932 Ward Avenue, Suite 430 Honolulu, HI 96814-2126 Phone: (808) 521-8961 FAX: (808) 599-2879 http://www.hah.org/

Issue

Medical advances have extended life and relieved much suffering, at the same time raising new ethical, legal, and medical dilemmas. As a result, in recent years there has been increased interest in an individual's right to die with dignity and to make decisions related to the dying process. Physician assisted suicide (PAS), one of many end-of-life issues, has been singled out for debate in state legislatures across the nation.

Healthcare Association of Hawaii (HAH) Position

Representing the state's acute care hospitals and two-thirds of the long term care beds, HAH believes that all people are sacred regardless of their physical or mental condition. Society through public policy should assure decency at every part of life, especially at the end. We oppose the notion that a physician or any other person can assist an individual in taking his or her own life. However, we affirm that individuals should neither be enslaved to technology nor be obligated to use every means to preserve life. We also affirm that a person should be able to use drugs or instruments to relieve pain, even if an unintended result would be that life may be shortened.

Background

The dying process raises profound questions about the meaning of life, suffering, and death. Acute care hospitals and long term care facilities both must contend with these issues on a daily basis. No other organization or entity in our community must deal with the process of dying as frequently or intensely as health care facilities. As a result of this experience, health care facilities have developed a considerable amount of knowledge and skill in working with, the dying person and his or her loved ones.

In thirty-seven states PAS is illegal, including Hawaii. Only in the state of Oregon is PAS legal. It is important to make the distinction that PAS is a deliberate use of some means such as drugs or instruments to cause death. In contrast, removing a life support system is allowing nature to take its course. Also in certain instances, it is appropriate to use pain management drugs that allow the patient to cope with living in pain, even if there may be an unintended result that may shorten life. This clear distinction and prohibition of PAS allows health care facilities to continue to provide health care with compassion as directed by their operating missions.

Lastly, more public education and discussion regarding end-of-life issues is needed. There are many misconceptions around dying with dignity rights. Currently, federal law mandates that a person be informed about the right to execute an advance directive when they are admitted to a hospital. These types of directives offer guidance to providers. For example, it may state "no resuscitation" or designate certain kinds of interventions. Yet, it is estimated that only about 15% of patients do so. With such low utilization of directives, there appears to be a greater need for more education and perhaps further development of the advance directive process.

HPACC members are:

• Hawaii Medical Association
• Hawaii Nurses Association
• Healthcare Association of Hawaii
• Hawaii Cancer Pain Initiative
• Not Dead Yet (Disability Rights Organization)
• Disability Rights Hawaii
• Hawaii Centers for Independent Living
• Hawaii Family Forum
• Hawaii Catholic Conference
• Hawaii Right to Life

6301 Pali Highway
Kaneohe, HI 96744-5224
Phone: (808) 203-6704
Fax: (808) 261-7022
hpacc@hpacc.org