STAND. COM. REP. NO.539-02

Honolulu, Hawaii

, 2002

RE: H.B. No. 2487

H.D. 1




Honorable Calvin K.Y. Say

Speaker, House of Representatives

Twenty-First State Legislature

Regular Session of 2002

State of Hawaii


Your Committee on Judiciary and Hawaiian Affairs, to which was referred H.B. No. 2487 entitled:


begs leave to report as follows:

The purpose of this measure as introduced is to authorize, in certain circumstances, a patient suffering from an incurable and irreversible disease that will produce death within six months to obtain, upon request, death with dignity (painless inducement of death) from a licensed physician.

Your Committee received testimony in support of this measure from the Office of the Governor, Advocates for Consumer Rights, ACLU Hawaii, First Unitarian Church of Honolulu, ILWU Local 142, The Kokua Council, National Association of Social Workers, Hawaii Chapter, the Unitarian Church of Honolulu, and numerous concerned individuals. The American Center for Law and Justice of Hawaii, Hawaii Catholic Conference, Hawaii Family Forum, Hawaii Nurses' Association, Hawaii Right to Life, Healthcare Association of Hawaii, Pro-Family Hawaii, and approximately six concerned individuals submitted testimony in opposition to the measure.

Your Committee finds that a terminally ill patient's decision-making over the time and means of death is a highly personal matter. A terminally ill patient's request for the assistance of a physician to accelerate death ought to be treated with dignity and respect. Your Committee finds it appropriate, compassionate, and humane to authorize a physician to prescribe medication to empower a mentally competent, terminally ill, adult patient, who has a full understanding of options and consequences, to exercise control over this intensely private decision.

In 1996, Governor Benjamin J. Cayetano appointed eighteen citizens to a Blue Ribbon Panel of Living and Dying with Dignity ("Panel"). On June 9, 1998, the Panel transmitted its May 1998 final report to Governor Cayetano.

The majority of the Panel endorsed a recommendation that the Hawaii Revised Statutes "be amended to legalize physician-assisted suicide and physician-assisted death." (Final Report, 29). This measure is consistent with that recommendation.

In describing their approach to the question of physician-assisted suicide ("PAS") and physician-assisted death ("PAD"), the Panel noted:

"These are societal matters too important for any one profession to shoulder, and which must be brought out into the open and addressed by the best efforts of the society.

"Our respect for individual's rights of self-determination brings us to the view that requests for assistance with dying should be taken seriously. The major concern is whether such requests are made by competent patients who have been offered all the services available to address their situation.

"Great care must be taken to ensure that a decision follows a full exploration of other options which may ameliorate the grounds for the request.

"But when all avenues and methods of assistance have been exhausted or unsuccessful and the patient with a terminal condition or intractable and unbearable suffering persists in his or her request for assistance in dying, that request must not be refused lightly.

"We believe that in Hawaii especially, it is important that no one perspective be allowed to impose its beliefs and mores on another. We have concluded that individuals who have no compunction regarding physician-assisted dying should be allowed to follow the dictates of their conscience." (Final Report, pp. 27-28).

Your Committee finds that a need exists to provide a humane solution to a situation that has caused families anguish and turmoil. Your Committee heard descriptions of needless suffering, excruciating pain, lack of control, gasps for breath, and loss of bodily functions. Your Committee heard pleas to allow individuals who wish to die in peace and dignity to make this decision for themselves, and to live out their years without fear of being forced, at some future time, to continue living in the painful circumstances they have seen others endure.

A minority of the members of the Governor's Blue Ribbon Panel on Living and Dying with Dignity strongly opposed the recommendation of the majority. The author of a 32-page Dissenting Report that begins on page 70 of the Final Report included a copy of the Dissenting Report in testimony submitted to your Committee in opposition to H.B. No. 2487. Your Committee heard many of the same concerns expressed during the hearing.

Opponents to this measure warn that patients may feel obligated to end their lives to avoid burdening their families with costly medical care, and that health care providers may be tempted to assist with death rather than providing expensive treatment or hospice care. Opponents wonder whether this measure is but the first step in a "slippery slope" toward involuntary euthanasia. Opponents are also concerned that this measure could impede progress toward expanding availability of hospice services and increasing physician knowledge of pain management techniques. Finally, they suggest that undiagnosed depression may cloud patients' reasoning at this critical phase of life.

Your Committee's support of this measure is in no way intended to detract from improvements in health care, hospice care, and public and professional education concerning pain management. Your Committee received testimony that in Oregon, hospice care and pain management efforts increased rather than diminished following implementation of legislation similar to this measure.

This bill explicitly provides that nothing in this chapter is to be interpreted to authorize a physician or any other person to end a patient's life by lethal injection, mercy killing, or active euthanasia. Therefore, your Committee finds that the fear of euthanizing the frail and helpless of society is unfounded and most may take comfort in knowing that this option is available to terminally ill patients.

Your Committee has amended this measure to closely track the Oregon Death with Dignity law, after finding that additional considerations and requirements will protect patients against abuse. This measure requires that a person be:

(1) 18 years or older;

(2) A resident of the State of Hawaii;

(3) Diagnosed with a terminal illness leading to death within six months; and

(4) Capable or able to make and communicate health care decisions.

Upon meeting the requirements, the patient will be eligible to request a prescription for medication from a licensed Hawaii physician upon meeting the following criteria:

(1) Two oral requests must be made by the patient to the physician, separated by at least 15 days;

(2) A written request to the physician witnessed by two individuals; of which one is not any of the following:

(a) A family member,

(b) A beneficiary of the patient's estate,

(c) An owner, operator or employee of the treating medical facility, or

(d) A primary caregiver.

A third witness shall be required and designated by the long-term care facility if the patient is in that facility at the time of the written request;

(3) The patient may rescind the request at any time;

(4) The diagnosis and prognosis must be confirmed by the prescribing physician and a consulting physician;

(5) The prescribing physician and a consulting physician must concur that the patient is capable;

(6) If either physician determines that the patient's judgment is impaired, the patient must be referred for a psychological examination;

(7) The prescribing physician must inform the patient of alternatives including palliative care, hospice, and pain management options; and

(8) The prescribing physician must recommend that the patient notify their next-of-kin of the prescription request.

Furthermore, the measure requires that physicians report to the Department of Health all prescriptions for medication, and affords protection from criminal prosecution to all physicians and patients using this right. Additionally, the choice of legal-physician-assisted dying may not affect the status of a patient's health or life insurance policies, and physicians and health care systems are not obligated to participate.

As affirmed by the record of votes of the members of your Committee on Judiciary and Hawaiian Affairs that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 2487, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 2487, H.D. 1, and be placed on the calendar for Third Reading.

Respectfully submitted on behalf of the members of the Committee on Judiciary and Hawaiian Affairs,