The law allows a terminally ill person to receive a prescription for a lethal medication if two doctors find that the person has fewer than six months to live and is mentally competent. The patient must undergo a mental health evaluation to determine that they are not “suffering from conditions that may interfere with decision-making, such as a lack of treatment of depression,” according to the AP.
The patient must make two requests for the life-ending medication, with a 20-day waiting period between requests, and sign a written request witnessed by two people, one of whom cannot be related to the patient.
A doctor may dispense the medication, but it may only be self-administered.
The law includes criminal penalties for tampering with a request for lethal medication or coercing such a prescription.
Ige emphasized the freedom of choice the law will provide for terminally ill patients.
“It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace,” he said. “It does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind.”
Bishop Silva pointed out that under the law, the death certificate of one who commits assisted suicide will list as the immediate cause of death their terminal disease.
“In other words, it will lie about the real immediate cause of death, which is freely and deliberately ingesting a poison into one’s system,” he wrote. “If we call it another name besides suicide, then it may become respectable. Under no circumstances should we call it what it is, since certain insurance benefits may not be available to one’s estate if one commits suicide. So let’s also lie to the insurance company by calling it 'death with dignity' or some other title that will make it sound more respectable.”
The bishop also wrote that “As a spiritual leader, I also must raise the question of whether someone who deliberately, with documentable soundness of mind and determination of will, violates God’s basic commandment 'Thou shalt not kill' may be flirting with a fate worse than a debilitating terminal illness … God does allow us the autonomy to make such decisions, but he warns us of the dire consequences – and relentlessly attempts to turn us away from such self-destructive decisions.”
Bishop Silva said, “While our State Legislature may not base its decisions on eternal consequences, it should still think beyond the individual terminally ill person. What of family members who will have to live with the weight of their own consciences regarding this very unnatural process?”
He also questioned the law's effects on those suffering depression: “Won’t this suggest to them that if life becomes too burdensome, checking oneself out of it sooner than later is a legitimate option?”
“If this door to choosing death is opened, will insurance companies and health care facilities continue to provide very expensive but ingenious treatments, developed over generations by scientists, technicians, and medical personnel? Or will the 'bottom line' lead them to refuse these expensive treatments because the patient has the choice of a much quicker and less expensive death?”
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The bishop also raised the question of conscience protections for medical personnel and pharmacists who consider suicide to be gravely immoral.
Bishop Silva's editorial echoed concerns about assisted suicide which have been raised by Pope Francis.
In June 2016, the Pope called assisted suicide a feature of the “throwaway culture” which offers a “false compassion” and treats a human person as a problem.
“True compassion does not marginalize anyone, nor does it humiliate and exclude – much less considers the disappearance of a person as a good thing,” the Pope told the directors of the orders of physicians of Spain and Latin America. He criticized “those who hide behind an alleged compassion to justify and approve the death of a patient.”
In addition to Hawaii, physician-assisted suicide is legal by law in the District of Columbia, Washington, Oregon, California, Vermont, and Colorado; and in Montana through a state supreme court ruling. A bill to legalize assisted suicide is under consideration in Indiana.
In September the New York State Court of Appeals upheld the state's ban on assisted suicide.