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Compassion & Choices Clarifies Aid-in-Dying Process

April 16, 2019, 2:15 PM HST
* Updated June 20, 2:27 PM
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The Medical Aid-in-Dying Process and Liability Protections. PC: Compassion & Choices, April 2019

Since Big Island Now’s last article on the Our Care Our Choice Act (OCOCA), it has been confirmed that aid-in-dying medication is available for all qualified patients in Hawai‘i.

“While these are not official numbers, we are aware of at least three people [in the state of Hawai‘i] who have filled prescriptions, one of whom has ingested the medication,” said Aubrey Hawk, Big Island resident and consultant for Compassion & Choices Hawai‘i, explaining that the new legislation is being put to use in Hawai‘i.

Compassion & Choices Hawai‘i works to ensure that healthcare providers honor and enable patients’ decisions about their care.

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A Hawai‘i pharmacy that has filled one aid-in-dying prescription wishes to remain anonymous, but Big Island Now can share that it is on O‘ahu. Big Island Now has also learned that, although this patient chose to pick up the prescription in person, it is possible to have prescriptions sent by the pharmacist to anywhere in the state via certified mail, with signature upon receipt.

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Another option available to patients is to have a designated person pick up their prescription. This can be done by having the doctor notify the pharmacy whom they intend to have pick up their medication and at what time. The designated representative will then show identification in order to pick up the prescription and deliver it to the terminal patient.

Female general practitioner welcoming two- generation family visiting her in the clinic. PC: Compassion & Choices, April 2019

Big Island Now used information on the Hawai‘i Department of Health website as the basis of its original article, which stating that Seconol is the only medical aid-in-dying medication available to Hawai‘i residents. Big Island Now was then informed that the Hawai‘i Department of Health has just updated information on the site with new statistics.

The updated site includes information about other more affordable options available, including DDMP2 and D-DMA, which requires a compounding pharmacy.

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“We do, in fact, have compounding pharmacies and prescriptions are being written,” said Hawk.

A patient taking Seconol must open (or have opened for him or her) around 100 capsules and mix the-contents into a liquid. DDMP2 is much easier for the patient; the powder comes in a bottle to which liquid can be added.

Although compounds are usually not covered by insurance, patients have the option of submitting a a claim form for reimbursement and some of the cost may be credited back to their estate.

A pharmacist who wished to remain anonymous shared that 95% of patients will have to pay for these prescriptions out-of-pocket, but most private insurance companies will make a reimbursement. Since Medicare, Tricare and VA insurance are federally funded, patients with these insurances will have to pay fully out-of-pocket. Hawai‘i has the option to use a portion of its Medicaid funds to help cover costs.

Many professionals are being extra cautious about their position on this issue. Our pharmacist source told us although they didn’t assume there would be any backlash from the community, they didn’t want to deal with it if there was.

Elena Cabatu, Hilo Medical Center’s spokesperson, said “The Medical Aid in Dying law is a significant piece of legislation that honors the full continuum of care for our patients. As the leading provider of healthcare in East Hawai‘i, we respect the law that allows the physician to support the best outcomes for the patient’s end-of-life needs and will support our medical staff’s decision as appropriate.”

“Hospital systems and hospices are figuring out how to support medical providers who want to support their eligible patients in this compassionate end of life option and it is a process that may take time,” said Compassion & Choices Hawai‘i  State Director Samantha Trad.

That is why Compassion & Choices provides resources and tools to help medical providers and patients navigate the process of finding providers who will support their end-of-life decisions (see resources below).

Compassion & Choices volunteers have been making public presentations addressing OCOCA throughout the island. Coming up next, Hawk will present at the Hāmākua Harvest farmers market in Honoka‘a on April 28, 2019. The event will be free and open to the public (time TBA).

Community presentation by Compassion and Choices Volunteer Aubrey Hawk on OCOCA/medical aid in dying held at the Pahoa Community Center sponsored by AARP on Friday, April 5, 2019. PC: Charlene Iboshi, Community First

For more information about what prescription options are available and for help finding participating professionals, patients can contact Compassion & Choices’ End of Life Consultation Line at (800) 247-7421 or email [email protected].

Medical providers can receive free and confidential consultation from a highly experienced physician specializing in end-of-life care and prescribing medical aid-in-dying by reaching out to the Doc2Doc line at (800) 247-7421 or by emailing [email protected].

Another resource available is the Pharmacist2Pharmacist consultation line for pharmacists and patients at (503) 943-6517.

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