USA
Hawaii legalizes medically assisted suicide

On 1 January 2019, the "Our Care, Our Choice Act", approved in April 2018, came into effect in the US State of Hawaii. With this new Act, it is now possible for individuals in Hawaii to end their suffering and life safely and legally, by self-administering the lethal medication.

The main prerequisites are: the individual must

- be at least 18 years old

- be a Hawaii resident

- suffer from a terminal illness with a remaining life expectancy of less than six months, confirmed by two doctors

- have mental capacity, confirmed by a mental health specialist

- have done two separate oral requests for life-ending medication, to a doctor, within a time interval of at least 20 days, and a written request, overseen by two witnesses

In order to avoid abuse and coercion, a number of safeguards were built into the legislation. Yet, there are a number of potential pitfalls for doctors and patients. For instance, an individual in weak state of health may no longer be able to comply with the prerequisite of making multiple requests over a three-week period.

Indeed, one can expect low utilisation rates in Hawaii, just as has been the case in the other states where physician-assisted dying has been made lawful.

The Act: https://health.hawaii.gov/opppd/files/2018/11/OCOC-Act2.pdf

Although efforts in the US to legalise assisted dying date back to the beginning of the 20th century, Hawaii is only the 7th US jurisdiction to legalise assisted dying. Just like in other States, legislators in Hawaii had proposed, discussed, and turned down a number of bills in previous years.

Physician-assisted dying remains legally controversial in the United States, despite increasing public support for it. To date, medically assisted suicide has been legalised – with slightly varying regulations and prerequisites – in the US States of Colorado, Hawaii, Oregon, Vermont, Washington, and California; and in the District of Columbia. Although the Montana Supreme Court decided in the case "Baxter" that physician-assisted dying is lawful in Montana, the Montana legislature is now considering legislation to ban it. In fact, three states have banned physician-assisted dying: Alabama (2017); Ohio (2017); and Utah (2018).

It is interesting to note that in the USA – similar to other countries – the idea of assisted dying gained wider social acceptance only after public discussion began to evolve more around the question of medical self-determination in a wider context. In 1938, Reverend Charles Francis Potter had founded the Euthanasia Society of America. The idea of assisted dying found little support at that time. Later on, the organisation started to put more emphasis on the right of self-determination with regard to the refusal of medical treatment. In 1967, the first living will was drawn up by human-rights lawyer Luis Kutner – who was also a co-founder of Amnesty International – and the Euthanasia Society. In 1973, the German translation of the American manuscript "Death is not the Worst: The Case for Voluntary Euthanasia" by Paul Moor, which in many parts continues to have a very contemporary feel, was published under the title «Die Freiheit zum Tode – Ein Plädoyer für das Recht auf menschenwürdiges Sterben – Euthanasie und Ethik».

It took another 30 years to anchor patient rights more firmly as part of every citizen’s freedom of choice and to find not only wider support in society but also solid political majorities in favour of medical aid in dying; in 1997, Oregon was the first US State to legalise assisted dying.

Newsletter 2019-1-1-e