Pulling the Plug in Paradise: Hawaii Legalizes Assisted Suicide

Americans strongly support the right to end suffering for terminal diseases, but states have lagged behind.

Jeff Wasserman / Dreamstime.com

There's not much good news for those with six months to live, but what if you could plan for your last moments to happen on a tropical island paradise?

You can. Yesterday Hawaii's governor signed a bill allowing for medically assisted suicide in the Aloha State. When the law takes effect next year, Hawaii will join five other states—California, Oregon, Colorado, Vermont, and Washington—and the District of Columbia in allowing terminally ill people to request and receive life-ending medication.

Mind you, people can't just fly into Hawaii, buy some pills, plop down on a beach, and end it all while watching the sun set over crystal blue waters. First of all, you have to establish yourself as a resident of the state. Then you must be diagnosed with a terminal disease that will kill you within six months. Then you must make two oral requests (20 days apart) and one written request (with witness signatures) for a prescription for life-ending medication. And you have to prove you're of sound mind. So don't expect a rush of suicide tourism to Hawaii.

It's good news whenever a state formally gives permission to treat people as though they own their bodies and can decide when to end their own suffering.

Assisted suicide is one of those issues—like marijuana legalization—where government policy has lagged significantly behind public polling. Surveys show that nearly three out of four Americans approve allowing terminally ill patients to end their own lives. Yet as Governing notes, New York's Supreme Court recently upheld a ban on assisted suicide, while 27 other state-level efforts just last year failed even to make it to a vote by lawmakers. In three of the five states where assisted suicide is legal, it took ballot initiatives from the citizens to force the state's hand.

So the struggles continue. Below, ReasonTV delved into a fight to bring assisted suicide to Montana back in 2013. Technically Montana is a sixth state that allows medically assisted suicide, but that's due to a state Supreme Court ruling and not an affirmative law. There have been efforts in Montana both to formally permit medically assisted suicide and to ban it entirely:

Comments

[Just Say'n]

"Then you must be diagnosed with a terminal disease that will kill you within six months. Then you must make two oral requests (20 days apart) and one written request (with witness signatures) for a prescription for life-ending medication. And you have to prove you're of sound mind. So don't expect a rush of suicide tourism to Hawaii."

These are probably good requirements. Assisted suicides in Europe have morphed from mercy killings to thinly veiled eugenics policy

[BestUsedCarSales]

Oh yeah, you have any information on that?

[Just Say'n]

http://www.washingtonpost.com/opinion.....edfe3f91be

http://www.telegraph.co.uk/news/uknew.....laims.html

[Just Say'n]

And this doesn't even touch on the thorny topic that governments are trying to force Catholic retirement homes to provide assisted suicide if requested, which opens a whole other topic.

I'm not saying that assisted suicide should be illegal. I was just noting that Hawaii's restrictions seem reasonable. At the very least, patients should have to provide their consent, which is not really required in many European countries. Of course, that is a continent that forces parents to let their children die rather than pursuing medical care in the US

[BestUsedCarSales]

I'm not saying that assisted suicide should be illegal. I was just noting that Hawaii's restrictions seem reasonable.

It's a hard thing. I don't have a great idea. I think suicide is pretty horrible, and that people should not do it. But I also believe that people own their own bodies and thus should have absolute right to decide to end it. If you don't have that, you truly do not own your body.

At the very least, patients should have to provide their consent, which is not really required in many European countries.

That's just murder at that point.

Of course, that is a continent that forces parents to let their children die rather than pursuing medical care in the US

Europe increasingly shows itself to have no value to human life, or particularly the lives of commoners. They still seem to have the focus and love of kings and the rich and powerful. They put forth this image of being caring and focused on welfare, but their actions show little but condescension towards people. The world is something to be controlled by those in power, because the people are worthless. They are ants.

It seems like everything comes from some old fashioned concept of Noblesse Oblige rather than any particular belief that the commoner's lives have value.

[BestUsedCarSales]

And this doesn't even touch on the thorny topic that governments are trying to force Catholic retirement homes to provide assisted suicide if requested, which opens a whole other topic.

I think it's more closely related than it might appear at first blush. This is government mandating euthanasia one way or the other. They are not stepping back and allowing people to make their choices, they are explicitly entering and taking a stance on what should happen.

Any coercion like that, particularly at the point of life and death, is monstrous.

[Bubba Jones]

In general, Europe isn't big on the whole "consent" thing.

This is a place where transplant docs get pissed when the potential donor recovers.

[JuanQPublic]

A clear, tangible distinction exists between assisted suicide of the terminally ill and killing the mentally ill, a population that has a sizable number of people who do not have the capacity to reason about ending one's life.

[Just Say'n]

Yes, I agree. But, the lines have most definitely been blurred in Europe. That's why I think Hawaii's restrictions are reasonable

[BestUsedCarSales]

killing the mentally ill, a population that has a sizable number of people who do not have the capacity to reason about ending one's life.

That's a big statement. Particularly that the largest mental illness diagnosis leading to euthanasia according to that first article is "depression." Which is a diagnosis so low that you could contrive anyone to have it if you have a psychiatrist who wants that diagnosis.

[cynicalretiree]

Belgium has assisted suicide for depressed patients who have tried many different therapies, still attempt suicide, and request a review for assisted suicide.. 3 doctors have to agree to each case. there are, infrequently, people who believe their existence is worse than death.the patient who chooses assisted suicide has to be fully cognizant of themselves [fully aware[. the patient is allowed to STOP the procedure right up to the last minute and leave the clinic.the choice for assisted suicide is a voluntary choice. nobody can decide for someone else.

[SQRLSY One]

Are there any states where you are NOT allowed to commit suicide so long as you are paying taxes, or are judged to be capable of paying taxes, but ARE allowed, as soon as you STOP paying taxes, in old age or in sickness?

If there are no such states yet, is anyone want to bet on how long it will take, for a state to pass some version of such a law? In light of continued decay in budgetary and deficit matters?

[ThomasD]

Yay permission!

[BestUsedCarSales]

It's good news whenever a state formally gives permission to treat people as though they own their bodies and can decide when to end their own suffering.

You don't own your body any more or less here, and the amount of permission one needs certainly doesn't imply you have that much agency.

[JuanQPublic]

It's good news whenever a state formally gives permission to treat people as though they own their bodies and can decide when to end their own suffering.

It's nothing short of amazing that in 21st century U.S., the notion of self-ownership, especially on matters of life and death, must need to be fought for.

Both socially conservative and progressive ideologies continue to infantilize grown adults with paternal posturing and moral superiority, clearly showing a reflexive need to control people.

[Mickey Rat]

Life, like liberty, is an inalienable right. Which means they cannot be handed over to another person. You cannot justly ask someone to kill you anymore than you can sell yourself into a legally binding slavery.

[OpenBordersLiberal-tarian]

As a left-libertarian, I support the right to doctor-assisted suicide for people who meet certain medical requirements (terminal illness) and who successfully navigate the approval process. What I cannot support, however, is people killing themselves by gunshot. In fact if a gun owner's friends and family suspect he or she or they are contemplating suicide, that should be grounds for the government to seize their weapons. Can't have people making such a major decision without going through the proper channels.

[NoVaNick]

What I cannot support, however, is people killing themselves by gunshot.

Strict gun laws do not stop Japanese and Koreans from killing themselves-they have some of the highest suicide rates in the world.

[colorblindkid]

While I have no problem with this, or with suicide in general, the end game of this is indeed a slippery slope, especially for older people who are a bit senile.

Also, the question I ask everybody on either side of the debate is whether or not depression counts as a disease. I'm neutral on the subject and really don't care, but it makes people think.

If depression is a debilitating disease, and there is no cure for some people, then what is to stop depressed people from getting assisted suicides? It is a disease that can ruin a life and make you suffer in agony everyday of your life. Why should we stop them from ending it?

And if that's the case, why try to prevent suicides at all?

These were just questions to ponder, because nobody likes to think things through. I personally lean towards letting depressed people off themselves. That might make me cold-hearted, but whatever.

[NoVaNick]

, especially for older people who are a bit senile.

And especially if the older person has a lot of money or property, and is talked into offing themselves by potential heirs.

Also, what about people who can't communicate because of disability?

Terminally depressed people usually live shorter lives anyway because they don't take care of themselves (smoke and drink more, don't exercise), so it might not seem like a big deal not to postpone the inevitable. But I believe that it should be their business alone to do the final act-don't involve a third party.

[Old Smokin' Egg]

I must disagree with the commenters who've asserted that Hawaii's requirements are reasonable. Specifically, I'd like to take exception to the terminal-illness requirement.

As I get older and more decrepit, my great fear isn't dying painfully of bone cancer while doctors refuse me painkillers because of opioid-epidemic restrictions, and offer yoga as an alternative. That's a concern, but far greater is my fear that I'll suffer a major stroke, which will leave me largely paralyzed and incapable of speech or reading, but that will do nothing to shorten my lifespan, so I can look forward to spending years propped up in front of a nursing-home TV blaring Doctor Phil.

No. I want to be able to end my life when it becomes unendurable by my standards, without my decision being vetoed by psychiatrists and politicians. Moreover, I want to be able to give a trusted friend a medical power of attorney, which expressly includes the power to authorize giving me The Shot, should I lose the capability of expressing myself on the matter.

[Scarecrow Repair & Chippering]

That sounds good to me.

The main question is, how can someone help me die, or even kill me, directly, at my request, without being prosecuted for murder?

Hawaii's requirements are fine for some, but should be voluntary. Whatever the assistor is satisfied with. I like your statement

want to be able to give a trusted friend a medical power of attorney, which expressly includes the power to authorize giving me The Shot, should I lose the capability of expressing myself on the matter.

I should be able to immunize my friend / doctor in this way, set down the guidelines, which, if we both agreed to voluntarily, and if the assistor follows scrupulously, makes them immune to prosecution. Of course, doing so with as many witnesses as possible in a hospital makes the immunity more likely to stand up compared to being shot in a cabin in the wilderness where someone discovers my rotting body six months later. But again, that is between the assistee and assistor and how satisfied they are.

[Old Smokin' Egg]

Right. We definitely don't want to see, as a defense against charges of murder, "This guy I met at a bar said he wanted to die, and if I'd help him do it, he'd give me his car and the contents of his wallet." Authorized suicide assistance should be an affirmative defense, not something that the prosecution has to disprove beyond a reasonable doubt.

On the other hand, the state has no business telling me that I can't kill myself, and recruit others to help me do so, as long as I'm capable of giving informed competent consent (or was capable of doing so at the time I filled out the medical power). There should be no condition's like Hawaii's terminal-illness requirement: if I want to commit seppuku because Trump won or the Patriots lost, that's my business and mine alone.

[Marty Feldman's Eyes]

Mind you, people can't just fly into Hawaii, buy some pills, plop down on a beach, and end it all while watching the sun set over crystal blue waters.

Well, you *could*... it just wouldn't be legal.

[wootendw]

Assisted suicide has been quietly going on for years with a few exceptions that become major media events. Hospitals are very willing to pull the plug on elderly patients if their relatives acquiesce - which they usually do if there's some time or inheritance involved.

[Michael Ejercito]

Why can these people not just shoot themselves?

[Old Smokin' Egg]

They're partially or completely paralyzed, or have such serious tremors that they couldn't wield a gun with any kind of accuracy.

They're confined to nursing homes, and any friend who brings them a gun would be looking at accessory-to-illegal-suicide charges, and possibly civil suits from the relatives who never bothered to visit the nursing-homed person, but care deeply about him once he's dead.

They're concerned about the failure rate, which is on the order of 10-20% for suicide attempt by gunshot, and that fact that a failed suicide by gunshot can be pretty unpleasant?for instance, one of the "Judas Priest subliminal mesages" suicides survived a self-inflicted shotgun blast to the head, which left him alive, but more or less without a face.

They'd like to die in the midst of family and friends, leaving them with a memory of their slipping away peacefully, rather than subjecting them to an experience that involves blood and brains spraying across the room.

They disapprove of private ownership of guns, and don't want to violate their principles by buying or borrowing one.

Or any of a great many other reasons. The point being: it's their business, not yours, not mine, not the AMA's, not Jeff Sessions's...

[cynicalretiree]

Victims of intractable pain are forced to live tortured by every movement. imagine nursing staff being overworked and continuously late changing your soiled clothes, adult diapers or wet bed sheets while you are lying, immobilized by pain. imagine being immobile, in pain, with federal guidelines mandating non opioid therapies.