Hawaii Governor Josh Green signed House Bill 650 earlier this month, euphemistically dubbed “A Bill for an Act Relating to Health,” allowing advanced practice registered nurses (APRNs) to evaluate whether or not a patient is eligible for assisted suicide and to prescribe the necessary drugs. The bill also reduces the required waiting period between the patient’s request to die and the administering of the lethal drug from 20 days to just five days. As per the new legislation, if it is believed that the patient would die in the interim, the waiting period can be waived to a minimum of 48 hours.
Green is a Democrat and an MD, and he has been awarded Physician of the Year by the Hawaii Medical Association twice in his career. He was born to Jewish parents.
Sen. Joy San Buenaventura explained that the law was necessary as many doctors were unwilling to perform the procedure.
“There aren’t many physicians that would help the patient to make that choice,” San Buenaventura said in an interview with the Hawaii Tribune Herald. “So, by increasing the ability of a patient to have an APRN prescribing is helpful. We also shortened the waiting time, because doctors, understandably, are not going to give the prescription drugs unless they know death is imminent. And patients need to get the prescription earlier to relieve them from the suffering, so we reduced the waiting time from 20 days to five days.”
Most health care facilities have adopted neutral policies on the law, leaving it up to individual doctors to decide whether to participate. Doctors are legally allowed to opt out of providing the service, and many do. As of the most recent report, which covered 2021, Kauai only had one provider who wrote a prescription.
“There are a number of healthcare providers, nurses and others who are really uncomfortable about this, so asking anybody to participate as a patient ends their life is a really tough thing,” said Melinda Ashton, chief quality officer for Hawaii Pacific Health, one of the state’s largest health care providers. “The most recent barrier does seem to be we haven’t yet located a pharmacy willing to provide the medication.”
Hawaii Pacific Health and The Queen’s Medical Center in Honolulu said their pharmacies will not fill the prescriptions, and hospitalized patients will not be able to take the lethal drugs on their campuses, the Honolulu Star-Advertiser reported.
To request a prescription for life-ending medication in Hawaii, a patient must be:
- At least 18 years old
- A Hawaii resident
- Mentally capable of making and communicating health care decisions
- Diagnosed with a terminal disease that will result in death within six months
The law’s restrictions require two health care providers to confirm a patient’s diagnosis, prognosis, ability to make decisions and that the request is voluntary. Patients must make three requests for the medication, voicing two at least 20 days apart and writing the third signed by two witnesses.
To use the medication, the patient must be able to ingest it on their own. A doctor or other person who administers the lethal medication may face criminal charges. Medically assisted death was legalized in Hawaii in 2018 in the “Our Care, Our Choice Act (OCOCA)” and it is estimated that between 40 and 70 patients each year request access to assisted suicide.
Euthanasia, which is practiced in some states of Australia, Canada, Belgium, Colombia, Luxembourg, the Netherlands, New Zealand, Portugal and Spain, is a practice in which another person — generally a physician — acts to cause death. Though not all countries with universal health care have legalized euthanasia, all of the countries that have legalized euthanasia have universal health care.
While euthanasia is currently illegal in all 50 states in the United States, assisted suicide is legal in Washington, D.C. and the states of California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, Hawaii and Washington. The status of assisted suicide is disputed in Montana, though it is currently authorized by Montana’s supreme court. Under these laws, terminating your own life is not legally categorized as suicide.
In Canada, euthanasia accounts for 3.3% of all deaths. Though the Canadian program is described as “Dying With Dignity,” the government has a financial interest in promoting medically assisted suicide. According to a study published in the Journal of the Canadian Medical Association, doctor-assisted death could lower annual healthcare spending across the nation by between $34.7 million and $136.8 million.
In the Netherlands, where a quarter of all deaths are now carried out by assisted suicide, euthanasia is utilized for babies under one year of age with “severe deformations” and “very grave … medical syndromes.”
Euthanasia and assisted suicide are both prohibited according to Jewish law and by the Noahide Law, which prohibits the spilling of blood, based on a verse in Genesis.
“Whoever sheds the blood of man, By man shall his blood be shed; For in His image Did Hashem make man.” Genesis 9:6.
“No person can be the master over life; not his own and certainly not someone else’s,” Rabbi Moshe Avraham Halperin from the Science and Technology Torah Law Institute said.
“In Judaism, there is no difference between morality and Torah law,” Halperin said. “What others call morality is how Jews serve God. This especially includes difficult life and death decisions, what we call the sanctity of life. Life is holy, the holiest thing in the world, because it is through life that we serve God.”
Halperin explained that the decision to end life was not in the purview of humans.
“Life belongs to God and He is the only one who decides when it begins and when it ends,” he remarked. “So even a person who is in a vegetative state, his soul being in the world increases the Glory of Heaven that is in the world.”
The rabbi explained that by choosing to take a life, man is not only “playing God, but is actually usurping the kingship of God.”
“Morality that is not based in the Torah is selective, placing Man at the top, in the decision-making role,” Halperin said. “A person can destroy his own property or tell someone else to destroy it because it is his property to do with as he chooses. In selective morality, if a man chooses to end his life, since it is his life, he is within his right to do so.”
“But if you believe that the essence of life is the soul that was placed there by God, and that belongs to him, is part of him, then taking life is the worst crime possible.”
Halperin explained that Jewish law was clear on this issue with no gray areas.
“It is absolutely forbidden under any condition to remove someone from life-saving measures, even if he is suffering, even if he requests it,” he said. “Similarly, it is forbidden to withhold normal treatment, or food and water, and medicine, that will extend his life. These things are murder, plain and simple. You can pray for his suffering to end but you cannot actively end it.”
“If a person has a chance to live after resuscitation or CPR, even if he will be disabled, then every effort must be made to lengthen his life,” he further said. “But if there is no chance for him to return to life, if he will for sure never return to consciousness, then there is no necessity to resuscitate the person.”
In an interview last year on the subject, Rabbi Pinchas Winston, a prominent end-of-days author, noted a particularly disturbing aspect of euthanasia.
“It is unthinkable, but many of these cases require a child giving permission to kill their parent,” Winston said. “Society seems to be moving in this direction as the connection between parent and child falls by the wayside. Abortion is a mother rejecting her child and euthanasia may be a child rejecting their parent.”
Winston pointed out that respecting a parent is one of the Ten Commandments and explicitly related to lengthening life.
“Honor your father and your mother, that you may long endure on the land that Hashem your God is assigning to you.” Exodus 20:12.
“Suffering is an important part of life,” Winston said. “It may be difficult to accept, but even suffering is from God. True humanity, true mercy and love, is long-term and may take years to work out. To cut that short is man’s desire for comfort, not a desire to be humane. The Torah fights against that. If you take away man’s divinity then all you are left with is a pursuit of comfort.”