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In April my grandmother will turn 98. Most of the time her mind is clear. She uses a cane, but still gets around. For all intent and purposes she is healthy.

But these days, she talks about dying the way most people talk about the weather.

My grandfather died 14 years ago of Parkinson’s Disease. When his body failed him, he said he wanted to die. For a while, my grandmother tried to gently force-feed him, saying: “You have to be strong! You have to keep going. You must do this for us.”

It was just her way of trying to keep him from losing hope on life. He died not long after. She says she talks to grandpa every day, asking for guidance. She told me recently she often keeps quiet about growing aches and pains, in fear of being more of a burden to the family.

Still, she is a proud woman, who wants to leave this world the way she lives it: with dignity.

It is part of the reality and complexity of the debate over legalizing what is called “Death with Dignity,” “Aid-In-Dying,” or “Physician-Assisted Suicide” depending on what side you are on. Right now, five states have legalized physician aid-in-dying, including Oregon, Washington, Colorado, California, and Vermont. A 2009 U.S. Supreme Court ruling also legalized physician-assisted dying in Montana.

Hawaii could be next. On March 7, by a vote of 22-3, the Hawaii Senate approved which, similar to other states that have done so, would allow doctors to prescribe a lethal dose of medication to a terminally-ill patient. That patient would then take on the responsibility of ingesting it themselves.

Oahu physician Craig Nakatsuka has been a leading opponent. He believes the elderly, like my grandmother, are at risk of being “self-sacrificing.” In a January Op-Ed in the Honolulu Star-Advertiser he asked: “Given the deeply-held cultural beliefs of many Hawaii families, will those diagnosed with terminal illness feel it is their duty to their families to end their lives?”

Dr. Nakatsuka is leading a of team of medical professionals fighting the bill at the state capital and in the community. He believes hospice provides the kind of quality end-of-life care that makes aid-in-dying an unnecessary option. I have personally spoken with doctors who truly believe, no matter how their patients view life and death, they as doctors, made a professional, moral, and ethical oath to take no lives.

But supporters believe this is the year Hawaii’s law will change. Long-time lobbyist John Radcliffe, who has terminal cancer, has been a powerful voice in the debate. As Civil Beat reported in January, he joined the nonprofit organization Compassion & Choices and physician Charles Miller in a lawsuit seeking to force the state to grant terminally ill, mentally competent patients the right to medical aid-in-dying.

An important point often missing in media reports; those who seek such treatment, are subject to multiple rounds of physical and psychological testing that can take months to complete. Patients who are deemed depressed, mentally unstable, or unable to voice their will, will not qualify for aid-in-dying.

Radcliffe may not need to win that lawsuit. So far, the majority of Hawaii lawmakers are showing support for efforts to change the law. And, as noted by Civil Beat earlier this year, a survey administered for Compassion & Choices by Anthology Marketing Group, found 80 percent of Hawaii voters support access to aid-in-dying for terminally ill patients.

Despite momentum on the state level, the nomination of Judge Neil Gorsuch to the U.S. Supreme Court has supporters concerned. In 2009, Gorsuch published his book: “,” which reveals his strong opposition to its legalization. “All human beings are intrinsically valuable,” Gorsuch wrote, “and the intentional taking of human life by private persons is always wrong.”

Gorsuch’s nomination hearings began Monday morning. He is appearing before a Senate Judiciary Committee for several rounds of proceedings expected to last three to four days. Compassion and Choices has released a petition asking supporters to ask their members of Congress to question Gorsuch about his position on medical aid-in-dying laws.

As the debate rages on, my grandmother is battling her own demons. Her body is slowly betraying her. Her mind and her memory, she says, are getting harder to control.

She is one of the fortunate ones. Two threads from 100, she can still share her thoughts, move her body, and make decisions based on how she feels about life and death. In no length of time, those freedoms will be gone.

In , physician Dr. Lonny Shavelson, one of a number of California doctors who administers lethal drugs to terminally ill patients, told the Washington Post, “It’s almost never about pain. It’s about dignity and control.”

If my grandmother had that choice, I don’t know what she would choose. I’m not ready to ask her.

But for anyone faced with that option, I know it would be an incredibly difficult and deeply personal journey. However we decide to structure our laws as Americans, but more importantly as human beings, we must at least allow our loved ones the opportunity to think for themselves, and guide that journey for as long as they can.