HONOLULU — Hawaii’s new medically assisted suicide law has gone into effect, but few doctors and pharmacies are willing to prescribe and dispense the life-ending medications.
Hawaii Pacific Health and The Queen’s Medical Center in Honolulu said their pharmacies will not fill the prescriptions and hospitalized patients will not be able to take the lethal drugs on their campuses, the Honolulu Star-Advertiser reported Tuesday.
The law allows doctors to fulfill requests from terminally ill patients for prescription medication that will allow them to die.
The law’s restrictions require two health care providers to confirm a patient’s diagnosis, prognosis, ability to make decisions and that the request is voluntary. Patients must make three requests for the medication, voicing two at least 20 days apart and writing the third signed by two witnesses.
Most health care facilities have adopted neutral policies on the law, leaving it up to individual doctors to decide whether to participate.
“There are a number of health care providers, nurses and others who are really uncomfortable about this, so asking anybody to participate as a patient ends their life is a really tough thing,” said Melinda Ashton, chief quality officer for Hawaii Pacific Health, one of the state’s largest health care providers. “The most recent barrier does seem to be we haven’t yet located a pharmacy willing to provide the medication.”
CVS Pharmacy said pharmacists in Hawaii will follow a “carefully outlined process for the filling of such prescriptions under the limited circumstances” defined by law. Individual pharmacists will decide whether to fill the prescriptions, the company said.
Physicians might be resistant to the law at first, said Dr. Daniel Fischberg, medical director of the Queen’s Medical Center Pain and Palliative Care Department.
“There’s definitely diversity of opinion. A minority of physicians feel prepared to actually participate in terms of writing a prescription,” Fischberg said.
The state Department of Health projects that 40 to 70 patients will seek medical aid in dying this year. Care providers and the state Health Department are offering training sessions to medical personnel on how to handle requests for life-ending medication.
Assisted suicide became legal in Hawaii from 1 January 2019.
The Our Care, Our Choice Act is modelled on the Oregon and Washington laws but has some differences.
Assisted suicide by telehealth
The Act requires the “attending provider” to refer every person who requests assisted suicide for “counselling” which is defined as “one or more consultations, which may be provided through telehealth, as necessary between a psychiatrist, psychologist or clinical social worker and a patient for the purpose of determining that the patient is capable, and that the patient does not appear to be suffering from undertreatment or nontreatment of depression or other conditions which may interfere with the patient’s ability to make an informed decision pursuant to this chapter.”
The use of telehealth for this purpose has been criticised by Katherine Drabiak, an assistant professor in the College of Public Health at the University of Southern Florida. She writes:
“Understanding the patient’s psychological condition is important because research in Oregon has found that patients considering PAS [physician assisted suicide] have concerns relating to loss of autonomy, ability to engage in activities that make life enjoyable, and loss of dignity. (Contrary to popular belief, excruciating pain is not a substantial factor in patient decisions to seek PAS.) Under Hawaii’s law, however, a patient may obtain a consultation via telehealth. While telehealth promises to reduce cost and increase efficiency to address other health care issues, we should pause to consider the sufficiency and ethics of a remote consultation with patients to discuss their motivations and screen for potential problems.
I take issue with what I see as a pro forma requirement. It looks like a protection, but it’s not designed to address underlying issues such as a patient’s depression and whether it could be relieved. Patients facing psychological, social, or existential concerns deserve compassion in the form of reassurance, social support, and practical solutions to address feeling like a burden on others. Needing connection and validation throughout our life–and especially at our most vulnerable when we require assistance from others–translates to knowing that we are meaningful and loved.”
Minimal data
The Act requires an annual report to be issued, however, there is no requirement under the Act for any information to be reported to the Department of Health on the reasons for requesting assisted suicide (apart from the underlying condition), on complications, on the length of the patient-doctor relationship, on the length of time from first request to death or from ingestion to either unconsciousness or death. There is no requirement for any witness to the lethal act.
Forcing participation – No assisted suicide free zones allowed
Although the Act contains explicit provisions protecting the right of a health care facility to prevent health care providers in its employ or on its premises from “participating” in the provision of assisted suicide there may be gaps in this provisions.
The American Civil Liberties Union is already threatening a law suit against Kahala Nui, a continuing care retirement community, which is run by a non-profit organisation and is situated on land owned by the Catholic Church, to force it to repeal a provision in its residents agreement which makes it clear that acts of assisted suicide under Hawaii’s new law are not permitted in the community.
The proponents of assisted suicide bitterly and aggressively object to any organisation seeking to preserve a life-affirming ethos.
Conclusion
As Hawaii’s experiment with assisted suicide begins it is clear that the lack of data will prevent proper scrutiny. The novel use of telehealth in assessing competence to request assisted suicide is disturbing. Roger Egan