 Today we will be talking about House Bill 2739, which is also known as the Our Care, Our Choice Act, which was signed into law by Governor Igay after this legislative session. My guest today is Blake Oshiro. He is a Vice President of Capital Consultants of Hawaii, and today he is representing the National Organization, Compassion and Choices, which not only supported this act, but has supported acts of a similar nature all over the country. So welcome, Blake, and thank you so much for coming today. I'm really grateful. Thank you, Martha. Thank you for having me today. Oh, I'm so glad you could make it. I am going to start by just turning this over to you. Let's start by telling people what the act actually is. What does it really say, and what does it mean? Yeah, so this law was modeled after the Oregon Death with Dignity Act, but there are probably a few more changes which have been deemed as safeguards to make sure that any of the concerns brought up by people that this could be abused is not going to happen. So a terminally ill patient, the person who actually is defined as not being able to have a prognosis beyond six months, is able to get a lethal medication of a prescription drug from their treating physician, and they have to have two physicians that concur with the diagnosis. It's terminal that they have no chance of surviving beyond prognosis of six months. They then have to also get a psychiatric or psychological consultation to make sure that there's no depression or other mental disorder that could be affecting their decision. Then they have to go through a waiting period, have to make two requests, and then finally they'll get the medication at which time they can decide on their own whether and when they want to take their own life. I see. I see. My understanding is laws of this kind have been in effect for close onto 30 years. Certainly I believe Oregon was the first state to put it in. And I also understand that the fears that were voiced, which were similar to the ones you've addressed, there has been no case of abuse reported from any of the few states that do have such laws since their laws came into effect. So did that information assist you in any way in finally getting this law approved or addressing the concerns of people? Because for them to bring up such concerns and to face them with the fact that over 30 years, no such evidence has been shown of any kind of coercion or force. It seems to me to be significant, and yet the same objections are raised. Did you find yourself facing that when this was being introduced? Yes, definitely. I mean, a lot of people have concerns about the potential for abuse or they hear anecdotal sort of stories about people suffering unnecessarily in a prolonged manner in order to achieve their own demise. But none of that is really documented in any of the evidence. This is a highly monitored law under Oregon. They've had annual reports going on for nearly 20 years now. And what you can really see from that is it really is people that tend to have cancer, tend to have severe cases of cancer, and most of them tend to be more highly educated. Most of them tend to already be covered by insurance. Most of them tend to be in the average to slightly above average economic income. So, you know, there's a lot of evidence that this isn't abused. It's something that people choose to do. And in fact, I think it's actually something that a lot of people want to know that is out there for them when they're going through this difficult time. Some of them may decide not to take it at the end. They just want to know it's there. I believe there are some statistics I was able to find that in Oregon, since they instituted the law, let's say 1998, a little bit less than 2,000 people have requested the medication in order to take their own lives. But about 1,300 have actually done it. And that's over the entire span of time from, you know, 98 all the way through today and in Washington, the state of Washington, since 2009, again, you have about 1,400 prescriptions written and about 1,360 actually having taken the drugs. So what it means is that more people over time have asked for the drug and chosen to take it. But it hasn't necessarily been an inevitable conclusion. A person can say, I would like to be able to make this choice, so I make it. And then they can change their mind and nobody will force them, because that's also protection I believe under this law. Nobody can coerce you or force you to commit the final act. It has to be performed willingly by the individual who's requested the medication. Is that correct? Yes, it has to be self-administered. It has to be something that the patient themselves can take and no one else can assist them. And that's really what distinguishes it from the idea of physician-assisted suicide or sort of euthanasia, which is oftentimes seen as somebody assisting somebody in a Kovakian-like sort of situation. But that's not the case here. It's actually a prescription drug that you take. You get it in two different forms, one so that it actually makes sure that your body is able to absorb the medication and you don't regurgitate it. And then the second one that you take a few minutes later is one that actually ends up ending your life. Right. Okay. Well, that to me makes perfect sense. Maybe we can talk about how long has the effort been instituted here in Hawaii to get this law through the signature and made into law? And what are some of the experiences you had in the process? How long did it take? How many objections were filed and how many little legislative tricks might have been used to keep it from going through? I think this is something that people would like to know in case they also have something they would like to push through Congress, local Congress. Yeah. You know, this has been around similar to the Oregon law in 1998, then Governor Ben Caetano commissioned a blue ribbon study to look at death and dying in Hawaii. And they came up with a number of recommendations in terms of hospice care, in terms of compassionate care, in terms of pain and suffering. But one of the recommendations they came up with was to look at the Oregon law, death with dignity at that time. And Governor Caetano put in a bill. So it wasn't until 2002, in his last year in office, when a bill was heard by the Hawaii State Legislature, it moved out of the house. And then it got stuck in the Senate. And it went through a lot of rigmarole being deferred, then having to get recalled onto the floor, then in a very dramatic final vote, it lost by two votes. So it failed to make it out of the legislature in 2002. So it came close, but that was about as close as it came. Because for the next 18 years, it didn't move anywhere. I was in the state legislature during that time for the next 12 years. I tried introducing it every year. Sometimes I'd get a hearing. Sometimes I wouldn't. Sometimes I'd get a hearing, but it would get deferred. So it never really went too far. It had a lot of stops and starts. And then it wasn't until 2017 that we were able to get it out of the Senate again. It went to the house. They couldn't move it out. And then in 2018, they took it up again. And we were fortunate enough to get it out of both chambers and then up to the governor's desk. What was the significant difference politically during these different times? Because the objections are essentially the same. They're the same ones that are raised every time. The points of view are usually represented either as a religious point of view or some doctors indicate that it violates their oath, which let us remind people technically it does not, because the doctor is not assisting in any act of death. The doctor is giving drugs to the person to let them decide if it's their time to go. So please, this is not doctor-assisted suicide. And I'm wondering what differences did you observe in the makeup either of the Congress or the political leanings of the time or any other pressure that was brought? Because for 18 years to have nothing happen, and then all of a sudden to have something start to happen, although I believe this was a very productive legislative session, what did you observe? Because you've been involved from the beginning, it seems. Yeah. I mean, I think there were a lot of different things. The landscape changed a lot nationally. A few other of the Western states ended up adopting the law or passing it via referendum. And so at that point, Hawaii was sort of an outlier, right? Because you had Oregon, you had Washington, then you had California. And so the Hawaii was just kind of the natural next place in order for this to happen. So I think that was a big change in the landscape. I think the other thing was we had already gone through really contentious debates over civil union, same-sex marriage, where a lot of the religious opposition had come out. And so I think by this time, supporters politically weren't as apprehensive about that sort of opposition, where I think initially there was just a lot of fear about their ability to mobilize. So I think that helped as well. And then the third thing is just over time, I think when you look at the general public support for it, it just became overwhelming. And I think it became clear to the legislature that this was something that they needed to take up because a supermajority of two-thirds of the Hawaii public supported it. Right. Well, I guess it is true that certainly over time, once you introduce an issue, over time the general community's perspective on that issue will change not only because of the facts that Oregon and Washington had these laws and had been practicing them, but as you said, the opinion of the nation and the view of life and death and its value and more importantly perhaps the right of a human being to have some influence over their own life or death. Yeah. And I think it gets back to I think one of the core things that your show is about is some people view the capital as a place where just bills get passed into law and that's its main purpose. And that is. Its main purpose is policy-driven and making sure it does its legislative duties. But the other thing that the legislature can do uniquely I think is be a forum for discussion on public policy issues and contentious issues that the public really needs to take up. And everybody's so busy in their day-to-day lives, you know, driving to work, going to work, taking kids to soccer, going to grocery store, all this sort of stuff. It's very hard to sit down and think about these really median heavy issues. And so it's when somebody like the legislature takes this up and you see it on TV, then I think it makes people kind of sit back on their kitchen table and say like, well, how do I feel? Exactly. Yeah. How do my family member feel? Mm-hmm. And it encourages discussion. And that's always a good thing. Right. And in the course of working with this law, and I know you've worked with others, you are from an organization that specializes in assisting people who are getting documents and laws written properly and gotten through over hurdles that guard them down. Was there a great deal of testimony? And was some of it more effective in person than written testimony? What is your experience when addressing contentious laws, okay? As opposed to ones that are simply slightly debatable. Is the physical presence of the individual more important than just a written testimony? What did you have to do to get this information out there and to start changing hearts and minds in the legislative offices? Mm-hmm. Yeah, you know, a lot of the discussion happens not just in the hearing room. It has to happen in meetings. It has to happen and when you're grabbing coffee with somebody, there's just a lot of different talk that needs to happen around the building. And so procedurally, you are correct. I think written testimony is always, always helpful, always welcome. It is better if you go down and present your testimony live. It's much, much better if you're not reading your testimony. If you're speaking about it sincerely and from the heart. When it comes to issues like this, if you're telling a story about how it personally affects you, even more so, I think people in the hearing will listen. Because you know, they have hundreds of pieces of paper in front of them. They review all of the testimony and they can read it and they can see what it says. But in order to really capture emotion, passion, sincerity, that's the kind of thing that you have to convey via oral testimony and being there. Absolutely. Okay, and Blake, if you don't mind, we're going to take a short break at this moment and I look forward to returning to the will of the people and speaking with Blake Oshiro from compassionandchoices.org and talking about the Our Care, Our Choice Act, which is similar to death and with dignity acts of other states. So thank you. We'll see you in a few minutes. My name is Stephanie Mock and I'm one of three hosts of Think Tech Hawaii's Hawaii Food and Farmer series. Our other hosts are Matt Johnson and Pamai Weigert. And we talk to those who are in the fields and behind the scenes of our local food system. We talk to farmers, chefs, restaurateurs and more to learn more about what goes into sustainable agriculture here in Hawaii. We are on at Thursdays at 4 p.m. and we hope we'll see you next time. Okay, we are back with the will of the people and we are talking about the Our Care, Our Choice Act. My name is Martha Randolph and my guest is Blake Oshiro from Compassion and Choices Organization. Now one of the things we were talking about when we went to break was basically how important it was to have people testify and why this session of Congress was different from others, and by that I mean local Congress. What else made this time a better time, made this time the time we could get that bill passed as opposed to not even having it considered in the past 18 years? You know, I think it was helpful that in 2017 we had a hearing on the bill. The opposition came out and mobilized. We had really good support from Hawaii residents and from the organization Compassion and Choices and Death with Dignity National, and we really were able to bring an organization and sort of a professionalism to the way in which we approached lobbying for this bill in 2017. We didn't get as far as we'd liked. Of course it got deferred in the House after moving out of the Senate. But I think in 2018 what it really did was set the stage so that the legislature was willing to take up this contentious issue, which is rare. I mean I'll be very frank that in the election year, typically the legislature is not as enthusiastic to take up contentious issues because it's so close to an election. They prefer that if they are going to do something contentious they do it in odd numbered years, which is the non-election year rather than the e-number year. But this year they actually going into it said, you know, we looked at the information, we looked at the data, we looked at what the experience of other states have been. Hawaii's residents seem to be very supportive of this. And so let's try and figure out if there's a way to address some of the concerns being brought up by the opposition. So there are a few more safeguards in here than probably any other law anywhere else. From Compassion and Choice standpoint, some of this we view as potentially problematic because it creates more barriers to access. But nonetheless we're very, very pleased that the law passed. So I think all of these things mixing together and the legislature feeling like they've really invested into this, put in their suggestions, they heard from the public, amended the law accordingly. They feel like this is probably the best product we can come up with at the time. And so we'll see how it works starting January 1st. And then at that point they said if there are barriers or problems to access then that's something we can take a look at. Okay, so I believe in California there were some legal challenges to the California law. Is that something we could reasonably expect in the future in Hawaii? And what about the opposite? What about if somebody wants to die and there's a provision in this law which eliminates them from the ability to be considered? And they want to insist no, I have a right to be considered even though I don't have an absolute six month limit on my life. Or because it's not the kind of disease that is destined to necessarily kill you but to debilitate you and remove your quality of life steadily until you are just sitting and waiting till your body gives out. Which is something sometimes it's difficult for a doctor to predict. So I would like to know where do people stand or what would they do if they felt that this law is supposed to apply to them and someone tells them it doesn't. Okay, so the first thing you know in California like you were mentioning it's stuck in litigation so we'll have to see where it all lands. It's in the courts it's probably most likely to be appealed it'll have to we'll have to wait until the California Supreme Court issues their decision until we have a firm understanding of where California is at. But I think for what you starting January 1st of 2019 when this law comes into full effect and people can start registering for it and availing themselves of it. I would not be surprised if we saw a legal challenge. It would I'm just speculating similar to California. It may be a physician challenging it saying I don't want to participate. But you know the law makes clear that no provider is forced to do this. But the flip side question that you mentioned about what about somebody that wants to avail themselves of this and cannot legally I think they'd have a problem because the United States Supreme Court has already indicated that there is no constitutional right to die. They've basically stated that this is a state issue in order to regulate how a person may choose to end their own life. But a person does not necessarily have a constitutional right for ending their own life. So somebody that's outside of six months or somebody that can't self-administer they may be able to try and challenge the law but I don't know if they'd have very much ability to succeed. I think the law is pretty tightly written. So there's a big difference between an end of life directive the medical forms that people fill out that they say do not resuscitate or anything of that nature and this law because the key is that the individual themselves has to be capable of giving themselves the medication. And yet often a person would not make a decision that my life is simply no longer worth living until their body is so incapacitated that they can't do that. I believe originally Dr. Kvorkin when he introduced this entire concept he would have stepped in at a point like that and acknowledged the person's request but the fact that they needed help. I believe it is also possible in other nations in the world. There are countries and I don't know them all Switzerland might be one where an individual can ask and receive actual assistance if they are physically incapable of giving themselves that the drugs necessary. Yeah yeah and here that they cannot it has to be self-administered and there's just no way around that and so unfortunately somebody that you know can't swallow for some reason if they have a you know collapsed esophagus for instance and they just simply cannot swallow then they'll have to figure out is that person willing to have a tube you know put down their throat in order to administer this but they'd still have to administer it themselves. A person cannot grab the tube or grab the medication and they can't have an intravenous line put in that they have control by pushing a button. Okay is that something that you think might be brought up in the future because I believe there are some places are all I'm sorry let me start with the basic question are there any death with dignity laws that allow for an exception where an individual cannot swallow or cannot do much more than say flip a switch. No the laws that have passed thus far are self-administration so it's a very it's a it's a narrow sort of type of way you can administer and people that cannot do that cannot avail themselves of the law. Do you or does Compassion and Choices as an organization feel that they are going to keep moving on this to expand the options for people who are in that situation it would seem to me to be the next step and I mean protection yeah I understand their concern is someone else would flip the switch. Well the question becomes the evidence has shown that nobody is forcing anybody to die this is not a contract you're putting out on someone's life so where do you think we're going to go from here with this? You know I think we'll have to wait and see there's going to be more experience and more states more data that's gathered and more evidence and I think the more and more we can show that this is highly regulated that there are no abuses it gives us the opportunity to look at where there can be improvements and that may be an area that you know they have to open up and take a look at but I would say right now I don't think that's anywhere on the agenda because the idea is to make the laws work as best as they can for those that are able to avail themselves of it and then expand it to other states and other jurisdictions and then eventually we can start looking at how it could be changed but I think the model is what they want to see spread across in different states rather than continuing to grow just in the handful of states so let's the more states that adopt this essential model with all the protections the better chances you have to eventually begin to look into expanding or the parameters of such a law but first you have to get it accepted by more than six states correct okay yeah all right one of the key arguments I believe doctors often raise in this question has been we don't need this law because we already have options available to us to help patients who are in so much pain that they want to die and I believe in that case they're specifically referring to drugs like morphine which are often given to patients with terminal cancer or other painful illnesses and they just keep increasing the dosage until the weakened body basically passes away because it can't take it anymore what makes this different from that because we are assuming now that a person who is in pain could be asking for additional drugs and they'd be given it to them without having to have this law as opposed to being able to say I'm conscious I'm alert my mind is working I know this is coming and I would like this prescription so I can make the choice when the time comes yeah I mean I think there's been tremendous advances in pain management I think when you talk to pain management specialists they'll tell you that they really are much better at figuring out that sort of tipping point and how you get a terminally ill patient suffering in an inextricable pain to the point where they can just ease into their passing but you are correct I mean a lot of it is morphine or a high high really borderline almost puts them in a comatose state so it really is an issue I think for people about their individual right and how they want to end their life I think like you mentioned for some people they don't want their last moments here to be remembered by family or for their own sakes to be in this sort of haze right what they want is clarity they want control they want to be able to say their goodbyes have that moment with their loved ones that they're not going to get again right and if you are sliding in and out of a morphine coma you can't you're not going to get that no you're not and it's a very different type of goodbye from everything we've heard of people that do avail themselves of this is it's a conscious choice of when they want to do it and they gather everybody and I don't want to make it sound like it's a ceremony but it is something where it's a clear understanding of this is where I'm at I'm going to do this and there's an acceptance absolutely and it's different than like we said and there's nothing wrong with having a ceremony most cultures and throughout the history of time have had ceremonies for both birth and death and ceremonies are very vital part of making the passing of any individual something you can deal with and that is another discussion for another day so we are out of time and I want to thank you again Blake for being here and explaining all of this to us ladies and gentlemen you can always go to compassion and care dot org compassion and they will tell you what you need to know about January they will keep updating their website and there's probably email lists you can sign up for so be aware of that and I want to thank you all for being here for this half hour next two weeks I believe we're going to have Colleen Hanabusa which could be very interesting discussion and I'd like to remind everyone that this Saturday is a voting Saturday it is a Democratic primary which for us in Hawaii is almost as big as important as a November election so I encourage you all to participate because a democracy is only as good as the voters who participate in it so we will see you in two weeks thank you very much bye