September, 2010: The tsunami of international media generated by the near-passage of Hawaii’s Death With Dignity (DwD) legislation in 2002 went largely unnoticed here in Hawai`i. We advocates were all too busy trying to get the bill through the legislature to give much thought to it. We enjoyed strong local media support and that was about all we could deal with, given our very limited resources.

Upon reflection, I believe that the reason for such broad international interest was because, at that time, only one American state had enacted a DwD law and it had only been in effect for 5 years; since Oct. 27, 1997. Oregon advocates (and in 2008 Washington State) achieved this using their states’ initiative process. A form of direct democracy, an initiative is a petition signed by a set minimum number of registered voters which forces a public vote on a proposed statute, constitutional amendment, charter amendment or ordinance. Hawai`i has no initiative process.

In Hawai`i, all proposed changes to state law must survive a minimum of one public hearing in both the State House and Senate (our bill has always been heard in their respective Judiciary and Health committees; four public hearings), survive a minimum of 3 floor votes in each body, and then not be vetoed by the governor in order to become law. A bill can be killed in any number of ways along this labor-intensive, circuitous, very controlled and often convoluted route.

In other words, passing a law via a state legislature is a doubly complicated matter when compared to the initiative process. In addition to conducting the requisite expensive public opinion campaign, sufficient monies must also be raised to fund the simultaneous legislative effort. Success with any political issue in Hawai`i is a very complicated and expensive proposition. Add a loud, opposing religious fervor to this political mix, and one will indeed have their work cut out for them. Our 2002 effort was highly visible, passionate — and loud! It also had a cast of world-class characters that Damon Runyon might have envied. No wonder it captured such international media attention.

In 2002, in Hawai`i, the planets had indeed aligned. We had a supportive Governor Ben Cayetano who introduced our bill, two stand-up-and-be-counted champions in the State House of Representatives, several more in the Senate, we had a seasoned group of on-the-ground-advocates, and we were able to quickly raise a modest-but-sufficient amount of money. And we had the great element of surprise.

Since 2002, the personal accolades have been humbling — “…the action in the House was historic as it was the first time any legislative body passed proactive death with dignity legislation…” — and it’s been particularly gratifying to be routinely contacted by interested scholars from around the world — from as far away as Japan and Texas — to discuss the DwD issue. I’ve heard from undergraduate college students, PhD candidates, research and media writers, and from grassroots advocates across the nation who want to learn more about Hawaii’s well-known Death With Dignity movement.

The following two documents indeed present excellent accounts of what took place in Hawai`i in 2002 and I thank their authors. Both did magnificent jobs of analyzing the volumes of materials that the issue indeed generated and I truly appreciate their scholarly perspectives. This also gives me the opportunity to present for the first time, my personal observations of what took place in 2002 — and the reason we lost (‘we was robbed!’). That can be read Here. — Scott Foster, HDWDS Communications Director


Auwe ua hala aku nei, O ka Lani iolani ka Moi
When the Vale of Death Appears: Death With Dignity in Hawaii
By Bill Kirtley
Central Texas College

NOTE: I retired after teaching high school for thirty years and followed my dream. In 1997, I earned a Doctor of Arts in Political Science at Idaho State University. Currently, I teach college level social science courses aboard deployed US Navy ships for Central Texas College and Columbia College.

My wife and I heard Scott Foster from the Hawai`i Death with Dignity Society speak at the Fifth Anniversary Forum on Oregon’s Death With Dignity Act in October 2002 in Portland, Oregon. In the spirit of Aloha he invited me to do research in Hawaii. The National Social Studies Association Journal published, Auwe ua hala aku nei, O ka Lani iolani ka Moi, When the Vale of Death Appears: Death With Dignity in Hawaii the following year.

I have followed developments in Hawaii since then. Dr. Lenora Lee pointed out in her well-written dissertation, A Good Death: The Politics of Physician Assisted Suicide in Hawaii, that there is an alternate spelling for the Hawaiian chant that I used in the title. I was even more amazed at how close Hawaii came to adopting Death With Dignity when I rewrote the paper for inclusion in my book. I noted that Governor Cayetano actually stood by, ready to sign the bill in the event that it passed the Hawaii Senate.

The editors of Athena Press of London indicate that my book, The Politics of Death: Oregon’s Death With Dignity Act will be available early in 2011. I look forward to many more visits to Hawaii talking story and observing the fight for Death With Dignity.

Sincerely, Dr. Bill Kirtley
September 8, 2010

I. Introduction

This paper’s title comes from a native Hawaiian chant composed at the death of King Kameamea (1834-1865).1 It celebrates the resolution of all conflicts and the King’s reunion with his extended family as he enters the valley of death. Traditional beliefs hold that ancient Hawaiians could choose the time of their death and simply will themselves to die. Their phrase for it was, “Na kanaka-oku’u wale aku no i kau uhane” (The people dismissed freely their souls and died). There is evidence that many Hawaiians died in this traditional way. Dr. Benjamin Young, a psychiatrist at the University of Hawaii, commented, “If a person could control his destiny at such a critical stage in life, that would be beautiful.” Continued Here



By Lenora H. Lee
August, 2009


This dissertation analyzes the politics of the conflict between the advocates of physician-assisted suicide in Hawaii and their opponents. The first part of this dissertation examines the role of society in deciding whether the individual’s decisions regarding end of life treatment should be governed by morals, ethics and beliefs maintained under the status quo or whether such decisions should also include the option of physician assisted suicide under strict conditions. This part of the study seeks to answer the questions, “What are the end-of-life options that define a “good death” and what are the arguments imbeded in the issue of physician assisted suicide?

The second part of this dissertation addresses the politics of winning the battle of physician assisted suicide legislation in Hawaii. The empirical focus is a small group of individuals joined together by their beliefs in choice and autonomy and who propose legislation to legalize PAS. They are opposed by a bigger and better financed group with ties to organized religion, to health care professionals and to groups whose members have disabilities. In 2002, except for three votes, the advocates almost win. Despite their continued attempts, the advocates have not repeated their “near win.” Challenged by the death of their leader, the lack of financial resources and a declining membership, the sustainability and viability of the advocates are in question. This dissertation concludes by proposing a strategy that may further their attempts to win. Download the 241-page pdf document Here