The Inside Story of Hawaii’s Long Road to Victory

For nearly two decades we have worked with citizens, legislators, and leaders to bring the right to die with dignity to the people of Hawaii. From former Governor Ben Cayetano, an early champion of assisted dying, to hundreds of citizens who faithfully have worked for this cause, the passage of Death with Dignity legislation in Hawaii represents a victory that belongs to many.

Today’s signing of the Our Care, Our Choice Act by Governor David Ige marks a new beginning in Hawaii’s treatment of the terminally ill.

The journey toward policy reform in Hawaii is unique to the place and its people, but the efforts to pass Death with Dignity legislation in many ways parallel the long road to victory in other states. In Vermont, whose Legislature passed its assisted-dying law in 2013, we first began our work with grassroots advocates in 2002. Seventeen years passed between Washington’s first attempt in 1991 and the passage of the Washington Death with Dignity Act by voters in 2008. And California’s adoption of the End of Life Option Act in 2015 was the culmination of a quarter century of work.

Our archives contain the first chapters of the Hawaii story and underscore the depth of our involvement in the earliest stages of the Death with Dignity movement in the Aloha State. The story is told through media clips, written correspondence, inch-thick reports, and even the red-ink notes scribbled in the margins of a strategic plan.

1997: The Conversation Begins

As history would have it, Hawaii residents began a robust debate about end-of-life issues at nearly the same time that Oregon voters affirmed their state’s groundbreaking Death with Dignity law.

In October 1997, a month before Oregonians voted to uphold the Oregon Death with Dignity Act first passed in 1994, public hearings began for the Hawaii Governor’s Blue Ribbon Panel on Living and Dying with Dignity. Formed in late 1996 by then-Hawaii Governor Benjamin Cayetano, a strong supporter of assisted dying, the Panel was comprised of Hawaii residents from a variety of professional and religious backgrounds.

During the 9 hearings, held in different locations across the state, over 300 people attended and shared their opinions and personal stories relating to end-of-life issues from palliative care and pain management to advance directives and legal issues involved in caring for the dying.

According to a summary written by Jeana Frazzini, former executive director of the Oregon Death with Dignity Fund (now the Death with Dignity Political Fund), “The hearings were promoted as an opportunity to share stories and opinions on a variety of issues related to end of life, yet the issue of [assisted dying] dominated the discussion.”

The Panel issued its final recommendations in early 1998. In addition to six unanimous recommendations pertaining to end-of-life care, a majority of panelists recommended that the state remove from the criminal code legal sanctions against doctors who at the request of their patients helped them obtain death-hastening medications.

Hawaii State Legislators introduced Death with Dignity bills in 1999, 2000, and 2001, but none of them received a hearing.

2002: A Near Win

In 2002, staff from Governor Cayetano’s office reached out to Oregon Governor John Kitzhaber to seek guidance about how to build support for the passage of an assisted-dying bill in Hawaii. Kitzhaber connected the Hawaii team to our predecessor organization, Oregon Death with Dignity.

Our founding board member, Eli Stutsman, JD, lead author of the Oregon Death with Dignity Act, drafted the bill Cateyano eventually sponsored, House Bill 2487, the Hawai‘i Death with Dignity Act (the companion bill in the Senate was SB 2745).

Crucially, the bill, modeled closely on the Oregon law, incorporated robust safeguards necessary to protect patients and physicians.

The bill was supported by numerous local and national organizations including Hawaii Advocates for Consumer Rights, American Civil Liberties Union of Hawai‘i, and the First Unitarian Church of Honolulu.

At the time, 72 percent of Hawai‘i residents supported the legislation. But as is the case in every state where Death with Dignity has been considered by lawmakers or voters, the bill was opposed by highly visible and well-funded religious groups, with the Catholic Church leading the charge.

Replicating its playbook from the Oregon campaign, Oregon Death with Dignity provided funding and expertise in messaging, media training, strategic campaign planning, and grassroots organizing to kick the campaign into high gear and to support the local advocates leading on-the-ground efforts.

The bill passed the House Judiciary Committee 10 to 1, with 3 abstentions, and on the House floor 30 to 20.

Supporters sensed momentum. They also saw a possibly insurmountable challenge in the form of Sen. David Matsuura, who was deeply opposed to the bill on religious grounds.

“Sen. Matsuura has managed to use his position as Chairman of the Senate Health and Human Services Committee to blockade the bill,” wrote Scott Foster, then executive director of the grassroots nonprofit Hawaii Death with Dignity and current communications director of Hawaii Death with Dignity Society. “But this is not over yet. We still have the opportunity to pull the bill out of committee and to a vote on the Senate floor.”

It was a long shot, but advocates and lobbyists worked together to identify Senators who could be persuaded to pull the bill. In a dramatic vote that shocked opponents, the bill was indeed pulled from Matsuura’s committee and moved to the full Senate for a vote.

“Until this time, no death with dignity proposal had come within striking distance of success in a state legislature,” recalled Stutsman.

A win seemed imminent. Oregon Death with Dignity and its partners prepared victory statements; supportive legislators felt confident that their stance on the issue would be rewarded. A May 2, 2002 headline in the Los Angeles Times declared, “Hawaii expected to give final OK to physician-assisted suicide.”

Additionally, advocates were still riding high from the mid-April 2002 ruling by U.S. District Judge Robert Jones that struck down Attorney General John Ashcroft’s attempt to prosecute Oregon pharmacists and physicians who were practicing lawfully under the Death with Dignity Act. overturn the Oregon Death with Dignity Act. It seemed the time was right for another state to adopt an assisted-dying law.

But opponents in Hawaii had other ideas.

Due in large part to a last-minute lobbying pressure by religious opponents, three Senators switched their votes from “yes” to “no” at the last minute. The bill fell short of passage in the Senate by just three votes, 14-11.

The loss was disheartening for Governor Cayetano and all of the organizations and supporters who fought so hard to pass the bill. But despite the high stakes of the issue, Governor Cayetano told Maui News after the vote that “the debate, unlike debates on many issues, was one on a high level without any hint of partisanship. There’s a tremendous opportunity to help raise the level of awareness on this subject.”

Cayetano sent a letter to Stutsman in November 2002 in which he expressed his gratitude for Stutsman’s guidance in drafting and working to pass the law:

Your expertise and support were instrumental in setting the stage for what turned out to be near passage of landmark legislation for our state. …Our well-publicized attempt to pass Death with Dignity legislation added to the national debate on this topic and has inspired officials and residents of other states. As my term of office comes to a close, I am pleased to include our work on this matter as an important component of my administration’s legacy.

2003: Growing Support

Grassroots advocates and movement leaders, keenly aware of how quickly the issue could fade from the minds of Hawaii residents, set to work organizing and planning for the 2003 legislative session.

Our archives contain Oregon Death with Dignity documents outlining a roadmap for the year: commissioning a poll, developing media strategy, building grassroots infrastructure in targeted voting districts, and, most importantly, forming a coalition with local and national organizations to share resources and amplify messaging on the issue of assisted dying.

Strength in numbers would be essential, as opponents had in turn formed a coalition of their own, with an aggressive media campaign.

As the 2003 session began, Death with Dignity supporters touted the results of a new poll showing 71 percent of registered Hawaii voters supported the latest assisted-dying legislation, HB 862/SB 391. Meanwhile, testimony from Hawaii and mainland supporters came pouring in to legislators’ offices.

Unfortunately, the political winds did not favor the bill. Opposition messaging was persuasive; legislators’ support was insufficient; and newly elected Republican Governor Linda Lingle opposed it. The bill did not get a hearing. Discouraged but undeterred, advocates headed back to the drawing board for 2004.

2004: “Death with Dignity is not going to go away”

Once again, Death with Dignity supporters marshaled their resources for a legislative campaign. Oregon Death with Dignity developed a detailed strategic plan for the year, a marked-up copy of which lives in our archives alongside pages of voter call sheets, handwritten meeting minutes, and fliers for advocacy events. Advocates were encouraged when lawmakers introduced an assisted-dying bill and passed it out of the House Judiciary Committee, 10 to 5.

According to David Shapiro, a commentator for the Honolulu Advertiser, both the vote and the preceding debate were noteworthy for their lack of partisanship.

“The committee showed courage in standing up for an important manner of personal choice in a contentious climate of election-year politics,” he wrote in his March 10, 2004 column.

Despite the positive vote, Democratic leaders withdrew the bill before it reached the House floor, saying they did not have the votes to advance it.

Roland Halpern, then the executive director of Compassion in Dying of Hawaii, implored supporters not to view the Legislature’s decision as a defeat.

“Death with Dignity is not going to go away,” Halpern wrote in a newsletter update to supporters. “Each year support among the public and healthcare community increases, and each year the gap between supporters and opponents narrows.”

Recognizing that they could not count on sufficient legislative support, half a dozen veteran Hawai‘i advocates decided to spearhead a hands-on local organizing and coordinating effort. The result of their considerations was the founding of Hawai‘i Death with Dignity Society in December 2004. This grassroots organization, which became one of our on-the-ground partners, would be a leading force for policy reform in Hawaii for the next 14 years.

2005-2017: Try, Try Again

Over the next dozen years, numerous Death with Dignity-related bills were introduced and subsequently died in the Hawaii State Legislature.

All the while, grassroots advocates continued to build support for assisted dying in the Aloha State among the general public. Their hard work, which paralleled the multi-decade effort by dedicated advocates in Vermont to pass an aid-in-dying law, guaranteed that they would be able to mount a strong campaign when political leadership once again was favorable toward the issue.

In 2017, a bill made it out of committee for the first time since 2004. Senate Bill 1129, Hawai‘i Death with Dignity Act, passed in the Hawai‘i State Senate on a 22 to 3 vote. The Hawaiʻi House of Representatives Committee on Health heard the bill on March 23, 2017, and deferred it. Advocates held out hope for the bill’s revival in the second year of the legislative biennium.

2018: “The will of the voters could no longer be ignored”

This January, the House took up four separate Death with Dignity bills, choosing to advance HB 2739, Our Care Our Choice Act, sponsored by Hawaiʻi State Representatives Della Au Belatti (D-Makiki), Mark Hashem (D-Hahaione), Nicole Lowen (D-Kailua-Kona), Sylvia Luke (D-Makiki), Dee Morikawa (D-Niihau), Scott Nishimoto (D-Kapahulu), Scott Saiki (D-McCully), Gregg Takayama (D-Pearl City), and Chris Todd (D-Hilo).

This time around, the legislative outlook for supporters was positive. Would 2018 be Hawaii’s year?

On February 28, the House Health and Human Services and Judiciary Committees passed the bill 4-1 and 7-1, respectively, paving the way for the landslide 39-12 vote in the full House of Representatives on March 6.

Urging the House Committee on Health and Human Services and the House Judiciary Committee to approve Death with Dignity Bill. #HiGov #HiNews pic.twitter.com/64UQsGokSY

— Office of the Governor, State of Hawai`i (@GovHawaii) February 27, 2018

The Our Care Our Choice Act received a major boost when Hawai‘i Governor David Ige said he would be “proud and honored” to sign the bill.

The Senate worked quickly to move the bill through committees. The Senate Committee on Commerce, Consumer Protection, and Health on March 16, 2018 passed the bill unanimously. The Senate Committee on Judiciary passed the bill 4 to 1 on March 23, 2018.

When the full Senate approved the bill on March 29, 2018 by a vote of 23 to 2, it became clear that Hawaii was on the verge of making history. Sixteen long years after the movement’s near-win, Death with Dignity advocates were one signature away from the Aloha State becoming the nation’s seventh jurisdiction with an assisted-dying statute.

Today, Governor David Ige signed the Our Care, Our Choice Act into law. (Watch the signing ceremony here.) Starting January 1, 2019, Hawaii’s citizens will have the same compassionate end-of-life option that residents of Oregon, Washington, Vermont, California, Colorado, and Washington, D.C. enjoy.

Reflecting on the legislative victory, Death with Dignity Executive Director Peg Sandeen expressed gratitude for the lawmakers and advocates who over many years worked to make policy reform in Hawaii a reality.

“We thank the members of the Legislature who recognized that the will of voters could no longer be ignored and brought the bill forward to successful votes in the House and Senate.

“As we celebrate the Governor’s signing this legislation into law, we cannot help but think of and thank the many citizens of Hawaii who worked for passage of this law, but never saw it come to pass. We thank them for the courage to speak out and begin this conversation.

“Hawaii residents can feel comfort knowing that the laws in other states, particularly Oregon where it has been in effect for more than 20 years, have proven flawless in their implementation, protecting the rights of patients, family members and health care professionals as they work through this process. Be assured that the safeguards your legislators have enacted into this law will ensure that patients are in control of this process and make their own decisions at every step of the way—as is their right.”