As of June 1, it is easier for terminally ill patients to obtain prescription medication to end their suffering.
Without fanfare, Gov. Josh Green, a physician, signed into law House Bill 650, which makes changes to the Our Care, Our Choice Act which went into effect in 2019.
The bill allows qualified advanced practice registered nurses, or APRNs, to be attending health care providers who evaluate if a patient is eligible to use the Act and prescribe medical aid-in-dying. And it also permits the use of consulting health care providers to confirm the attending provider’s evaluation that the patient is eligible.
The original law allowed only physicians to be attending and consulting providers.
“It is a pretty big leap, although it doesn’t put us out in front,” said Aubrey Hawk, advocate for Compassion &Choices Hawaii. “New Mexico’s law is just a couple of years old, and they had APRNs prescribing (medical aid-in-dying) in their first law. And I believe Washington has also changed their law to allow APRNs to prescribe.”
In addition, the Hawaii law now reduces the waiting period from the first oral request by a patient for the medical aid-in-dying prescription from 20 to five days, and also waives the waiting period if it’s determined the patient won’t survive it. In that event, the waiting period is 48 hours.
Written testimony submitted about HB 650 during the legislative session was overwhelmingly supportive.
Sen. Joy San Buenaventura of Puna, who chairs the Senate Health and Human Services Committee, said the new law “really helps neighbor islanders” to exercise the medical aid-in-dying option.
“There aren’t many physicians that would help the patient to make that choice,” San Buenaventura said. “So, by increasing the ability of a patient to have an APRN prescribing is helpful. We also shortened the waiting time, because doctors, understandably, are not going to give the prescription drugs unless they know death is imminent. And patients need to get the prescription earlier to relieve them from the suffering, so we reduced the waiting time from 20 days to five days.”
Patients still need a third mental health evaluation before exercising the option, and Hawaii is the only state with a medical aid-in-dying law that requires that third mental exam.
The law now, however allows a licensed marriage and family therapist to perform that third exam.
“The first oral request has to be made; then that, basically, starts the clock. Then all the other eligibility requirements can happen after that first request,” Hawk said. “All of this can be done via telehealth.”
Patients must be adults with an official prognosis of less than six months to live to request the prescription.
The annual report to the Legislature from the Department of Health suggests that access to medical aid-in-dying is easier for Oahu patients than those on the neighbor islands.
In 2019, the first year of the law, 30 prescriptions were written to qualifying patients. Twelve doctors on Oahu wrote prescriptions, one on Hawaii Island, and none on Maui or Kauai. In 2020, there were 37 prescriptions written by 14 physicians, 11 on Oahu, two on Maui and one on Hawaii Island. None were written on Kauai.
And in 2021, the last year for which data is available, 49 prescriptions were written by 21 doctors — 14 on Oahu, three each on Maui and Hawaii Island, and one on Kauai.
“What’s really groundbreaking, and will really help people, is the reduction of time between the first and second oral requests,” Hawk said. “In fact, I know of three patients who were suffering and were not going to be able to (survive) the 20 days, and have now been able to take advantage of the five days because (Green) signed when he did. Which is why we are so grateful to him for expediting that signing.
“He’s an M.D. himself and knows suffering, and he’s a compassionate man. And we’re just beyond grateful for him to hop on that so quickly.”
Email John Burnett at jburnett@hawaiitribune-herald.com.