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A decades-long drive to legalize medical aid in dying for lucid, terminally ill adults ended Thursday with a smattering of speeches at the Capitol, an expected vote overwhelmingly in favor of the measure and quiet cheers from a few dozen advocates who have been there from the beginning.

The Hawaii Senate voted 23-2 to pass . Sens. Breene Harimoto and Mike Gabbard voted against it.

The bill, which cleared the House earlier this month 39-12, now heads to Gov. David Ige, who has said he looks forward to signing it into law.

“Without a doubt this is the most complicated issue we have ever had before us,” said Sen. Josh Green, who has struggled with the conflict it creates for him as a physician sworn to do no harm. He supported the measure but with great reservations.

Harimoto, who has battled pancreatic cancer, cast doubt on the polls that show strong public support for medical aid in dying. He also said it is impossible for him to set religion aside in his decision, as some advocates have said is necessary.

“My faith holds the very foundation of who I am,” he said, adding that he learned last week that he has cancer in his lungs.

Harimoto also took issue with the legislation’s latest label: “Our Care, Our Choice.”

“Euphemisms do not change what it is,” he said. “It is physician-assisted suicide.”

Sen. Russell Ruderman said the bill is all about freedom.

“Religions rightfully carry great respect in our society but must not dictate our laws,” he said. “If you don’t believe in it, don’t do it.”

Sen. Gil Riviere, who voted against a similar measure last year that had fewer safeguards, said he supported the bill this year but with strong reservations.

“I have for the last two years, waffled back and forth,” he said. “We’re crossing a very profound threshold here.”

Senate President Ron Kouchi heaped praised on Sen. Karl Rhoads, who introduced the bill last year that he said paved the way for the passage of the measure this year. Rhoads did not make a public statement on HB2739 Thursday.

“It has helped get us to a better place,” Kouchi said. 

Scott Foster, who has championed aid in dying for two decades with the Hawaii Death with Dignity Society, said he was “elated but not surprised” by the final vote.

Eva Andrade, head of the Hawaii Family Forum, said she and opponents of the bill are “very disappointed” that their concerns were not addressed.

“There are a lot of voices yet to be heard,” she said, adding that the group plans to continue working to educate people about the dangers they see in the legislation.

Some senators, including Gabbard, raised concerns about the bill requiring death certificates to say the individual’s primary cause of death was the underlying terminal disease, not the lethal dose of drugs.

“It’s ridiculous that we’re going to falsify the cause of death,” Riviere said.

Foster said that’s a “valid argument” but it came down to making sure there would not be any issues with insurance companies covering the life-ending drug and even prior treatments, which has been an issue in some states. He said it’s something the Legislature could revisit next session.

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