Hundreds of people are expected to pack the state Capitol auditorium this evening as the House Health Committee once again takes up the emotionally charged issue of physician-assisted suicide.

Despite repeated efforts by proponents, the House has never passed legislation that would allow terminally ill and competent patients to receive a lethal dose of medication through a physician.

Proponents face an uphill battle again today as they go up against physicians, religious groups and people with disabilities and their advocates who oppose the measure.

Health Committee Chairman Rep. Josh Green said he is willing to revisit the contentious issue out of respect for both sides. In addition, there have been medical advances in pain management and changes to laws in other states — such as passage of a death-with-dignity bill in Oregon — that could change lawmakers' positions, he said.

OPPOSITION NOTED

While the Hawai'i Medical Association has been a primary opponent of death-with-dignity legislation in the past, Green points out that although he is a physician, he does not belong to that organization.

However, he said he has found the opposition from physicians and the disabled community compelling and it will be up to the supporters of physician-assisted suicide to convince him that passing the bill is a responsible move.

"I don't want to be reckless with something this huge," he said. "It has to be a very compelling argument if we're going to chart the course in the country in an issue like this."

Physicians have worried that the authority to help terminate a patient's life would compromise their medical relationships, since patients expect them to fight to keep them alive. "If you reverse course on that, it may make a lot of people wonder," Green said.

The disabled community, on the other hand, worries that insurance companies will make it harder to receive care and steer their clients toward physician-assisted suicide instead.

But those who support physician-assisted suicide have a different take.

Rachel Orange, 31, said that opponents are blowing the issue out of proportion. If physician-assisted suicide is legalized, "We aren't going to start killing people," she argued. "A lot of people live out very painful ends to their lives and would like to have more of a choice about how they go."

Andi van der Voort, president of the state chapter of the Final Exit Network, said that patients who are suffering and need relief need to have a choice whether or not to end their lives, and physicians are the only source of the lethal medication they need.

"It shouldn't be anyone else's business," she said. "It beats jumping off a freeway overhang. It beats swimming out in the ocean so far that they drown."

DEATH BY STARVATION

For some terminally ill patients, the only recourse is to starve themselves. "I don't want to have to do that," she said. "I should be able to say that I've had enough, I don't want to suffer anymore."

To Kelly Rosati, executive director of the Hawai'i Family Forum, which opposes physician-assisted suicide, the answer is better end-of-life care, such as palliative care aimed at keeping people pain-free and comfortable as they go through the natural disease process.

Such care aims at "eliminating the reasons why people request suicide in the first place," Rosati said.

But van der Voort said that argument has been used for five years and terminally ill patients are still suffering.

"I don't want to have to wait any longer. I'm just about 80," she said. "If they're going to improve it, why don't they do it? Why do we have to threaten them with getting a pill?"

Reach Treena Shapiro at tshapiro@honoluluadvertiser.com.