It's never come this far before.
Now a measure that would legalize medical aid in dying heads to the governor.
The Senate passed the measure in a 23-2 vote Thursday.
Hawaii is close to becoming the seventh state to allow terminally ill adults with only six months to live the option to make their own end-of-life decisions.
Lawmakers have closely examined this issue a number of times over the past two decades.
Sen. Breene Harimoto was one of the votes against the measure and shared some emotional news. His cancer is back, this time in his lung.
"So after this session ends, I will hurry out to hopefully get my chemo treatment," he said. "For me, I just cannot vote for an environment of hopelessness and allow physicians to assist in causing death."
Sen. Mike Gabbard also voted against the measure. "Why are we insisting that government be involved in a deeply personal decision?" he asked.
Some senators voted yes despite its flaws.
"Of all the bills, this is the one bill we shouldn't pass with flaws. We should not race to pass," said Sen. Josh Green.
"It's interesting, because all of the comments show again, they are very concerned this bill is flawed and so just to pass it out, we believe is a danger to the community and it's not the route to go," said Eva Andrade of Hawaii Family Forum, who is against the measure.
Supporters say the reason why, after so many years, the "Our Care, Our Choice" bill has had momentum is because of all the safeguards.
"The time has come and I think it was clear we have the strongest bill in the nation," said Scott Foster of Hawaii Death with Dignity Society.
Some of those safeguards include:
Confirmation by two health care providers of the patient's diagnoses, prognosis, and medical competence;
Two verbal requests from the patient, separated by not less than 20 days, and one signed written request that is witnessed by two people, one of whom must be unrelated to the patient;
Counseling required for all qualified patients with a psychiatrist, psychologist or clinical social worker to determine that the patient is capable of making an informed decision and is not suffering from undertreatment or nontreatment of depression or other conditions that interfere with their ability make an end of life choice; and
The patient retains the right to rescind the request for life-ending medication.
"I think what's really important about that is counseling and the opportunity for the individual again to speak to someone so that we know that this is their authentic choice," said Rep. Della Au Belatti, one of the authors of the bill.
House Bill 2739 now goes in front of Gov. David Ige, who is in support of it.
If it does become law, it goes into effect Jan. 1.