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The Honolulu Advertiser
Posted on: Tuesday, June 24, 2003

Roland L. Halpern is executive director of Compassion In Dying of Hawai'i.
ISLAND VOICES
Assisted dying isn't about pain

By Roland L. Halpern

Opponents of physician-assisted dying frequently argue that pain is the real reason patients seek a hastened death, arguing that if we can control pain, the requests for physician-assisted dying will disappear.

Not so, says a new study published recently in the Journal of Palliative Medicine. The study, led by Dr. Linda Ganzini, a psychiatrist at the Oregon Health & Sciences University, again confirms that it is loss of autonomy and not pain that motivates terminally ill patients to explore assisted dying as an option.

In speaking about one patient, the physician noted, "It was a control issue, not a pain issue." The patient said: "I want to do it on my own terms. I want to choose the place and time. I want my friends to be there. And I don't want to linger and dwindle and rot in front of myself ... I want to go out with some dignity."

Another physician commented that some patients are unwilling to even consider alternatives like hospice or palliative care until the issue of assisted dying has been addressed. "They're really not able to talk about things like hospice care until they know that this other issue has been taken care of."

Not surprisingly, once this hurdle has been overcome, patients are more receptive to discussing other options.

Now let me be the first to acknowledge that Hawai'i needs better pain management. The state recently received two black eyes. First, last November the Last Acts national study gave Hawai'i an "E" (the lowest grade possible) for its failure to have any pain-management policy, and this past March, Public Citizen ranked Hawai'i 51st (last) for failing to have adequate disciplinary oversight of its physicians.

Ironically, in Oregon where physician-assisted dying has been legal for five years, it was the very passage of the law that catapulted that state into improving its overall end-of-life care. Even opponents admitted that absent the law, significant improvements would have been slow in coming, if at all.

As revealed in the Last Acts report mentioned above, a full third of residents in Hawai'i's nursing homes are dying in persistent yet treatable pain. If this hasn't been enough to motivate the "cure the pain" believers into action, what will it take?