 I'm Marcia Joyner, and we are navigating the journey. Navigating the journey is dedicated to exploring the options and choices for the end of life care and to assist people to talk about their wishes. It's time to transform our culture so we shift from not talking about dying to talking about it. It's time to share the way we want to live at the end of our lives. And it's time to communicate about the kind of care we want and don't want. We believe that the place for this to begin is not in the intensive care unit. Together, we can explore the various paths to life's ending. Together, we can make these difficult conversations easier. Together, we can make sure that our own wishes and those of our loved ones are expressed and respected. If you're ready to join us, we ask, navigate the journey. Today's guest is Dr. Charles Chuck Miller. He is board certified in internal medicine, medical oncology, and hematology. He served 30 years in the US Army Medical Department and was chief consultant through Surgeon General and spent nine years as chief of hematology at Kaiser Medical Center in Honolulu. And I'm so glad you're here. Just so glad to meet. Now, is it OK if I call you, Chuck? Please. OK. Absolutely. So tell us about you. Tell us all of those big words, hematology and oncology and all of that kind of good stuff. Noncology is the general specialty, I guess that's the way to describe it. It's a general specialty that deals with all types of cancer. Hematology deals with cancers of the blood, but also nonmalignant blood problems. So the reason it's separated, they have two board certifications, one just for hematology and one just for medical oncology. But at some point, they overlap. They overlap. For you and your OK. Absolutely. So your experience in your education, they come together. Yes. Is that correct? Yes. Yeah. Absolutely. It just seems that you can't have cancer without having an issue with your blood. Mostly, that's true. But we also look at different types of anemia, or for instance, sickle cell disease is under hematology. So it's not all malignant diseases. It's all blood diseases. Yeah. So you were in the military or civilian? No, I was 30 years in the army. In the army. Excuse me. Out of those 30, I was fortunate enough to spend 14 of them at Tripoli. At Tripoli? Wow. All in off. So is this your home originally? No. No. I wish. So where did you come from originally? Illinois. Illinois. And then I did my medical school training at USC. And then I did all of my post-graduate medical internship residency fellowship all in the army. My fellowship was at Walter Reed in medical oncology and hematology. When was that? When were you at Walter Reed? 75 to 79. So that was at the end of Vietnam? Yeah. So you got to see it a lot. I did one year in Vietnam in 1971 to 72. I was assigned to a medical assistance team in Pleiku, in the central Highlands. And I worked primarily with the Vietnamese Civilian Medical Department to support the medical care for civilians, not for their army or for our army. It was an experience. Oh, I would imagine so. Education. So you had to learn the language and everything. I had interpreters. That's quite an education. And then you got transferred here. I came back here, finished a residency, then went to Walter Reed. And did my fellowship stay on the staff a year and then came back here in 1979. 79. And I was chief of oncology at Tripler, 79 to 83. Wow. And then you retired and went to Kaiser? Lord, no. No? I did 30 years in the army. Oh, so after you left Tripler, where did you go? I went to the Presidium Letterman Hospital in San Francisco. I was chief of medicine there for eight years. Then I went to the 93rd Field Hospital in Germany. I was deputy commander. Then I made commander, and we actually took a hospital into Zagreb and to Croatia. The US Army supported the UN peacekeeping mission in the Balkans. Yes. And so we were responsible for providing, basically, we did a MASH unit in Zagreb, the airport. So for anybody that wasn't in the military, tell us what a MASH unit is. Medical. And something that's not on television. Everybody knows what a MASH unit is. Well, it's a lobal surgical hospital to basically support battle injuries, more injuries. Wow. So you've had quite a bit of experience. The reason I'm asking you about all this experience is that you come to us as John Radcliffe's physician. And John has been on with us sometimes. And he talks glowingly about you. So we wanted to talk about not just John. And incidentally, he did give us permission to talk about it. So you're not violating any trust. So tell us about the kinds of issues that he's going through. And people like that. Not just John, but people like that. You know, even though I've taken care of thousands of cancer patients throughout my, basically, 40 years, it's very difficult to actually personalize and personally understand what an individual patient is going through. I mean, John and I have talked a lot. And I think he is going through anxiety. Oh, of course. Not so much, I don't think he's in much actual pain, but the anxiety of knowing that you're going to die and knowing that, you know, in the end, the medication, the chemotherapy, all of the stuff that he is receiving that is keeping him, keeping his cancer in check, it's going to stop working. And just that knowledge, that thing sits in your brain 24-7. And that produces an incredible amount of angst. The side effects of the chemotherapy, I think, he's a strong man. It's amazing. He takes that in stride, and it tolerates it, and then comes back, jumps back up, and does it again. He said 44 times, 44 rounds. It's just hard to imagine. Do other people go through that much? Other people, let's just talk about cancer. We're not going to talk about ALS and all the others. Just the cancer patients, do they go through that much? Some do more. Really? You know, there's a difference between patients with stage 4 cancer, with basically cancer that cannot be cured, at least with the tools we have available today. And many of them will go through several years of ongoing intermittent, but ongoing treatment with all of the associated side effects, weight loss, nausea, you name it, infections. But the individual patient makes that decision to say, I'll put up with this so that I can live longer. So it's also the individual's right, I think. They're the only, the patient's the only one who knows or recognizes or says, you know, it's not worth it anymore. And they do that. A little bit of what are some of the side effects of the, this is the chemo, right? What are some of the side effects? Well, they differ with different drugs, obviously. But in general, most chemotherapy treatments cause significant nausea. Hair loss, which is not a big deal in men so much, but in women it is. You lose your appetite. You start to lose weight. You lose, you just lose energy. You end up feeling washed out for any place from a few days to several weeks even after a treatment, depending on what the drugs are that are used. And your blood counts get knocked down. So you usually end up having to get injections to push your blood cells, the white blood cells back up to keep you from getting infection. And infection is always a risk when your blood counts are low. And it's a lot to go through for years because John said it's been since 2014. And this is 17, and he's been going through that a lot. Then it's just hard to imagine this kind of thing that people, not just John, but cancer people go through at that stage four. Do you ever see people with? I'm going to ask you several more questions, but we should take a break. And then I want to ask you about terminal sedation, OK, but we do need to take a break. You're watching Think Tech Hawaii, which streams live on ThinkTechHawaii.com, uploads to YouTube.com, and broadcasts on cable OC16 and Ollello 54. Great content for Hawaii from Think Tech. Aloha, I'm Richard Emory. I'm with co-host Jane Sugimura of Kondo Insider, Hawaii's weekly show about association living. The purpose of these videos is to educate board members and Kondo residents about issues relating to association living. We hope they're helpful and that they assist in resolving problems that affect the relationship between boards and their residents. Each week, Thursday at 3 PM, we bring you exciting guests, industry experts, who for free will share their advice about how to make your association a better place to live, and answer a lot of very interesting questions. Aloha, we hope you'll tune in. Aloha, we're back. And we're talking with Dr. Chuck Miller about all kinds of horrors, but people do have to deal with this. Now, we were talking about at the end, when people choose, they say, OK, I've had enough. This is more than I can handle. We want to talk about the choices people have and the choices they don't have. So let's talk about terminal sedation. And what is terminal sedation? And when does that happen? Terminal sedation is a procedure that, first of all, is legal in every state and union. And it is used, nothing else will control a patient's pain, suffering, anxiety at the end of their life. And this usually happens in a hospice situation, either inpatient hospice or home hospice. And I'll give you the example that when I was actively practicing, what would happen is the hospice nurse would call me up, say, Dr. Miller, Mrs. Smith is just having more and more pain. And so I would say to the nurse, all right, double her morphine dose, call me back in an hour if it's no better. And in the worst case scenario, I'd get a call back in an hour and say, she's not any better. Double the morphine again. And basically, you keep doing this until the patient becomes unconscious. That's called terminal sedation. And you continue that level of sedation. And basically, the patient stops breathing. So that's legal everywhere. I have a problem with that. Well, no, no, I keep going. It's legal. And even the religious doctors who are very religious, they accept this on the basis of what's called a double effect. I think it's hypocritical. But the concept is that because the procedure you're using, you're not intending to end the patient's life. You're just intending. The only thing you're intending to do is take away the pain. It's OK. I find that the ultimate hypocrisy, attitude. And the biggest problem I have with terminal sedation, and it works. And every oncologist I know has used it many, many times. But the problem I have with it, and that's why I'm really such an advocate of aid and dying, like California and all the other states have, is that it takes the patient's choice away. The terminal sedation, the patient has no choice when he or she is going to die. The died are the ones making the decision as to when that patient's life will end. And I don't think that's good. I think I'm obviously doing good for that patient because otherwise it'd be a horrible, it couldn't tolerate living basically. But I would much rather that the patients have the choice of saying, now's the time. So with aid and medical aid and dying, the patient has the choice. So tell us exactly what that means. Well, looking at the Senate bill that's currently being debated in the Hawaii legislature, it's modeled almost exactly after Oregon's law. You have to be a terminally ill patient, and the expectation is six months or less to live. And you have to be of sound mind. You have to have your wits about you. And you have to request twice to get a prescription from your physician for medication to end your life. And you have to do it in writing. And then another physician has to say, has to go with consult on your case and say, yes, I agree. Mrs. Smith is perfectly capable of making this sort of decision. And then the patient basically takes the prescription to a pharmacist and gets the drugs. And then the medication, she or he keeps it at home. And he or he decides, well. And this medication will last a while. So even if it's a little over six months, the medication is still good. So then as I said, well, I don't think I want to do this. OK. So there's no issue about rescinding. It's all about patient choice. And the patient, and it's clear that that's happened in Oregon probably 30, maybe 35% of the time. Patients will get the prescription and then never use it and die of the event of the disease, a progression of the disease. And that's OK. But what we get feedback from is that just having that prescription, having that medication there, knowing that it's available if they want to use it, relieves a lot of that anxiety that end of life approach occurs. So we hear all these negative things about this choice of medical aid and dying. But I heard one doctor say, well, we take the hypocritical oath to do no harm. Now, you have to tell me this, or is this just my opinion, some of the medication that people are given for high blood pressure, for diabetes, for all of these other things. If you read the fine print and the side effects, one of which will kill you, how can you say that there's a difference? How can you say that you'll do no harm and you're writing prescriptions for opiates, for instance, or you're writing prescriptions. My husband has high blood pressure and emphysema. And when I read the label, the fine print on that paper they give you when you get the prescription, if you read the whole thing, which they expect you not to do, if you read the whole thing, it says, and may cause death. It's always there. So how can you say that you'll do no harm? And it's legal to write these prescriptions and it's not legal to write a prescription? I think the reason that's on that little piece of paper is the drug companies want to cover their fancies. And yet maybe it's a one in a million chance of that happening. That's why that's there. I mean, in reality, 99.99% of drugs taken as prescribed by individuals without allergies to them are perfectly safe. Back to your question a little bit about the issue of the Hippocratic Oath. First of all, nobody does the Hippocratic Oath anymore. I graduated from medical school in 1970. We didn't even use it then. It's irrelevant in the 20th century, 21st century. We took the oath of Geneva. But the bottom line of this is the medical caveat is premium non-notary, which is Latin for first do no harm. And the critics will say, well, if you're helping your patient kill themselves, that's harmful. And myself, I think, and many other physicians disagree with that. We look at that mandate of doing no harm as supporting. It should be our job to support our patients' choices and wishes on how they want to end their life. It shouldn't be our choice, regardless of my own feelings about one way or the other. If the patient, I need to support my patient's choice in the most important decision in their entire life. Well, we hear so many things that seem strange about a slippery slope. The opponents do this talk about a slippery slope. What is a slippery slope? Well, the critics of this say that, OK, once this starts, the next step will be, well, the patient's family can ask for it. And then somebody else can ask for it. And then we'll start killing people. And you'll have euthanasia. And in 20 years in Oregon, there has never, ever been a documented case of abuse of the medication or, they say, we've got elder abuse. Well, that's simply not, it's never been documented. It's not true. We have statistics for 20 years and for a few more years in Washington as well. And it just, it hasn't happened. And I think that the reason it hasn't happened is because physicians are very, are basically, we're good people. And it would be antithesis for a doctor to support any sort of misbehavior, for lack of a better term, by anyone when a patient's at their end of life. Well, we have, I want people, if you want to come meet Dr. Miller and John, tomorrow is Thursday. So tell us what's going to happen. There's a forum at the Capitol. It is sponsored by the University of Hawaii School of Public Policy. And I think it's Judge Michael Broderick who's going to moderate this for us. And we're going to have the state attorney general, Doug Chin, myself, John Radcliffe, Dr. Craig Nakasuka for the opposition. And the other lady is Joy, anyway, from another person from the opposition. And we're going to have time to take questions and also give our points. Wonderful. Well, if you want to come meet the doctor, please do tomorrow at the Capitol at 7 o'clock. 7 o'clock. 7 o'clock. And we'll see you then. Thank you so much for coming. It's been a pleasure. And I look forward to seeing you again.