On Thursday, Hawaii became the sixth state to legalize physician-assisted suicide. The bill, signed into law by Gov. David Ige, received overwheming support in the legislature.
California, Colorado, Oregon, Vermont and Washington state, plus the District of Columbia, all have laws on the books allowing terminally ill patients to ask doctors to end their lives. The laws passed either through ballot measures or legislative action. The option is also available in Montana, where the state's Supreme Court deemed it legal in 2009.
Hawaii's law comes at a time when "aid-in-dying" has recently suffered defeat elsewhere. The New York Supreme Court upheld a ban on the practice in September, and none of the 27 states where an aid-in-dying bill was introduced last year made it to the floor for a vote.
Despite that, public support for the policy remains high. According to a Gallup poll from June, 73 percent of Americans favor the right to die. And in three of the states where it's legal -- Colorado, Oregon and Washington -- it was voters at the ballot box who approved doctor-assisted suicide.
For advocates of aid-in-dying, Hawaii’s law is proof that recent setbacks don't signal the end of their progress.
"We are thrilled that Hawaii residents now have access to this compassionate end-of-life option. About 20 percent of Americans now have access to medical aid-in-dying, and Hawaii’s passage shows that momentum for these laws continues to build," Charmaine Manansala, national director of political advocacy for Compassion and Choices, wrote in an email.
The American Medical Association is opposed to physician-assisted suicide laws, but some of its state chapters are starting to shift their stance to "neutral" in places where it's legal. The Hawaii Medical Association said it would not oppose passage of the law.
Just two senators voted against the bill in Hawaii. One of them, state Sen. Mike Gabbard, raised concerns about the bill requiring death certificates to say the primary cause of death was the terminal disease -- not the lethal dose of drugs administered by a doctor.
Hawaii’s law, which will take effect next year, is similar to other states. If a patient has been given six months to live, they can request a life-ending medication after undergoing a mental health examination. Only a doctor can prescribe it.
But the state also added new safeguards to win over some lawmakers who were on the fence. They include requirements for written testimony from two witnesses who can attest to the patient’s wish to die and for the patient to take the medication on their own.
The last time the issue came up for a vote in Hawaii, in 2002, 14 state senators voted against the bill. Since then, several lawmakers shifted their stance, and only one person still in the legislature remains in opposition, according to the Honolulu Civil Beat.
“I think more and more people are coming to terms with it," state Sen. Donna Mercado Kim -- who voted against the policy in the past -- told the Civil Beat this week. "As the population ages, they’ve been caregiving for their parents and relatives, and just seeing all the technology to keep people alive, unlike before, and see people suffering."