Eva Andrade, hands extended, leads the group presenting Gov. David Ige with a 18,036-signature petition of people opposed to physician-assisted suicide April 4 in the governor’s office at the Hawaii State Capitol. The petition sheets were carried in four lauhala boxes. (Photo courtesy of Nathan Hokama)
Eva Andrade is president of Hawaii Family Forum and communications director of Hawaii Catholic Conference, the public policy arm of the Diocese of Honolulu. For about 20 years, she has been on the front lines at the State Legislature and in the public square in the fight against the law to permit physician-assisted suicide.
By Eva Andrade
Special to the Herald
Gov. David Ige on April 5 signed Hawaii’s physician-assisted suicide bill into law, under the comforting title, “Our Care, Our Choice” Act. On that gloomy day, to get away from the exhausting 20-year crusade I had fought against that bill, I went to the movies.
I was surprised to see I was the only one in the theater. The film, “I Can Only Imagine,” was outstanding. It was about a young boy who grew up entangled in a bitter war of unforgiveness and lingering anger toward a father who abused him and a mother who abandoned him. When the father is diagnosed with pancreatic cancer, his final moments provide an opportunity for forgiveness and mercy between him and his now-adult son. As a Christian, I understand that reconciliation is a gift of our good and gracious Father who sees us through life and then, death. Alone in the theater, I cried — not only for the movie relationship restored, but also for the real island families who will be harmed by the stroke of the governor’s pen.
News stories and legislators celebrated the suicide bill as having “rigorous safeguards that are the strongest in the nation.” The bill allows Hawaii residents 18 or older with a terminal illness, diagnosed with six months or less to live, to receive from their doctor a prescription for a dose of drugs that will cause death. The patients must be un-coerced, of sound mind, and have the approval of two doctors and a mental health professional. They must make oral and written requests over a 20-day waiting period, and finally, self-administer the drugs, presumably as a supportive family gathers round for the final goodbye.
That last part is how this law has been sold to the community.
But have we been told the entire truth? Have we been given a good bill, or sold a bill of goods?
The first confounding thing about this law is its very definition. Nowhere — not in the title or body of the statute — is the action the law now permits called “suicide.” But that is what it is, the intentional killing of oneself with drugs ordered by a doctor. That was previously a felony for a doctor. Which is why a law was required, to sanction what the law dares not call itself – physician-assisted suicide. No amount of “rigorous safeguards” can hide that bald fact.
Nevertheless, let’s examine some of those safeguards.
A diagnosis of six months or less. Doctors testified that they can’t make this determination with certainty. How much time a patient with a terminal illness has left is only an educated guess. Some who were told they only had six months lived months and years longer. Terminal diseases were also identified as conditions that would cause death “if left untreated.” Would that include type 1 diabetes which is “terminal” without daily insulin shots?
You need a second opinion. The agreement of two doctors sounds pretty safe. The bill, however, doesn’t require you to have any particular relationship with the doctor. If your primary care physician of 20 years refuses to write the prescription, any doctor will do. Compassion and Choices, a physician-assisted suicide advocacy group, will give you names. It has said as much in recent interviews.
A mental health professional will ensure you are of sound mind. The law requires the judgment of a “mental health professional” to make sure patients are “capable” of making an “informed decision” and are not suffering from depression or other psychiatric condition that would warp their judgment. Psychiatrists and psychologists are trained to do this. However, the law includes “social workers” as mental health professionals. And they are permitted to make the diagnosis via telemedicine rather than in person. So a social worker, untrained to spot depression, can, after a Skype interview, give the OK for someone to end his or her life. It’s the law.
No one will be forced to participate. Can coercion be proven? The bill requires two witnesses, one of whom is not related to the person or eligible to benefit by the person’s death. But the other witness could be. Legislators have assured us that abuse and coercion would not be tolerated, that such behavior would be a Class A felony. OK, how are such acts reported and investigated? The law does not say.
Patient privacy will be protected. Clouding everything even further is the requirement that the cause of death on the death certificate cannot be the self-administered lethal dose of drugs, but the underlying terminal disease. So with the death certificate, the lethal prescription, the prescribing doctor, the witnesses, the mental health professional, the required written requests all disappear. Poof. It will be as if the “death with dignity,” or whatever advocates want to call it, never happened. The death would be classified as natural. That would be a lie. Doctors have testified that they could not, in good conscience, sign a false death certificate. But no worries, some will.
Access to the lethal drugs without unnecessary barriers. The patient will be surrounded by loving family members. OK, maybe, maybe not. Witnesses are only mandatory for the written request for drugs, not for the death itself. No one is required to be there. In fact, the patient is not required to inform the family of anything. So an 18-year-old can choose to hide his decision from his family who, God forbid, may try to talk him out of it.
The drugs, if unused, will pose no danger. If a patient acquires a lethal prescription but does not use it, the person “who has custody or control” of any unused lethal drugs is required by law to personally return them for disposal to the “nearest qualified facility” and if none is available to dispose of them by “lawful means.” This is fraught with ambiguity. Is the family responsible for custody of the drugs? But what if the family does not know about the drugs? What is a “qualified facility?” Is it a pharmacy? What if the pharmacy does not take back medication? (None currently do.) What if the medication is hidden or disposed of? Well, there is a penalty for not returning the medication. What is that penalty and for whom? The law is not clear.
So what’s all the fuss? If you believe the rhetoric swirling around this bill, the primary opponent of the bill was the faith-based community, mostly Catholics. That’s a tactic: label the opposition as “religious” and then cry “separation of church and state.” This strident hostility toward religion unfortunately helped drown out voices of opposition from the medical community, the disabled community and other concerned citizens. Of course, the U.S. Constitution gives the church every right to contribute to the public debate, especially when it comes to moral issues. But the church’s position, “Thou shalt not kill,” is no more an imposition of church doctrine than are civil laws against murder.
Even the state attorney general called a couple of sections in the bill vague and overly broad. He said the “good faith compliance” as described in the bill was unenforceable. He also asked legislators to fix the law to state more clearly that healthcare providers are not required to inform a patient about the option to kill themselves. These recommendations were ignored. The attorney general predicts lawsuits.
The bottom line, we have been told, is that it is your choice to request suicide or not. It didn’t take me long to discover that more than 57 percent of the cases in California were paid by Medicaid, Medicare or “other government insurance.” In other words, our taxes. That means you and I are paying for something we didn’t choose. So, who is forcing who to do what?
Sitting alone in the movie theater was pretty depressing. I didn’t have anyone to laugh or cry with. Just like an old woman in the nursing home who has just received a terminal diagnosis. Maybe the thought of a “mercy” pill to end her life when she wants is better than dying alone in a nursing home or hospital room.
Somewhere in this end-of-life journey lies a connection that only God knows about. Stopping it prematurely may tear families apart instead of providing the dignity supporters are searching for. Taking care of someone at the end of his or her life lies beyond an individual’s personal choice. Suicide tears people away from hope — and that will forever change the face of Hawaii’s families.
Death is final and rests in God’s hands! The journey getting there is what we need to be fighting for.
