maui and one on Hawaiʻi Island). Just two-thirds of those who requested the medication (25 terminally ill people) used it to end their suffering. This is common, says Compassion & Choices Hawaiʻi State Director Samantha Trad. “Nationwide, about one-third of people who go through the 13-step process to access the law never actually take their medication, but having it on hand gives them a huge sense of relief to know it’s available if their suffering becomes unbearable.” Additionally, 28 of the 37 patients were enrolled in hospice, a facet of end-of-life care encouraged by the DOH and nongovernmental advocates, including Compassion & Choices Hawaiʻi.

The report reiterates DOH’s 2019 recommendation to the Legislature to amend the OCOCA, which was modeled after Oregon’s bill, by allowing qualified advanced practice registered nurses (APRNs) to participate. It also recommends waiving the waiting period between the state’s mandated first and second verbal requests if doctors determine the patient will not survive it, as Oregon has done with their aid-in-dying law. In fact, Hawaii has the longest mandatory minimum waiting period between the two required oral requests: 20 days. In contrast, New Mexico’s law, which was passed earlier this year, has no waiting period. 

The mandatory minimum waiting period has proven to be a traumatic barrier to patient access to the law. Data from Kaiser Permanente Hawaii show that up to 30% of their terminally ill patients who want the peaceful option of medical aid in dying do not survive the waiting period.

State Telehealth and Health Care Access Coordinator Laura Arcibal said, “Hawaiʻi continues to face physician shortages across the state, especially in primary care, according to the latest University of Hawaiʻi Physician’s Workforce Report. Neighbor island patients not only face the challenge of finding a physician in a doctor shortage, but finding that one physician who can bring relief and support them in ending their suffering. The department highly encourages the utilization of telehealth for both patients and physicians and maintains its recommendation, which is the same as last year’s report.”

“We are encouraged to see that the OCOCA is working and that many terminally ill residents have been able to access this compassionate end-of-life option,” said Trad. “However, we continue to get calls from dying patients who struggle to access the law, especially those in rural areas or who are extremely ill. We fully support DOH recommendations to improve access.”


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