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Oregon came first, then Washington, Montana, Vermont and, most recently, California.

Each state has passed legislation that allows terminally ill, mentally competent individuals to end their own lives with medical assistance, legally.

Gov. Jerry Brown summed it up best in his ��He noted the thoughtful opposition arguments and his own religious convictions about the issue before saying he had decided that it should not be a crime for a dying people to end their lives.

“I don’t know what I would do if I were dying in prolonged and excruciating pain,” Brown said. “I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others.”

That did not stop an attempt to overthrow California’s new aid-in-dying law, with the hopes of gathering enough signatures to place��a referendum on the November ballot. The Catholic Church encouraged parishioners to sign the petition, and a coalition called got involved, but to no avail.

Not enough signatures were obtained. The bill still stands, and will be enacted 90 days after a special legislative session on health care concludes.

Specific requirements that must be met by patients, including two documented prognoses, and written and oral requests for the medication at least 15 days apart. Finally, patients must be able to take the dose themselves.

So the entire��West Coast has passed legislation regarding death with dignity.��Where does Hawaii stand?

Last legislative session, to consider death with dignity legalization, however it didn’t go very far. It may be reintroduced this year, only time will tell. But an that only had nine signatures as of October now has 21,681 signatures, some from as far away as South Africa, others much closer to home. The��petition is directed at Hawaii House Speaker Joe Souki, and urges the Legislature to consider passing a law similar to the other Western states regarding death with dignity.

There is no greater need than that of someone who is in pain, gasping for breath, and unable to choose to��leave this world on their own terms.

As a physician, I see people who are suffering in their later stages of illness, and have witnessed firsthand the difficulties that patients and families face during this time of crisis. We do have excellent hospice services in the islands, and offer top-notch care for those who choose to terminate treatment if it’s been determined to be futile.

But in my opinion, we need to consider going one step further. Hawaii needs to legalize physician-assisted suicide.

Of course doctors take an oath to do no harm, and yes, in some people’s eyes, this is the very definition of harm. But we also take an oath to help those who are suffering in their time of need.

There is no greater need than that of someone who is in pain, gasping for breath, and unable to choose to��leave this world on their own terms.

The last time I wrote a��column about this, there were quite a few provocative comments. Some people questioned my ethics as a doctor, others took issue with the wording “euthanasia” and “suicide.” Still others wondered if this was just another futile attempt to propose legislation that was accepted in other communities but not meant for ours.

Legalizing something doesn’t mean it’s for everyone. There are many people who have religious beliefs that would prohibit them from participating in or advocating for any end-of-life measures, and therefore would never choose medication to hasten death as a result. Their opinions are equally valid.

Shouldn’t everyone have the right to choose for themselves?

In Oregon, after more than 15��years, only 1,327 people have requested the medication and of those, 859 (64.7 percent) ingested the medicine and died. Over-one third didn’t use it, but it was available to them if they wanted it. They had the option.

Why can’t we?

As I looked at the statistics and the efforts nationwide (��have recently been considering death with dignity), I had to wonder if Hawaii might be next.

And I became signature No. 21,682.