 This is Stink Tech, Hawaii. Community Matters here. 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, but to talk about it. It's time to share the way we want to live our lives 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 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. So if you're ready to join us, we ask, navigate the journey. Today, we are visiting with Blake Oshiro. Now for those of you that have been with us for the last 65 weeks, Blake was our very first guest. And we started this journey because we were dedicated or dedicated to the bill of medical aid in dying. And as you know, every week, that's what we talk about with somebody different. However, we think we are at the journey's conclusion. We think. We think. So tomorrow, Thursday is the 29th of March, the full Senate will hear the bill for the last time, we hope, because it's only been 20 years. So we asked Blake to come back and let's talk about a wrap up. What is the bill? What it isn't and where we are in the process, okay? And for those of you that have been with us and you know our yellow lay has been our home mark, we dedicate the yellow lay to you. All of you that have supported us, have written testimony, have called, have done all those wonderful things. Thank you. Thanks for having me, Marcia. Great time to be here. I think like you said, we're right on the cuss of the final stages for the bill and we're very optimistic and hopeful that we're going to get a law very soon. Yes. So tell us exactly what is the bill that we keep talking about the bill? What is the bill? The bill is House Bill Number 2739, House Draft 1. And it was introduced this session by Representative Della Albaladi. And she took some of the bill from last session, Senate Bill 1129, which was largely based off of the Oregon model. She took a look at the California law and saw what safeguards there were that maybe could be put in here. And then additionally in drafting it, she also put in some additional safeguards in the process. And so that is the bill that's before us now. It's probably as they like to frame it one of the strongest laws in terms of the amount of procedures, the waiting period, the number of providers and physicians that actually are in the process. And so they feel very confident that it's a law that won't be subject to any abuse. And so they're really, I think, worked hard on it in the interim. And I think that's why this session we've seen it have some really good momentum. So we are talking about medical aid and dying. So what is medical aid and dying? What is that? What happens with medical aid? It really is about a resident who is diagnosed with a terminal illness, meaning that they have six months or less in which to live in their prognosis. And they've decided on their own to self-administer a lethal medication to end their life. And so what they need to do is go through the process with their own provider, with a consulting provider, with a counseling provider, and make sure that their decision is completely of their own volition, that they are doing this with sound mind. And then after they've gone through that process, they get a medication. And then when they feel it's their time, they can take the medication. And their life typically in anywhere from 30 minutes to two hours is the estimate. Do we know what the medication is or does it vary from patient to patient? So there's a standard when it comes to what the medication is now. It's evolved over the 20 years since Oregon has had this in place and now California is participating as well. And so it's a couple of different medications. The first one you take just so that it ensures that you're not going to regurgitate the medicine. So it helps settle your stomach and settle your body. And then you take the actual medication that will stop your life. So you take two different things, and it's usually bitter tasting, so it's not something that is just a pill and you swallow. It's something you actually have to mix up in what typically people do is like in juice and then they drink it back. So then they just quietly go to sleep. Is that what happens? Yeah. And I think the reason why a lot of terminal patients decide to go with this route is they've indicated that it allows them to decide on their own when their time is up. And so they get to set the terms and conditions and environment with which they'll have their last breath. And usually that's surrounded by family and friends. They can say their goodbyes. They're usually always a very sharp and clear mind. I think for a lot of them their concern is the typical way that at least before this is people would often be dosed with so much heavy pain medication and morphine that you slip into a comatose state and you wave in and out and then at some point your body just passes. But that doesn't allow you the choice of choosing your own conditions of your death and saying goodbye to the people you want to say goodbye to. And I think that's why for a lot of terminal ill patients that's why they choose this path. My mother, we had her at home with hospice and they just loaded her up with the morphine and she was like coming, like you said, she was in and out and then finally just went to sleep and didn't wake up. But in that state she could not communicate with us. She couldn't, I don't think she even knew we were there just watching this process and it seemed to have gone on forever, you know, that it was a long drawn out process. Yeah, that's the unfortunate thing and I think for a lot of the patients, the opportunity to have a control over their last few moments is something they really long for, right? They've been fighting this illness for a while going through their pain. Everything is kind of outside their control. And so they want to say in their last moments, I'm controlling my own life, I'm controlling my destiny, I'm controlling how I will tell people I'm leaving. And that's really one of the aspects that I think is something that terminal ill patients long for. In one of the, we talked to in these last 65 weeks, we've talked to lots of people about the different methods and in their cultures and traditions. One of them that I really liked the best, and that was the Buddhist from the Hong Kong, Hong Wanzhi Temple. And he says that they gather with the patient, the loved one, at home and they tell them, they have a real ceremony and they tell them all the things that they cared about and all that you meant to me and the family gathers and it is a real gathering, it's the kind of thing that we as Christians do after the person's gone. Well this is done before. And I thought that is such a great idea, such a great idea to have this before the patient goes. They didn't do any drugs or no morphine or none of that, but it was just the pleasantness of it so that the person can go in peace. Yeah, and I think that's really important, especially the discussions you've had with people of different cultures, different religions. The bill makes absolutely crystal clear that this is somebody's choice entirely. Nobody is forced to do this, this is not really forced on anybody else if this is against your wishes, against your religion, you don't have to participate, right? You can do whatever you want to do to the traditional past. But for those people that want to choose this, we want to make sure that it's done safely, securely, and in a way that we can closely monitor it's reported and make sure there are no abuses. And that's what the law does. I think when people talk about abuse, that you know if somebody wants to get rid of Grandma, they'll find a way to do it. They don't need this bill to, you know, if she's in the way, they'll find a way to get rid of her or if Grandma has a huge estate, they'll find a way. But they don't need this kind of a bill to get to seldom they can't do it. People have been doing it forever. So you know, all the safeguards in the world won't stop somebody if they are determined to get rid of so-and-so. Yeah. And this really is not euthanasia, this is somebody self-administering. And that's a really, really important distinction. So I think also that we have to make it real clear that the cancer or whatever the illness is, is taking the life away, not the patient. Correct. Yeah. I think that's why for those of us that are proponents of this law is we don't like the idea of suicide because they are terminally ill, right? They have a diagnosis where they are expected to die in six months or less. And so going through this process really is just letting them decide when that death is going to happen because it is going to happen. It's going to happen. Correct. And the cancer or whatever it is is already eaten up the body. Correct. You know? Yeah. Yeah. As John Radcliffe says, that cancer is the emperor of all diseases. You know, it's the bee. Yeah. And you mentioned John Radcliffe, and that's a perfect example. He's outlived his diagnosis and prognosis by months. Yes. And so people say, well, John is a perfect example of why we shouldn't have this law. But I say the opposite. John is a perfect example of why we should. When he is ready, he's done with his fight, and this guy is fighting, fighting, fighting. 60 rounds of chemo. Exactly. And so when he's done with his fight, he'll know it's his time. The ego on it keeps fighting, so he's not going to start doing this right away. He would do it when he knows I'm done. Yes. Well, he told us also that the reason he went to court was to protect his doctor, because in Hawaii there's an arcane law that anyone, not necessarily just the doctor, anyone, brother, sister, anyone that assists you in dying is manslaughter. So he went to court, he said, to protect his doctor, to keep him from being charged with manslaughter. Yes. So that's our next step is an arcane law. Who knows? How long has it been on the books? Oh, decades. I mean, several decades. I think it was in the 40s or something that was put into law. Yeah. Yeah. Anyway, that's the next step. We need to take a break, and we will be back with Blake Oshiro, who has been with this fight for ever. Almost from the start. Almost from the start. Yes. Okay. We'll be right back. This is Think Tech Hawaii, raising public awareness. I just walked by and I said, what's happening, guys? They told me they were making music. Welcome to Hawaii. This is Prince Dykes, your host of The Prince of Investing, coming to you guys each and every Tuesday at 11 a.m., right here on Think Tech Hawaii. Don't forget to come by and check out some of the great information on stocks, investings, your money, all the other great stuff, and I'll be your host. See you soon. It's been five weeks. Aloha, and we're back. I'm Marcia, and we are visiting today with Blake Oshiro, who was our very first guest 65 weeks ago, when we first started navigating the journey. Blake spent, what, 11 years in the legislature? Correct. Yes. And you were a majority leader? Yes. And then you went to work for Governor Neal Abacromba. Correct. What did you do there? I was his deputy chief of staff, so I was in charge of his policy office and his initial budget and a lot of the legislative outreach. Neal was a very good friend of mine. We met a long, long time ago during the Vietnam protest here, and so, you know, it's been a long time. Anyway, I saw him not too long ago, and he looks great. Yes, he does. He looks great. He looks like he's enjoying. Yes. He's doing well. All of the, because he spent so many years as a professor, as a city council, the legislature, Congress, and the governor. Yes. 40 years. Yeah. God. Has it really been that long? Yes. Okay. Yes. We're talking about what is the bill number, HB-2739. 2739, and Thursday, March 29, the full Senate will hear it, and we think it will pass at last. Yes. At last. Yes. We first started this 20 years ago, and we'd been the ups and the downs and the close. The first time, we lost by three votes, and then on and on. Sometimes we got there, sometimes we didn't, sometimes somebody would propose it, and somebody would get scared, and then they said, not in an election year, and all that kind of stuff. Yes, yes. And you know, when you referenced 20 years ago, a lot of kudos really does go to Governor Ben Caetano. He established the Blue Ribbon panel at that time. They looked at the Oregon law and death of dignity. They couldn't come to a recommendation, but they thoroughly discussed it, and based off of that, Governor Caetano put a bill in his admin package, and that's where it really started. Yeah. And we have had really good support all those years. However, it always came down to the vote and just didn't quite get over the hump. Yes. Yes. Socially controversial issues are always very difficult, and they take time, but that's our process, and you just have to keep plugging away like we did, and hopefully you get there. Yeah. I have to tell you my little story here. I guess I was 15, and I'll be 80 next month when I walked my first picket line, when I first looked at a mob of angry white men, I thought, and I have been out there for people's civil rights ever since, and then we morphed into human rights. So you know when we testified for the house, the full house, and there were fifteen to seventeen hundred written testimony, the theater, the auditorium was packed, five hours of testimony. Well I had come to the conclusion that I had testified before Congress, I had testified before the city council, and the legislature, and I came away with this, they don't nobody listens, you know, so you can say what you want, but nobody listens. That was my theory. So I promised, I said, you know, I've been on this road for civil rights all this time, and this is a civil right, and I went on, I don't know what I said, but that's what the whole thing is. This is a civil right. We have a right to choose who we're going to marry, what school we're going to, what we're going to have for dinner. We get to choose that this is a civil right, and I sat down, and the thing went on for five hours right. Yes. You were there. Yes. Well, the next day, on a headline in Civil Beat, John Mizuno says it's a civil right, he listened. Yes. He actually listened. Yes. I had to change my whole attitude about legislators listening. Yes. Yes. No, they do. They, especially on a bill like this, they want to hear from the public, and based off of that, they, you know, take it to heart and make their decision. Yeah. So I was, like I said, thrilled that somebody listened, absolutely listened. Yes. Yes. And I was very proud of him because he, I know he took a lot of slings and arrows. Yes. And my representative, Mark Hasham, who was one of the signers of the bill, said to me that immediately he got calls from people telling him that they were disappointed in him for, you know, taking a stand. Yeah. You know, if you don't take a stand, you can't get elected. Yes. Yes. Yeah. And, you know, the thing is that there is a vocal minority that will oppose this bill. But, you know, poll after poll has shown that an overwhelming majority, a supermajority of our residents support this law. And they just want to be able to have this choice, and they think it's something a term of the ill patients do their, that choice. Could you speak to one of the things that comes up constantly? I know where it started, and that was in 02, of scaring handicapped people. Will you speak to that once and for all, that this is not about them? Yeah. You know, I think for the disabled community, there is a fear of the slippery slope, that somehow this law will turn into euthanasia, then it will turn into people choosing when the death of somebody is appropriate. And I can say that with almost 100 percent certainty, we've seen that not happen at all. You know, we've had 20 years in Oregon, and they've documented no evidence of abuse. There is no slippery slope of this turning into euthanasia, of, you know, mercy killings, I think is the concern. Again, this is just about self-administered, a small, small population of people who are terminally ill want to have that choice. And that's as limited as it's been, and that's as limited as it will be. I have read that of the 100 percent of people that take the prescription and have it filled, oh, what is it, maybe less than 20 percent actually take the prescription, that actually take, ingest the drug. Yeah, you know, initially it was a very small percentage. Initially it was. Yeah. A small percentage of anywhere from 25 to 30 percent, so one-third of the people. But as the years have gone by and the process has been much more set, it's become much more rigorous, what you see is actually when people decide to go through this process and get the medication, they are going to take it a majority of the time. It's kind of changed from one-third that used to take it. Now it's actually one-third that don't take it, so two-thirds actually do. One of the considerations besides everything else we've talked about is the medication is not cheap, it's not covered by insurance. And so it's not something you just fill a script, get it, put it in your medicine cabinet and leave it there. It's something that usually costs a few hundred dollars. If you're going to do it, you do it when you want to do it, you have it ready and you know you're going to take it. So I think it's evolved since that time that you referenced a small minority to only take it, now it's kind of changed. Now another issue, I'm trying to pick out the issues. They took out the nurses, the APRNs. Now we fought for that and the house recognized it last year because in rural Hawaii most of the time it is the nurse that she or he has a practice and they are the primary caregiver. And the people that took it out live in Honolulu, so they don't understand the issue of rural health. Can you speak to that one? Yeah, so in last year's bill it allowed the primary provider, the person that does a diagnosis is the one that has the main contact with the patient to be an advanced practice registered nurse, a professional who is clinically trained and has prescriptive authority. So that really was to get at the rural issue like you talked about. I think this time around there was concerns that they needed to tighten it up, put more safeguards on it, so they left it mostly just to physician providers. But the one thing that they've done to sort of soften the access issue is they've allowed telehealth. Now telehealth is a growing approach to providing medicine. It does it through video streaming and you establish a relationship. You do the same interaction. It's just done over. But that's still discriminatory. Yeah. If you live in Captain Cook, are you going to get telehealth? Are you really going to get streaming? And to leave out this advanced practice RN who has been your primary caregiver to say that that person is no longer capable of this? That's discriminatory. Yeah. I mean it wasn't something that I think it was a difficult issue to grapple with. I think our hope is this law will come into effect in the calendar year of 19. There is a working group established in this bill and what they would end up doing is closely monitoring the access issue. And I think if there is data in a year or two to show that that really is a problem, then I think we then have a really good case to demonstrate we need to make changes. Well, if we look at rural health, now the way this happened, the last session, the nurses said they were out and I thought, oh, we can't have that. So I called the nurse that had said the nurses are not going to support this. And I said, why? And she told me. And I didn't know anything about rural health. I stayed up all night reading about rural health. It's disgraceful in Hawaii, disgraceful. When you step out of downtown Honolulu and you go to Hale'iwa, Kahuku, Kauahiwa, that's where rural Hawaii begins. And like I said, Captain Cook, can you imagine trying to get an ambulance up to Hana? And it's, what, 200 miles from Hilo to Kona, whoever did not look at rural health? Yeah, rural health is a much bigger issue than just this bill. It is. And I do think it is an issue that needs to be faced. I mean, we have community hospitals. We have our federally qualified health centers that do a wonderful job in the communities. They are the, at the front lines in rural health, they're in rural areas, they deal with that population, they see all of their struggles. And so I think what we need to do is find ways to work with them and bring their networks in here. I think the one other thing we have to make clear in this right is no provider is forced to participate. And so like you talked about the nurses, if the nurses decide they don't want to do this, they don't have to do it. No, but what they said, unless they were included as providers, that's when I learned about, I said, oh, so they, as providers, so they're excluded because they're the, in this bill, even though they're the provider. Yeah. I think that there's something we'll have to look at. We've got to deal with it. But let's, I know, we've got to get to tomorrow first. Yes. Yes. Yes. Yes. Yes. First things first. Yes. Yes. Well, again, thank you for being the beginning. And well, you will come back again. Yes. Yes. Of course. Of course. But then we'll have another issue. Yes. Yes. But thank you so much for all you've done for us over the years. And real quick, I have to tell you this, the date, first time he was elected and we had this lovely dinner at the Japanese Cultural Center. Yes. And he sat next to me and he was brand-spanking new. Yes. Yes. And that was my first time meeting you. Yes. So that's been, how many years now? Oh, 14, 16. 16? 16 years? Yes. Yes. Yes. Thank you for all you've done. Thank you for being with us through this. No. Again. Thank you. And we'll see you soon. Thank you very much. And we'll see you next time.