 I'm Marcia Joyner and today we are going to begin a series navigating the journey. This program is dedicated to exploring the options and choices at the end of life. And to help people talk about these issues, to bring them out, to look at the different options we have, the different choices we have, and as we move through the series we will talk to people who have different traditions, different ways of dealing with these things, different religions, and all of those kind of things that give us an opportunity to have a real conversation about the end of life and the options and choices. And so we want you to stay with us to send us your comments and what your feelings are about end of life. And since the government has so much to do with what we do, how we do it, and I say interfere in our lives, we have asked representative or former representative Blake Oshiro, who is absolutely beautiful, and Blake has been a friend for years. Blake was in the legislature for 11 years and you worked as the majority leader. You worked in the governor's office, Abercrombie, as what was the deputy chief of staff. Wow! So that was public policy and budgets and what all did you and overseeing about three or four departments as well? Well, so we've asked Blake to come because of that depth of knowledge of how the government works or doesn't work in any case. And to talk about the practices of whether that's interfering in someone in our lives, is it to protect our lives? What is it that we get from the government in their position on end-of-life choices? Well, thanks so much for having me, Marcia. It's a really important topic. I'm glad to be here. So tell us, what is it that the government does or why do they impose their will on people at the end of their lives? I mean, you know, we get to choose who we marry. We get to choose what school we want to go to. We get to choose to get on the plane and go. So what is it about this particular issue and the choices? The role of government, especially for a lot of issues when it comes to health care, is really about protecting patients and making sure that there is not only adequate access, but there are the proper safeguards so that there is not any abuse. And so that really is a overarching theme when it comes to aid in dying or end-of-life issues. Is the government actually properly regulating this space or is it over-regulating and being too prescriptive in terms of what people's choices are? What do you mean over? How do they do that? Over-regulating. So back in 1997, Governor Ben Cayetano at that time established the Blue Ribbon Panel and he wanted to look at the panel plea of what are the issues associated with end-of-life. And at that time the Blue Ribbon Panel came up with a lot of recommendations and a report in 1998 and the government since that time has actually enacted a lot of those recommendations when it comes to issues such as a living will or an advanced health care directive or making improvements with palliative care or with pain management. But the one issue that the government still has not dealt with for the state of Hawaii came to death with dignity and so that remains the large outstanding piece of that recommendation that we still are looking at. So let's go back to the pain management and hospice and palliative care. I mean those are excellent programs so what is it that's going on there? You know back in the late 90s I think people were aware that there were certain options but I don't think that people really had a full discussion and I think that patients when they were faced with permanent illness felt very uncomfortable about talking a lot of these things with their physicians and so it's really great to see that the system responded and came up with a lot of different options for folks and what we see now is hospice is just something everybody is aware of they kind of know what it is they have that as a full discussion with their physician as one of the options. Pain management of course and palliative care remains something that there is a specialty doctors really are focused on how to provide that to patients but even with those options for a terminally ill patient sometimes those are not enough and they want to control their own destiny. Well now you know growing up in the south you had people were born at home people died at home and so there was this there was never any discussion about going to the hospital and being wired up and all of that sort of stuff you just sort of accepted that this was the normal way that the end of life came and the body was in the house and people came to view the body and and had this great meal that was always the wonderful meal that went with paying respects to the family and the body and at what point did we lose that? You know I think you know we are so lucky to live in a country living in modern technology and we've seen that modern medicine really has the ability to enhance people's lives but it also has that burden of prolonging somebody's life perhaps when they don't want it to and so that is why especially for terminally ill patients or folks that are in a vegetative state you do need to fill out things like an advanced care directive you need to make it clear that if there is no brain activity I don't want to be just kept alive on machines and being fed with machines and being liquefied and that is my choice and so that is something that had to develop since the 80s and into the 90s and become more commonplace but it really is sort of the dichotomy of medical science has become so good at treating us the question sometimes becomes is it too good and it's not what you would prefer for the end of your life? It just seems to me so impersonal to be in the hospital with all the wires and what have you and with people you don't know as opposed to being close with family and friends and that this was the way you want to go this is your choice at the time it I mean it just seems comfortable that the end of life should be a sacred at the beginning of life yes yes yeah and it's really interesting you bring that you know when you look at the Oregon experience they've had this death with dignity program to allow terminally ill patients to get access to a lethal medication what you see in the data is a large large majority end up choosing their location of where they want to pass and that by and large overwhelming majority is they want to be at home they want to be surrounded by their loved ones they want to have that opportunity to be cognizant be lucid say their goodbyes in a proper way and then pass rather than I think what you're sort of talking about which is if you're in a hospital you may be doped up on morphine you're not cognizant really what is that quality in your last days well now speaking of the hospital the big big thing of course is who pays the bill with when somebody just keeps that with all the medical for the physician the nurses the aids the equipment and all of that I at one point I know that the fence picked up the bill but now I don't think that I don't know who pays for that yeah most people in Hawaii were fortunate that we have medical insurance so you do have to have your co-pay so it is somewhat of a burden but it drives to a larger question when you look at the data in those final few weeks or months that people are passing away in the hospital when you compare that cost versus how much actually health care cost they've gone through in their entire life it actually is for terminally ill patients it ends up being a about three-fourths of the cost is actually for those final few months and it's because of that 24-hour seven-day a week care that is extremely exorbitant and it's a larger question of not so much about finances but is that the best way to be investing funds especially if somebody chooses to have some a different scenario yeah so now if you're in the hospital and you don't have a directive you don't have this piece of paper that says don't do not resuscitate what happens then at that point it's really up to your family if you are not capable of making your own decision if the doctor deems that medically you are not of sound mind then at that point it really is up to your living relative first your spouse if you don't have a spouse it would be up to the children to make that decision and unfortunately we've seen several times in high-profile cases on the mainland where the wishes of a spouse are different than that of the children and you end up in court fighting it over in litigation so that is why it's so important for people to have an advanced healthcare directive so that they make it clear what their wishes are and then it actually is something that very very seldomly is able to be legally challenged well so if they have different opinions that like I said the part of the family does one thing and part of the other what are the legal is the hospital legally bound to just keep you on that ventilator or whatever yeah if there is a family member that challenges the decision to end someone's life then at that point the house they will go to court and the hospital will then be enjoying from taking action so a person can be stuck in that stasis until the court makes it oh how awful yeah and then you get the bill yeah yeah oh that's all yeah but it but I think it's even more so awful when you look at how it just splinters apart family right I mean you know I would think that the person that is lying there that is not what they would want of course they want their family to get along and that is one of the good things that you do see about more we talk about end-of-life options I think the more people become comfortable with it the more they can actually approach their family and talk about it and tell them what their options are and what their wishes are well I hope well that's our intention with this series is to have a conversation about all of the different paths that you can take to get there because not all of us have the same traditions the same religions the same aspirations and so that is what we're looking at is to look at all of these conversations to make people comfortable with talking about it I mean we we do have to at some point it talk about it and and so that's that is our goal to really look at where we're going how we get there and the fact that all of these paths are valid yes and there's not just one way to do that no and so that was why we want to talk about the state first before we start looking at all of these other paths to see what obstacles there are are there obstacles to having your own path are there is the state put in barriers to you choosing how you want to do this are there yeah I don't know if the state has put in barriers but there are traditional laws that don't necessarily fit with the situation a good example would be the physicians liability right if a person a terminally ill patient decides that they want to end their own life a physician actually is not only ethically prohibited from supposedly providing legal medication but they're also legally prevented because then they that medication is actually the cause of the death and hastening that death so there are legal barriers which existed for good reason but in today's modern medicine and with the proper safeguards I think there's a way to find the right balance so that it's the option for the terminally ill patient just terminally ill patients if that's what how they decide they want to pass this world we have to go take a break and we will be right back stay with us there's a lot to talk about and I promise you we will go through lots and lots of wonderful people meet great a traditionalist a rabbi a Greek orthodox a bishop from the Buddhist tradition so that we get a look at all of these options not just something that I'm made up so we will take a break and we'll be right back hello I'm crystal from clock talk I've got a new show here you've got a tune in check out my topics on sensitive provocative female issues so Tuesday mornings 10 o'clock don't miss it is gonna be fun and dangerous hello ha my name is Danelia D A N E L I A and I'm the other half of the duo John Newman welcome we are co-hosts of a show called keys to success which is live on the think tech live network series weekly on Thursdays at 11 a.m. we're looking forward to seeing you then hello ha hello ha my name is Reg Baker and I'm the host of business in Hawaii with Reg Baker we're a show that broadcasts live every Thursday from two to two thirty we highlight success stories in Hawaii of both businesses and individuals we learn their secrets to success which is always valuable I hope to see you on our next show aloha aloha I'm Shantel Seville the host of the Savvy Chick show you can watch the show every Wednesday at 11 a.m. Honolulu time and enjoy how to be inspired empowered if you're a woman or girl everyone is welcome but it's really dedicated to you and we look forward to seeing you you can also find us on thinktech Hawaii comm see you soon aloha aloha and we're back and I'm Marcia Joyner if you just tuned in we are having a discussion about the end of life choices we are navigating the journey and I'm with it's a long journey with lots of options and lots of roads so stay with us our guest today is former legislator Marcus Blake Blake different ocean different Oshiro oh mercy okay uh Blake Oshiro who was in the legislature for a long long time 11 years and in the governor's office for how long for three years with governor Abercrombie and now you're a consultant correct and you're also an attorney yes and he is absolutely a jewel you can see how what do you do work out and whatnot try try to stay healthy healthy healthy so we don't have to worry about losing you and but Blake has an in-depth knowledge of the workings of the government from being in and and as an advocate as well as a legislator and that is the reason we wanted to talk to Blake to set the stage to look at what is out there what we need to be concerned with as we go down this road toward the end of life and my feeling is that it's sacred the end of life should be as sacred as pleasant as the beginning of life and i have to tell you a story and everybody that knows me knows i have stories and i'm a drama queen so i had made a big deal out of the fact that my mother was with me when i took my first breath therefore i had to be with her when she took her last so we had hospice and we had her in our home for the last year of her life so the day came and i don't even know why i knew but i crawled into bed with her and so that we had that moment that when she took her last breath i was with her and then we called everybody in the family all the hospice people came and we had a bedside ceremony instead of a funeral and judith came and and bathed her in some kind of wonderful local oils and made the beds and the flowers people you know in the bed with her and dressed her so beautifully and everything so we got to do this ceremony the minister from hospice came and one of the hospice workers had this great contraldo voice it was absolutely the most beautiful ceremony and all of those years of pain were gone she was so beautiful her skin was like brown velvet it was just the greatest moment of my life to see her in no pain because she had emphysema and watching her struggle to breathe and to see her leave so lovely so peaceful and then my number one son looked at her and she smiled oh poor baby he cried like a bathtub overflowing but it was a beautiful moment it was so beautiful that everyone should have a moment like that that should be great story and that that should be how most people pass this world yeah and so anyway let's get back to you yeah so your position now is to help us navigate through the the weeds of the state right is that what we're going to do as we move forward with this series we want to look at the what i'm calling the weeds of down in the the belly of the state and how we can move through this smoothly with all these different paths we have what it is what can we do how can we get through the minutia yeah you know so currently there are laws that would prohibit somebody from taking their own life and rightfully so but i think especially for a terminally ill patient i think there are very limited circumstances where they should be allowed to control their own destiny so hopefully that they aren't suffering in days and weeks of inextricable pain so that they can actually enjoy a situation and be lucid enough to have those final moments with their family exactly how you had illustrated for us and how significant that can be but a lot of those things can only happen if we make some changes to the current law because what we really need to do is clear the pathway so that physicians feel that they can do this and they are not going to be held legally responsible so that patients are aware that this is an option for them and how they can do it in a way that will be safe and actually will be in a manner that we can ensure there aren't going to be abuses and so we need to find the laws that can help us get to that objective now tell me what is the difference of doing something at home and in turning off the ventilator in the hospital which seems to me terribly cruel that you withhold water and turn off the ventilator i know my mother struggled forever with trying to breathe because she had emphysema if you had turned off the ventilator how that seems to me to be terribly suffering yes yes yeah and so usually when we're talking and the doctors aren't held liable for that yes so usually when we're talking about turning off the machines it's because it's an advanced health care directive and usually that's because the brain has been declared dead and there is no activity so the person just really will not survive and what you're turning off is either the air the ventilator that keeps the lungs pumping you you are turning off or not giving them food and or water which is often the other way that people just continue to live even if their lungs are working their brain isn't working so the other way that they can choose to in their life is to not having artificial nutrition provided and those are not very pretty situations at all they are not but they are very limited in the circumstances of brain death the vegetation and what we're talking about here is actually what we do for a terminally ill patient who is very cognizant aware of what they want to do and chooses to have a different scenario for how they pass and that is something that we really need more discussion on is are there different options besides they can go to hospice they can go through pain management and care their physician can even prescribe them heavy doses of painkillers but those also have their side effects is there a better way and i think that's a conversation if you're terminally ill do you really care about the side effects yeah so um come on but you know if you give a person opiates and you say well that'll make you addicted well come on you only have you know a week to go what difference does it make yeah yeah i i think that's right i mean if somebody is terminally ill um some of the side effects like addiction are not that important but the other side effects like loss of of clarity the fuzziness that goes on if you are being really heavily doped up with morphine so that you're barely conscious then though that to me is an entirely different scenario that's that's different yeah yeah because my thought well for me anyway i want to enjoy this last and look forward to because with my sense of adventure there's got to be something over there there's got to be an adventure on the other side and i'm totally willing to do that and i don't want to be drugged and all those wires and things i want to say this last few moments with my family yeah and it's interesting when you look at the data from a place like organ that's how definitive for almost two decades now the the real drivers for why people end up choosing to take the medication are loss of autonomy loss of enjoyment of life and pain and it's when things reach that tipping point i think that's when people decide my life is is done but if you can still bear through it if you can just take some opioids and continue on most people want to actually continue to do that but where is that tipping point right where you want to say i just don't want anymore well and the tipping point is here and now because we have to come back to today and reality and reality is we're out of time okay okay so please join us again we welcome your comments we do have a facebook page and it is navigating the journey hawaii and please join us we'd love to hear your comments thank you so much this has been a real pleasure aloha