A 71-year-old man's alleged attempt to kill his terminally ill wife could reignite the discussion about physician-assisted suicide in the Islands, some say, while others argue the case points to the need for more family education and counseling about end-of-life issues.

Supporters of physician-assisted suicide say they hope the case of Robert Yagi moves lawmakers to again introduce a "death with dignity" bill, but they also concede the bill would face considerable opposition and might not get far given that 2010 is an election year.

Opponents of physician-assisted suicide and other onlookers say the Yagi case underscores a need for more community discussion on end-of-life issues. And they say it could fuel reforms to hospice care, including changes that would allow more of the terminally ill to qualify.

The case comes as the number of people being admitted annually to hospice care is growing, and as the state is grappling to come up with long-term plans to deal with an aging population.

Yagi, of Olomana, was charged Thursday with second-degree attempted murder after allegedly shooting his wife, Leatrice, also 71, as she lay in her hospital bed at Castle Medical Center. Police believe that he may have wanted to end his wife's life because she is suffering from a terminal illness. Police believe Yagi also wanted to end his own life.

Leatrice Yagi suffered minor injuries from the gunshot wound.

What's not known is whether Leatrice Yagi expressed a desire to die — or if Robert Yagi is mentally sound. But in the months before Leatrice Yagi went into Castle, neighbors say the two enjoyed spending time together, going places or working at home.

Robert Yagi is set to make his initial appearance in court Tuesday.

The Yagi family would not comment for this article.

LONGSTANDING ISSUE

Over the past 20 years, state lawmakers have considered the issue of physician-assisted suicide several times. The Legislature last held a hearing on a physician-assisted suicide bill two years ago. A hearing on a "death with dignity" bill also was held in 2005, but it didn't advance far.

Two states, Oregon and Washington, allow physician-assisted suicide, which lets doctors prescribe a lethal dose of medication to a terminally ill patient deemed competent. Oregon passed its law in 1997, and the Supreme Court upheld it in 2006. Washington's law went into effect this year.

Physician-assisted suicide is a religiously and ethically charged issue. The hearing on the Legislature's 2007 bill lasted more than four hours. The 2005 hearing went on for nine.

State House Majority Leader Blake Oshiro, D-33rd ('Aiea, Hälawa Valley, 'Aiea Heights), introduced the physician-assisted suicide bill in 2007 and in previous years, and said he would like the Legislature to again discuss "death with dignity."

He added that the case of the Yagis "brings the issue to the forefront" and highlights the anguish families of the terminally ill go through.

But Oshiro wasn't sure whether the case would be the "tipping point" that would get the bill passed.

"It is a tragic event and really unfortunately demonstrates the extreme measures that some people think they need to make (about) end-of-life decisions," Oshiro said, adding that the Legislature may not have "the will" to support a physician-assisted suicide bill in an election year.

Lawmakers who oppose a physician-assisted suicide measure didn't think the Yagi case alone will prompt another look at the issue in the upcoming session.

State Sen. Josh Green, vice chairman of the Senate Health Committee and also a physician, said there are strong opponents to the bill, including religious organizations, which came out in force against civil unions this year.

"I would be surprised if it was taken up," said Green, D-3rd (Kohala, Kona, Ka'u).

He added that the Yagi case could instead spur discussion on hospice and end-of-life issues, including on the requirements to be eligible for hospice. Currently, only those with a prognosis from a doctor that they have six months to live can receive hospice care.

Green said he would support a widening of those eligibility requirements to include other terminally ill patients, though he added that any plan to admit more people into hospices would require talk on how that care would be paid for.

Most patients pay for hospice through Medicaid, Medicare or their insurer.

DIFFERING VIEWS

Dennis Arakaki, a former legislator who serves as executive director of the Hawai'i Family Forum and the Hawai'i Catholic Conference, said the shooting at Castle should be seen as a case of a lone individual who apparently wasn't getting the help he needed.

He added that the case should spur discussion about end-of-life education and resources, not about physician-assisted suicide.

"When these things happen, it's usually a cry out of desperation," Arakaki said.

But Andi van der Voort, board member of the national Final Exit Network and a longtime local advocate of physician-assisted suicide, said Yagi may not have resorted to violence if his wife had the option of taking a prescribed lethal dose of medication.

"If you are terminally ill and you want to terminate your life, I think it's awful that someone has to shoot you," she said.

Van der Voort added that she isn't hopeful a physician-assisted suicide bill will be passed in Hawai'i anytime soon.

Court documents say Yagi shot his wife shortly after 6 p.m. Tuesday at Castle Medical Center. He used a shotgun round from a flare gun, police said.

Yagi has no criminal record in Hawai'i. He has been released on bail, which was set for $50,000.

Hospice care professionals say the Yagi case is a chance to raise awareness about end-of-life issues. They say those who are watching a family member die are under enormous stress, and are sometimes unsure of where to go for help or what assistance they're eligible for.

"Facilitated discussion is key," said Jeannette Koijane, executive director of Kokua Mau, a hospice and palliative care advocacy organization. That means families should come together and connect with a hospice provider to talk over what they should expect and what their options are, she said.