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When it comes to one of the most high-profile issues before the Legislature — medical aid in dying — most House members are remaining silent about their position.

Civil Beat called all 51 members to find out where they stood on a bill to let doctors prescribe lethal drugs to terminally ill patients after the Health Committee, chaired by Rep. Della Au Belatti, shelved it last month without a vote. The Senate had passed it two weeks earlier, 22-3.

More than 30 representatives did not return messages seeking information about whether they support or oppose aid-in-dying legislation.

The seven-member committee’s indefinite deferral of kept the measure from reaching a floor vote by the full House. This lets lawmakers who fear political repercussions, like religious groups mobilizing their constituents to oust them next election, dodge the issue altogether or talk about it in terms that still leave their position vague.

“There was a reluctance in the House to take on a controversial issue. That’s my read on it,” said Mary Steiner of , a national nonprofit that advocates for expanding options at the end of life.

“People are dying, people are needing medical aid in dying, and I personally feel terrible that we weren’t able to help them this year,” she said.

Steiner and other supporters of the bill plan to press skittish House lawmakers to reconsider the measure next legislative session, or perhaps the following year.

The support might already be there. 

Interviews with lawmakers, lobbyists and others who fought for and against the bill indicate that a majority in the House — perhaps as many as 31 members — may now support the concept of medical aid in dying, which is also referred to as physician-assisted suicide and death with dignity.

But ultimately, the overwhelmingly Democratic chamber’s power brokers decided it was too soon for Hawaii and had concerns about adequate safeguards to prevent abuse.

Majority Leader Scott Saiki, who supports medical aid in dying, said he did not poll House members to gauge their support but thinks it’s roughly split in the middle.

“It’s the kind of issue that is so complex, but also emotional, and it’s really up to the members to decide for themselves how they want to vote on a bill like this,” Saiki said. “Who am I to ask a member to vote a certain way on an issue like this?”

Lawmakers still felt pressure. Groups including the and were urging them to pass the bill.  The , the hospice care industry and others were opposed. 

The medical community was split. And experts on both sides acknowledged holes in the legislation.

A Bill ‘Beyond Repair’

The House Health Committee received almost 800 pages of and heard from concerned citizens and representatives of various organizations for more than three hours during its March 23 hearing, even after limiting public comment to one minute per person.

Ultimately, the votes weren’t there to pass it out of the committee, which includes Belatti, and Reps. Marcus Oshiro, Andria Tupola, Bert Kobayashi, Sharon Har, Dee Morikawa and Chris Todd.

Belatti, like many of her House colleagues, including Kobayashi and Todd, said she supports the concept of medical aid in dying but could not back the bill in its present form or find a way to amend it that would alleviate concerns about insufficient safeguards.

“With something of this significance, when you have testimony from agencies that are weak, and that don’t show a complete commitment to this policy decision that is so important, the committee was within its rights to kind of slow this process down,” she said.

There are lessons Hawaii can learn from the five other states that have such a law, she said, adding that moving the measure through the legislative process over the past two months has helped further a broader public discussion that will continue after this session ends in May.

The bill was based on , which was enacted in 1997.  would have allowed “mentally competent adult residents who have a terminal illness with a confirmed prognosis of six or fewer months to live to voluntarily request and receive a prescription medication for self-administration so that they can die in a peaceful, humane manner.”

A similar measure, , was introduced by Speaker Joe Souki and Reps. Jarrett Keohokalole, Angus McKelvey, Scott Nishimoto and Saiki. It never received a hearing. That was also the case for , introduced by Reps. Calvin Say and Ken Ito.

Heading into the Health Committee hearing, many political observers assumed Belatti, Todd, Morikawa and Kobayashi would pass the bill. But as the hours wore on, Todd and Morikawa shifted their positions. In the end, even Belatti and Kobayashi were not sold on it.

“I really hope that the public recognizes that this bill was really considered by the House members and the decision to defer was not made lightly,” Saiki said.

Oshiro and Tupola opposed the bill, and generally oppose medical aid in dying. Har did not return messages seeking comment but lawmakers and lobbyists considered her a “no” vote. Their questioning of experts focused on potential dangers.

Morikawa, who did respond to requests for comment, said during the hearing that she grew up supporting euthanasia. But life experiences, including the deaths of her parents from cancer, have caused her to question her stance.

“I’m torn with this decision,” she said. “I think that what we need to do is work more on this if this is what we want to do.”

Tupola, one of five Republicans in the House, cited Dr. Rae Seitz’s testimony in a statement she put out supporting the deferral of the bill. Har, too, noted Seitz’s comments as compelling. Seitz, a palliative care expert who supports the concept of medical aid in dying, told the committee that “Hawaii’s health care community is not yet prepared.” 

“I was concerned with the bill because of issues with death certificate accuracy, no mandate that the medication be taken in a controlled environment with a witness, lack of enforcement and no definition for ‘self-administration,’” Tupola said.

Oshiro echoed those concerns, describing the bill as “beyond repair.”

“I take this seriously. It’s literally life and death,” he said.

He explained how hard it was for him to not support the measure. Before the hearing, Oshiro said he gave John Radcliffe a hug and apologized to him for not being able to back the bill despite their decades-long working relationship.

Radcliffe, a longtime lobbyist and arguably one of the most influential figures at the Capitol, was diagnosed with terminal cancer and has been fighting to get the legislation passed with the support of Compassion & Choices.

They are also pushing the matter in court, though that lawsuit is not expected to be decided for months or even years if it is appealed. They sued the state, seeking to clarify whether there are laws prohibiting medical aid in dying and if there are, whether they violate the state constitution.

Policy Not Made On Personal Stories

For those House lawmakers who did respond to Civil Beat’s requests for comment, their views on medical aid in dying were largely shaped by morals, matters of protocol, personal experiences and in some cases, miracles.

“I’ll tell you straight up: I believe in miracles,” Rep. Romy Cachola said. “That’s the reason why I’m against it, because there’s a lot of miracles happening. A person diagnosed to be only a few months away (from death), before you know it they’re recovered and are really contributing members of society.”

“It’s just a common sense thing to do,” Rep. Kaniela Ing said. “I generally think people want to make sure that they retain as much control of their end of life and in order for them to do so we need to pass this sort of compassionate legislation.”

Staff members fielded calls for other lawmakers. Rep. Lynn DeCoite’s secretary said she defers to the committee chair when voting. Rep. Justin Woodson’s assistant said he would prefer not to comment. And Rep. Cedric Gates’ office worker said he didn’t have time to talk about the bill.

Lawmakers’ concerns mostly centered around the safeguards and a series of “what-if” scenarios. Should a witness be present when the lethal medication is taken by the patient? What qualifications should the medical professionals giving the terminal diagnosis have? How are records kept?

Belatti said it was the Legislature’s job to “balance the right to choose with protecting those who are most vulnerable…There must be a broader discussion about safeguards and oversight to this ‘aid in dying’ proposal.”

Her fellow committee members and those who offered testimony gave Belatti credit for hearing the bill, allowing her colleagues to ask their questions and ensuring time for discussion with the experts and concerned parties who attended. She could have just killed it by not giving it a hearing.

Even if the bill had passed the Health Committee, there was still another hurdle before it could go to a vote by the full House.

Its next stop would have been the Judiciary Committee, chaired by Nishimoto. Its 11 members include Belatti, Oshiro and Morikawa.

The other seven members — Reps. Joy San Buenaventura, Tom Brower, Aaron Ling Johanson, Chris Lee, Mark Nakashima, Bob McDermott and Cynthia Thielen — are mixed on the issue.

Buenaventura said she supports the concept of medical aid in dying, but hadn’t looked at the bill yet.

McDermott, a conservative Republican, opposed the bill.

“It’s not for man to decide when life begins or ends,” he said. “Everyone has a story of a family member who has died a slow death, and I have my own story, but we don’t make policy based on anecdotal stories. I’ve seen firsthand how pain medicine works, and it takes the pain away.”

A Matter Of Timing

This was the farthest medical-aid-in-dying legislation has made it in the Hawaii Legislature since 2002, when a similar measure cleared the House but died in the Senate Health Committee.

Senate Bill 1129 is technically still alive.

House rules allow a bill to be “recalled” from a committee 20 days after it was referred to that committee if one-third of the chamber’s members vote in favor of the recall. But Saiki said a recall is not going to happen this session because it would “shortcut” the process.

Back in 2002, the Senate recalled a death-with-dignity bill after the Health Committee deferred it. But when it went down to the full chamber, senators voted against it 14-11.

Saiki said passing the bill next session could be “a little bit problematic,” since 2018 is an election year. But he said the interim should be spent in the medical community working to shore up support. 

“I remain optimistic” that aid in dying will eventually pass,  he said. “It’s just a matter of timing.”

For Steiner, too, it’s not a matter of “if” but “when.”

“This is an issue that is going to come back again and again until it passes,” she said. “We really thought that this was going to be the year for medical aid in dying in Hawaii. It’s unfortunate that our hard work did not pay off this year.”

Several lawmakers and lobbyists said it felt similar to when the Legislature took up gay marriage in a 2013 special session. That bill passed after groundwork was laid in years prior to legalize same-sex civil unions.

“People here are still sensitive to the gay marriage thing. That still has some echoes,” said Rep. Richard Creagan, a medical doctor who supports death with dignity.

“It’s not taking rights away from people,” he said. “It’s just giving rights to people.”

Colin Moore, a political science professor at the University of Hawaii, said he was surprised the bill did not pass this year. He thought it had momentum coming out of the Senate and broad community support.

“The state Legislature is always a very cautious body despite being a one-party state,” he said. “But their level of caution does creep on the level of cowardice. That’s troubling to me. This is their job. They are elected to make these difficult decisions.”

Here’s the list of lawmakers who did not return Civil Beat’s messages seeking comment for this story, with links to their Capitol websites which include contact information.

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