EDITORIAL
Hawai'i not paradise for the twilight years

Last week, we heard about a U.S. government Web site rating nursing homes around the nation. And this week, a new report by the Washington, D.C.-based Last Acts ranks states according to palliative or end-of-life care.

Hawai'i neither makes nor fails the grade in either of these eye-opening studies. But from what we can extrapolate, the Aloha State is still lacking in the critical areas of pain management, hospice care and death with dignity.

That said, it's important to note that the state Executive Office on Aging has taken some steps to improve the end-of-life experience since Last Acts gathered its data.

A 1999 Robert Wood Johnson Foundation grant helped create a public-private partnership for continuous care called Kokua Mau. Also, more nursing school students, hospitals and nursing home staff are receiving end-of-life training.

And, according to the report, Hawai'i wins high marks for tending dying patients in the intensive care units of hospitals and in supporting living wills and medical powers of attorney for dying patients.

But the report also finds that one in three nursing home patients in Hawai'i suffers persistent pain. If that number hasn't been lowered by now, it certainly should be.

Also, the study laments, "most hospitals in Hawai'i do not have hospice or palliative care programs." And that's underscored by the relatively few number of Islanders who die at home — 23 percent.

Once a doctor has determined that a patient has a matter of months to live, there is no reason why the patient should have to die in a hospital hooked up to life-support machines. That's where hospice comes in.

Hospice is not a place but a care program designed to provide comfort, support and dignity to patients and their families when terminally ill patients no longer respond to treatments. It also deals with the emotional, social and spiritual impact of the disease on the patients and their families and friends.

Last, a terminally ill person who is in chronic pain ought to have the choice to end his or her life with the help of a physician. We're confident that solid safeguards against abuse can be written into physician-assisted suicide legislation, as they were in Oregon. It's now up to the new governor and Legislature to pass laws that will make Hawai'i a better place to die.