John Radcliffe, right, who was diagnosed with cancer in 2014, watches as Hawaii Gov. David Ige signs a bill to legalize medically assisted suicide on Thursday, April 5, 2018 in Honolulu. Radcliffe testified in favor of the measure and said Thursday he was happy it passed. Doctors in the state can now fulfill requests from terminally ill patients to prescribe life-ending medication. Hawaii is the sixth U.S. state, plus Washington, D.C., to legalize the practice. (AP Photo/Sophia Yan)

John Radcliffe, right, who was diagnosed with cancer in 2014, watches as Hawaii Gov. David Ige signs a bill to legalize medically assisted suicide on Thursday, April 5, 2018 in Honolulu. Radcliffe testified in favor of the measure and said Thursday he was happy it passed. Doctors in the state can now fulfill requests from terminally ill patients to prescribe life-ending medication. Hawaii is the sixth U.S. state, plus Washington, D.C., to legalize the practice. (AP Photo/Sophia Yan)

HONOLULU (AP) — Hawaii became the latest liberal-leaning state to legalize medically assisted suicide Thursday as the governor signed a measure into law allowing doctors to fulfill requests from terminally ill patients to prescribe life-ending medication.

“It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace,” Gov. David Ige said.

Ige said the law was written to ensure the patient is in full control and it provides just one option available for end-of-life care, knowing assisted suicide is not for everyone.

“But we know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind,” the governor said.

Hawaii’s heavily Democratic lawmakers approved the legislation late last month. The state joins California, Colorado, Oregon, Vermont, Washington state and the District of Columbia in allowing the practice.

Critics say they are concerned that the option will lead to hasty decisions, misdiagnoses and waning support for palliative care, in which dying people can be sedated to relieve suffering.

The law has safeguards to prevent abuse. Two health care providers are required to confirm a patient’s diagnosis, prognosis, ability to make decisions and that the request is voluntary.

A counselor also must determine that the patient isn’t suffering from conditions that may interfere with decision-making, such as a lack of treatment of depression.

The patient must make two oral requests for the life-ending medication, with a 20-day waiting period in between, and sign a written request witnessed by two people, one of whom can’t be a relative.

Criminal penalties will apply to anyone who tampers with a request or coerces a prescription for life-ending medication.

“The time was right for Hawaii to adopt this law,” said Peg Sandeen, executive director of the Death with Dignity National Center, a nonprofit advocacy group. “The safeguards Hawaii state 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.”

Allowing medically assisted death has been a divisive issue in Hawaii. Last year, a similar measure passed the state Senate but was later tabled in the House.</s>HONOLULU (AP) - Hawaii became the latest liberal-leaning state to legalize medically assisted suicide Thursday as the governor signed a measure into law allowing doctors to fulfill requests from terminally ill patients to prescribe life-ending medication.

"It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace," Gov. David Ige said.

Ige said the law was written to ensure the patient is in full control and it provides just one option available for end-of-life care, knowing assisted suicide is not for everyone.

"But we know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind," the governor said.

Hawaii's heavily Democratic lawmakers approved the legislation late last month. The state joins California, Colorado, Oregon, Vermont, Washington state and the District of Columbia in allowing the practice.

Critics say they are concerned that the option will lead to hasty decisions, misdiagnoses and waning support for palliative care, in which dying people can be sedated to relieve suffering.

The law has safeguards to prevent abuse. Two health care providers are required to confirm a patient's diagnosis, prognosis, ability to make decisions and that the request is voluntary.

A counselor also must determine that the patient isn't suffering from conditions that may interfere with decision-making, such as a lack of treatment of depression.

The patient must make two oral requests for the life-ending medication, with a 20-day waiting period in between, and sign a written request witnessed by two people, one of whom can't be a relative.

Criminal penalties will apply to anyone who tampers with a request or coerces a prescription for life-ending medication.

"The time was right for Hawaii to adopt this law," said Peg Sandeen, executive director of the Death with Dignity National Center, a nonprofit advocacy group. "The safeguards Hawaii state 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."

Allowing medically assisted death has been a divisive issue in Hawaii. Last year, a similar measure passed the state Senate but was later tabled in the House.</s>There's not much good news for those with six months to live, but what if you could plan for your last moments to happen on a tropical island paradise?

You can. Yesterday Hawaii's governor signed a bill allowing for medically assisted suicide in the Aloha State. When the law takes effect next year, Hawaii will join five other states—California, Oregon, Colorado, Vermont, and Washington—and the District of Columbia in allowing terminally ill people to request and receive life-ending medication.

Mind you, people can't just fly into Hawaii, buy some pills, plop down on a beach, and end it all while watching the sun set over crystal blue waters. First of all, you have to establish yourself as a resident of the state. Then you must be diagnosed with a terminal disease that will kill you within six months. Then you must make two oral requests (20 days apart) and one written request (with witness signatures) for a prescription for life-ending medication. And you have to prove you're of sound mind. So don't expect a rush of suicide tourism to Hawaii.

It's good news whenever a state formally gives permission to treat people as though they own their bodies and can decide when to end their own suffering.

Assisted suicide is one of those issues—like marijuana legalization—where government policy has lagged significantly behind public polling. Surveys show that nearly three out of four Americans approve allowing terminally ill patients to end their own lives. Yet as Governing notes, New York's Supreme Court recently upheld a ban on assisted suicide, while 27 other state-level efforts just last year failed even to make it to a vote by lawmakers. In three of the five states where assisted suicide is legal, it took ballot initiatives from the citizens to force the state's hand.

So the struggles continue. Below, ReasonTV delved into a fight to bring assisted suicide to Montana back in 2013. Technically Montana is a sixth state that allows medically assisted suicide, but that's due to a state Supreme Court ruling and not an affirmative law. There have been efforts in Montana both to formally permit medically assisted suicide and to ban it entirely:</s>Hawaii has become the seventh state to legalize medically assisted suicide, a topic that has been deeply divisive in the medical community.

The practice that has come to be known as 'dying with dignity' involves prescribing life-ending medication to terminally ill patients.

Supporters say it's a compassionate choice to prevent suffering and critics say it's immoral and goes against the Hippocratic Oath which states: 'I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan.'

Physician-assisted suicide is becoming increasingly common around the world and several other states including Massachusetts and Alaska have been considering its legalization.

Medically assisted suicide is also legal in California, Colorado, Oregon, Vermont, Montana, Washington state and the District of Columbia.

Critics of the practice say could lead to hasty decisions, misdiagnoses and decreasing support for palliative care, in which dying people can be sedated to relieve suffering.

Hawaii's new law was debated for several hours in the state Senate in late March.

In a hearing Democratic Senator Breene Harimoto said that allowing for the option of medically assisted suicide could create 'an environment of hopelessness' that would allow a doctor to help cause death.

The Hawaii Family Forum submitted a written testimony that the legislation may create subtle pressure on the elderly to end their lives early so they are not a burden to their families.

Senator Russell Ruderman countered those arguments saying the bill is about freedom.

'If you don't believe in it, don't do it. But there is no reason to deny to others the freedom to live and die as we choose,' he said.

The chamber's only doctor, Senator Josh Green, who works in an emergency room, voted for the bill but said he wished lawmakers would take more time to debate it.

When Governor David Ige signed the bill on Thursday he said: 'It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace.'

'We know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind.'

In order to be eligible for the option under Hawaii's new law, patients must be 18 or older and have fewer than six months to live.

To safeguard from potential abuse the law requires that two medical providers confirm the diagnosis and prognosis.

A counselor must also confirm that the patient isn't suffering from any conditions that may interfere with their ability to make decisions.

The patient has to make two oral requests for the life-ending medication with a 20-day waiting period in between.

They're then required to sign a written request witnessed by two people, one of whom cannot be a relative.

There will be criminal penalties for anyone who tampers with a request or coerces a prescription for life-ending medication.

'The safeguards Hawaii state 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,' said Peg Sandeen, executive director of the Death with Dignity National Center, a nonprofit advocacy group.</s>April 6, 2018 -- A bill legalizing medically-assisted suicide in Hawaii was signed into law Thursday by Gov. David Ige.

The state joins California, Colorado, Oregon, Vermont, Washington state and the District of Columbia in allowing the practice, the Associated Press reported.

"It is time for terminally ill, mentally competent Hawaii residents who are suffering to make their own end-of-life choices with dignity, grace and peace," Ige said.

The law permits doctors to prescribe life-ending medication to terminally ill patients, the AP reported.

Ige said "we know that we have gotten to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind."</s>Hawaii just made the mistake of becoming the eighth jurisdiction in the United States to allow assisted suicide.

We can learn a lot about the folly of this path if we look to other places here and abroad where assisted suicide already is legal. A quick survey turns up countless instances of the failures of these laws to safeguard the most vulnerable.

From Europe, there seems to be a constant stream of documented cases related to the practice of assisted suicide and euthanasia, which would give anyone pause.

In the Netherlands, the number of people with experience of mental illness being euthanized is rising by the day. There are known cases of such people being abused or coerced into death by people they should be able to trust. A whistle-blowing doctor in Belgium went to the Associated Press with the details of a dementia patient’s death by euthanasia – the patient had never formally asked to die.

A column in the Washington Post recounts another sad story of one case gone very wrong. In 2016, an otherwise healthy elderly woman with dementia, having made an ambiguous advanced directive to end her life “when the time was right,” was euthanized against her will at the request of her husband by a nursing home doctor whose assessment was that the patient’s suffering was “unbearable and incurable.” She prepared the lethal injection. The physician tried silencing the patient’s protests by slipping a sedative into her coffee. When the sedative failed, this doctor had the family of the patient restrain her so that she could administer the lethal injection.

The columnist rightly asks, “How many botched cases would it take to end euthanasia of the vulnerable?”

In January, a physically healthy 29-year-old suffering from depression was euthanized. The Daily Mail reported that in Holland in 2013, “a total of 42 people with ‘severe psychiatric problems’ were killed by lethal injection compared to 14 in 2012 and 13 in 2011.”

Are these abuses confined to Europe or are they the inevitable fruits of what is everywhere bad public policy? There is evidence for the latter.

In Oregon, Michael Freeland, who had a 40-year history of acute depression and suicidal ideation, not only received the lethal prescription but also was allowed to keep the drugs even when all other means of his taking his own life had been removed from his home.

Another Oregonian, Kate Cheney, who had been diagnosed with dementia, was first referred for the non-required psychiatric evaluation and denied the lethal dose. Her family shopped for a doctor until they found one who would sign off; the doctor’s report stated that her “choices may be influenced by her family’s wishes and her daughter, Erika, may be somewhat coercive.”

In fact, just this legislative session, there was a bill before the Delaware General Assembly that would sanction the assisted suicides of people with intellectual and developmental disabilities. This flies in the face of the central concerns of the disability rights community: Nothing in the proposed Delaware bill ensures that people actually have access to the pain relief, palliative care and home-based and community-based personal care services they need.

Moreover, just like all of the proposed bills and assisted suicide laws, the Delaware bill utterly fails to prevent coercion. Coercion to request lethal drugs, like any form of abuse, occurs behind closed doors.

Let’s all note how legalizing assisted suicide and euthanasia has led to the tragic death of vulnerable people. Whether in Europe, Canada, or even here in the U.S., this public policy push is unsuccessful at instituting any structures that would protect those who are most vulnerable from abuse and coercion.

We can avoid making the same mistake here by rejecting such laws and proposals altogether.

Matt Valliere is executive director of Patients Rights Action Fund, a national organization that opposes assisted suicide.</s>With the governor’s signature on Thursday, Hawaii has given terminally ill patients the option to decide when they want to die.

The new law, known as the Our Care, Our Choice Act, will make Hawaii the sixth state in the U.S. and the seventh jurisdiction to legalize physician-assisted suicides. The law takes effect Jan. 1.

It will allow patients in Hawaii to request medication from their physicians that would end their lives. Patients eligible for this option, which has come to be known as “dying with dignity,” must be 18 or older and have less than six months to live.

“I do know that even within my own family there’s different opinions about whether there should be an option or not ... but we know that we have got to a point in our community that it does make sense to give the patient a choice to request the medication, obtain it and take it, or ultimately change their mind, if they so choose to,” he added.

Activists have been working with state lawmakers in Hawaii to pass the bill for 20 years, according to Kim Callinan, CEO of the nonprofit advocacy group Compassion & Choices.

“This has really been the building of a ground-up operation,” Callinan told HuffPost, adding that her organization has been working with the state since the beginning.

At least one group had started a petition before the bill’s signing, garnering more than 18,000 signatures from people who oppose it.

“We are very concerned that a lot of the concerns that were brought up by the medical community ... the disabled rights community, they were not taken into consideration,” Eva Andrade, the group’s president, said at the time.

Speaking to HuffPost on Thursday, Callinan said laws that legalize physician-assisted suicide are about more than giving people a chance to decide when they want to die ― it’s about giving terminally ill patients more options.

Like other legislation passed in other states, Hawaii’s Our Care, Our Choice Act requires that physicians tell patients who are considering this option about all of the other options that do not involve assisted suicide. Physicians are also required to let patients know that they are allowed to back out at any time after they are given a prescription for the medication that would end their lives.

“Patients see this law as a way for them to have autonomy at the end of life,” Callinan told HuffPost. “What they’re most worried about is that they’re going to die suffering and in pain.

“Most people don’t choose to use the medication, but they want it because it gives them a peace of mind to know that if their suffering becomes too great, they have the option to end it.”</s>Ige signed the bill Thursday, making Hawaii the sixth liberal-leaning state plus Washington, D.C., to legalize the practice.

Ige said the measure gives full control to terminally ill patients. He says everyone knows their loved ones will eventually die, but they don’t need to suffer.

The law allows doctors to fulfil requests from terminally ill patients for prescription medication that will allow them to die. The legislation includes safeguards intended to prevent abuse.

The other states that allow medically assisted suicide are California, Colorado, Oregon, Vermont and Washington state.

Montana doesn’t have a specific law on the books, but the state Supreme Court ruled in 2009 that doctors could use a patient’s request for life-ending medication as a defence against criminal charges.</s>HONOLULU, Hawaii – Are there downsides to a low unemployment rate? In Hawaii, which has the United States’ lowest jobless rate at a minuscule 2.1 per cent, the answer is yes.

Employers are frustrated by their inability to find workers. And unfilled jobs may be slowing the state’s economic growth.

A low unemployment rate is certainly better than a high one. And many employers are responding to the worker shortage by offering higher pay.

Still, Hawaii’s experience serves as a cautionary tale for the nation as a whole: Low unemployment can mask underlying problems. Nationwide, the jobless rate is at a 17-year low of 4.1 per cent, and economists forecast it could drop another half-point by next year. That would bring the rate to a half-century low.

U.S. employers are already complaining about their struggles to find qualified employees. The number of open jobs nationwide reached the highest level on record in January.

Like the rest of the country, Hawaii has an aging population, and its unemployment rate has been held down in part by retiring baby boomers.

The state also has unique challenges, such as an economy long dominated by tourism. Many of Hawaii’s available jobs are in the service sector and don’t pay enough to cover the state’s high housing costs. And economists say Hawaii’s ongoing economic sluggishness could make it harder for the state to pay its public pension obligations in the future, and fund highways and other expensive infrastructure.

U.S. Rep. Colleen Hanabusa, a Democrat, cited the deceptively rosy jobless rate when she launched her campaign challenging a sitting governor from her own party in this year’s election.

“We cannot wait as more and more of our young people, discouraged by the future they see for themselves here, leave Hawaii in hopes for better opportunities on the mainland,” Hanabusa said in January. A recent poll conducted for the Honolulu Star-Advertiser gave her a 20-percentage point lead over Gov. David Ige in the August primary.

Hanabusa was pointing to a trend reflected in census data: People are moving away from Hawaii even as employers here clamour for workers.

Last year, the state suffered a net loss of more than 1,000 people. On Oahu, home to Honolulu and major military installations like Pearl Harbor, the population declined an average of 11 people per day. The median price of an Oahu home tops $770,000.

According to the U.S. Census Bureau, 47 per cent of Hawaii’s residents spend more than a third of their monthly income on rent. That’s greater than any other state. About one-quarter of renters put half of their income toward housing.

The personnel squeeze is forcing employers to offer incentives to attract workers.

Maui Divers Jewelry, a retailer in the old whaling town of Lahaina, offers employees extra money to cover the cost of driving to its stores from Maui’s bigger cities.

Star of Honolulu Cruises and Events has raised the hourly wage for servers on its boat cruises to $12 from $10.

“They can be picky now, I feel like. The ball is in their court,” Sheridan Andres, the company’s human resources manager, said of job applicants. Star of Honolulu is also advertising for kitchen staff, boat maintenance workers, bus drivers and supervisors.

Hawaii Pacific Health, one of the state’s largest health care providers, is pursuing a pilot program to train medical assistants at five public high schools so they’ll be ready to walk into jobs when they graduate. The company has 7,000 employees, along with 44 openings for medical assistants and more than 400 openings overall.

The demand for labour is driven by a tourism surge that brought a record 9.4 million visitors to the islands last year. Strong hiring and income gains in the Western U.S. mean more Americans can make the trip. And Japan and Canada, where most of the state’s overseas visitors come from, also are experiencing solid growth.

That’s led to an increase in low-paying hotel and restaurant jobs, which accounted for 60 per cent of Hawaii’s job growth in 2017, according to data compiled by Moody’s Analytics. Hotels and restaurants employ about one of every five workers in the state, double the proportion in the rest of the U.S.

Adam Kamins, a senior economist at Moody’s Analytics, says the state has had little success in luring better-paying tech jobs from western states such as California or Washington, because of high housing and business costs. Tech firms are instead moving to cheaper states such as Utah, Colorado and Idaho.

An economy with an unemployment rate as low as Hawaii’s should be growing about 3 per cent a year, said Eugene Tian, the state’s chief economist. Instead, it’s growing at about 1.5 per cent.

“We don’t have enough housing. We don’t have enough trained labour. That’s limiting the growth,” Tian said. “They are connected.”

Paul Brewbaker, an economist with consulting firm TZ Economics, said Hawaii’s growth rate has lagged the nation’s for the past decade. On average, Hawaii’s economy has grown just 1.6 per cent per year compared with the national average of 2.1 per cent since 2009.

On a per-capita basis, gross domestic product in Hawaii was one-third higher than the national average 40 years ago, Brewbaker said. It’s now the same. The trend could have profound consequences for Hawaii in the long term.

“Where do we go from here? If we’re on this road, how do we pay for the public employee retirement system? If we’re on this road, will we ever be able to build another freeway, not to mention a mass transit system?” Brewbaker said.</s>Hawaii officials were quick to offer condolences, via Twitter and news releases, after learning that former U.S. Sen. Daniel K. Akaka died early this morning.

U.S. Sen. Mazie Hirono: “Senator Daniel Kahikina Akaka embodied the Aloha Spirit. He dedicated his life to serving the people of Hawaii as an educator, and in the U.S. Army, state government, the U.S. House, and the U.S. Senate. In Congress, Senator Akaka’s care, empathy, and collegiality served as an example for us all. It’s an honor to sit at his desk in the Senate chamber, and we continue his work to improve the lives of veterans and the Native Hawaiian community. My thoughts are with Millie and the Akaka ohana in this difficult time. As he so often said, mahalo nui loa, my friend.”

U.S. Sen. Brian Schatz: “Daniel K. Akaka was beloved by everyone in Hawaii, and his colleagues of both parties in Washington DC. A pure heart, a determined warrior for native Hawaiians, and a true public servant. We will miss you, Senator Akaka. Aloha.”

U.S. Rep. Colleen Hanabusa: “Hawaii’s heart is broken this morning as we learn of the passing of one of Hawaii’s greatest statesman. Thank you, Senator Akaka, for your legacy of courage and love. You taught Congress and our nation how to fight with dignity and Aloha. We all aspire to lead like you. Senator’s passionate advocacy on behalf of Hawaii, Native Hawaiians, his students, veterans, and his contributions to our community and humanity cannot easily be measured. He gave his heart to Hawaii. Our thoughts and prayers are with Aunty Millie and the entire Akaka Ohana.

U.S. Rep. Tulsi Gabbard: “Senator Akaka truly embodied the aloha spirit & selflessly dedicated his life to serving others. He treated everyone equally, with kindness, respect & love – no matter who they were or how they treated him. He responded always with aloha, sharing his warm smile & embrace w/ all. I’m so grateful to have known & worked with him over the years & to have spent time with him the last few days. He impacted the lives of countless people. His legacy of aloha will live on thru all who continue to be inspired by his example. We love you, Senator Akaka. A hui hou.”

Hawaii House Speaker Scott Saiki: “Senator Akaka served Hawaii with dignity, respect and humility. He never lost sight of his values and the need to protect our state and its people. Hawaii has lost an extraordinary statesman.

Honolulu Mayor Kirk Caldwell: “Senator Akaka lived a life of love, kindness & aloha. I never heard him utter an unkind comment about a single person. He represented the best of Hawaii and set the highest standard for all of us to achieve in terms of human decency. I will miss his quiet leadership. Our hearts got out to Millie and his entire family.”
Medically assisted suicide became legal in the state of Hawaii.