Pictured: Dr. Steven Pantilat speaks to the Geriatric fellows and faculty at Kuakini Medical Center. Deborah Manog Dimaya photo.
By Deborah Manog Dimaya, UH Med Now
As of January 1, 2019, Hawaiʻi joined six other states in legalizing physician-assisted suicide through the “Our Care, Our Choice Act.” The new law allows qualifying patients, those who are found to be mentally competent and have a prognosis of six months or less to live, the right to request a lethal prescription in order to die.
In preparation, the Departments of Medicine, Geriatrics and Psychiatry at the University of Hawaiʻi (UH) John A. Burns School of Medicine (JABSOM) invited a speaker from California, where that state’s “End of Life Option Act” (EOLOA) has been legal since June 2016.
The visiting professor, Dr. Steven Pantilat, Director of Palliative Care at the University of California San Franciso, discussed his experiences in the field related to medical aid in dying and how to better communicate with seriously ill patients about all of their options at the end of life.
“The sadness of death does not go away because it’s been chosen. It’s really sad,” Dr. Pantilat said, on his experience with the EOLOA as a prescribing physician.
In palliative care, the goal is to prevent and ease suffering for a patient with a serious illnesses and improve the patient’s quality of life. As a palliative care physician, Dr. Pantilat believes that those who request medical aid in dying need palliative care but stressed that palliative care does not equal the end of life.
“The thought that people often have a decent quality of life but they worry about losing their (physical or mental) capacity—that, for me, has been the hardest part of this law, is that I think people end up having to do this before it is necessary,” Dr. Pantilat said.
Dr. Pantilat’s takeaway message to physicians is that when patients start to ask questions about medical aid in dying, “step into the issue instead of away from it.” He urged doctors to be up front with their patients about their willingness to participate (or not participate) in the “Our Care, Our Choice Act” and explain all the options available to patients who might be fearful about what their end of life may look like.
According to an article published in 2013 in the New England Journal of Medicine, the top reasons stated for wanting to participate in Oregon’s “Death with Dignity Program” were loss of autonomy (97.2%), inability to engage in enjoyable activities (88;9%) and loss of dignity (75%).
For patients who are worried about their future, the correct response, Dr. Pantilat says, is “to be a compassionate doctor and reassure them of their health care.”
His talks to the JABSOM departments at The Queen’s Medical Center (QMC) and Kuakini Medical Center were sponsored under the Dr. Ryder Onopa Visiting Professorship. The day before, Dr. Pantilat was invited by The Queen’s Health Systems to speak at its Annual Conference on Pain and Palliative Care. One of his two presentations was featured as the Dr. Ryder K. Onopa Memorial Lecture, named after the 2010 JABSOM alumnus and medical resident who died an early death from cancer at age 30.
“Ryder Onopa was an extraordinary young physician with a brilliant mind and a huge heart. He was dedicated to serving the people of Hawaiʻi and planning a career in palliative medicine for which he had tremendous aptitude,” said Dr. Daniel Fischberg, JABSOM Chief of Palliative Medicine and QMC Director of Pain and Palliative Medicine.
“His death at such a young age was a great loss for our community. Ryder’s memory lives on in the hearts of his family, friends, and all the patients, family members, and colleagues whose lives were the better for knowing him,” said Dr. Fischberg.
Several continuing medical education courses will be offered to health care professionals:
Jan. 19 from 8:00 am – 11:30 am at the UH Cancer Center and provided by the Hawai’i Society of Clinical Oncology. See details on their website.
Feb. 1 from 1:00 pm – 4:45 pm at The Queen’s Medical Center. Contact them to register at cme@queens.org.
Feb. 2 from 9:00 am – 12:45 pm at UH JABSOM, room 314. Register through email to Crystal Costa.