Death With Dignity: Is Hawaii the Fourth State?

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“It appears that for the last 100 years Hawaii was a prohibition-free state, but we didn’t know,” says Robert Orfali, author of the Kirkus-starred book Death with Dignity.

It is the eyes-wide-open look at how life ends that makes it required reading for anyone who plans to die in the United States— Foreword Five-Star Review

In early October, a conference titled "Is Physician-Assisted Dying Already Legal in Hawaii?” was held in Hawaii’s State Capitol. Kathryn Tucker of U.S. Supreme Court fame argued that it was already legal. A ten-person panel agreed. Tucker's arguments were based on a constellation of  laws—including one that was passed in 1909 to help people with leprosy die with dignity. She rediscovered that ancient law, and it now appears that Hawaii was the first state to pass a death with dignity act.  Panel member and author of Death with Dignity Robert Orfali says, “My wife Jeri was not aware of this law when she died from ovarian cancer in 2009: the prescription was not an option for her. Today, patients in Hawaii who are in Jeri's situation will be able to openly ask their doctors for a prescription.”

According to Orfali, “Based on the Oregon experience, just asking for the prescription will trigger a final palliative conversation between patients and their doctors. They will use the conversation to discuss death more openly. Doctors will try to deal with patients' fears and needs.  Patients will be referred to hospice much sooner.” Orfali believes that the prescription will raise the bar for the standards of pain management and palliative care. “Hopefully, Hawaii will follow in Oregon's footsteps and become a leader in palliative care. As in Oregon, the standards may improve to the point where very few patients choose to self-sedate. Having this extra option will have a huge impact, all good, on how palliative care is delivered in Hawaii.” 

What’s next? “I expect Compassion and Choices of Hawaii to work with our physicians on a set of Oregon-like safeguards.” says Orfali. “The idea is to make the safeguards part of the medical standard of care in Hawaii. Because assisted dying is legal, it won't be a clandestine practice any longer.  Physicians will be able to openly discuss the best practices. Over the last 14 years, the state of Oregon served as our nation's lab for developing these practices. Today, they can easily be cloned in any state where the prohibition is lifted.  Hawaii is a prohibition-free state.” 
Robert Orfali’s book Death with Dignity: The Case for Legalizing Physician-Assisted Dying and Euthanasia is an in-depth exploration of the shortcomings of our end-of-life system. The reader will learn about terminal "torture" in hospital ICUs and about the alternatives: hospice and palliative care. With laser-sharp focus, Orfali scrutinizes the good, the bad, and the ugly. He provides an insightful critique of the practice of palliative sedation. The book makes a strong case that assisted dying complements hospice. Oregon, by providing both, now has the best palliative-care system in America.

“Because Death with Dignity is comprehensive, objective, and well documented, it belongs on every public library shelf. Because it avoids hyperbole, it is essential reading for those on either side of the issue. Because it is honest and compassionate, it is a must read for anyone who wants to understand this challenging issue.... But it is the eyes-wide-open look at how life ends that makes it required reading for anyone who plans to die in the United States.”
— Foreword Clarion Five-Star Review (August, 2011)
Robert Orfali, the guru of client/server systems in the early days of Silicon Valley, co-authored three best-selling books that demystified the complexity of these mission-critical systems and made them understandable to a whole new generation of programmers. The books sold over a million copies. In this book, Robert uses his analytical skills to deconstruct the most complex system he has yet encountered: our modern end-of-life system. He wrote this book after helping his soulmate and coauthor, Jeri, navigate her death from ovarian cancer in 2009. The deep emotions Robert felt allowed him to look at how we die from a different perspective, another angle. Robert also wrote Grieving a Soulmate
Paperback: 254 pages
Publisher: Mill City Press, Inc. 
Publication date: April 15, 2011
ISBN-10: 1936780186
ISBN-13: 978-1936780181
Paperback list price: $14.95
E-book list price: only $ 0.99 “almost free.”

Book and e-book available from Amazon, Barnes and Noble, Apple Store, and others.
E-book formats include Kindle, iPad, iPhone, Nook, Android, and others.
Book website:

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