Legislature(2003 - 2004)
05/16/2003 01:51 PM Senate HES
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* first hearing in first committee of referral
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HB 25-HEALTH CARE SERVICES DIRECTIVES
CHAIR DYSON announced CSHB 25(JUD) to be up for consideration.
MS. LINDA SYLVESTER, Staff to Representative Weyrauch, said that
this bill had previously passed the House unanimously as HB 197.
It deals with the end of life health care directives and was
inspired by a concept called the five wishes. The issue this
bill addresses is that the process of dying in American is
overly complicated. For example, identifying an individual for
power of attorney is in a completely different section than
other end of life issues like decisions of how you want to be
treated, cremated, die at home, etc. Organ donations are another
issue. This bill follows 37 states in taking end of life and
health care decision issues, as well as mental health care
directives, and repealing them from all of the statutes. It then
reimplements them in one section of the statute. HB 25 repeals
the organ donation statute, the living will, the do not
resuscitate orders, the power of attorney for health care and
Alaska's mental health directives.
The new concepts in the bill are entirely logical. She explained
that currently in Alaska if you are injured and incapacitated,
you're unable to make decisions yourself and you presented to a
hospital, they would turn to someone who is with you to act as
your surrogate. But, statutes don't support the hospitals in
that practice. It's further complicated if you're an older
person and have two adult children. The question is who has
precedence and what standard of care you will have when they
make decisions for you.
HB 25 sets out the hierarchy for surrogates who are not
nominated by executing a legal form; they have a standing in
statute - like a spouse, an adult child and on down the line to
a very close friend. The surrogate makes decisions for you
considering your values, intentions, beliefs and expressions you
have made about how you want to be treated. There are also
discussions about if there is disagreement in the group covering
issues like how much pain medication or where someone should
live after they are stabilized. HB 25 brings these issues to the
forefront so families can discuss them in advance and broadcast
them so there is no confusion.
She said that every interested group has reviewed the bill and
an incredible amount of work has gone into making sure that
nothing has been left out and they are not seeking to make major
changes, but are simply combining some sections and inserting a
new section on surrogates.
CHAIR DYSON said with today's blended families and serial
marriages he could see where certain family members would have
vested interest in who is making these decisions. He asked if
hospitals and other caregivers have been subject to lawsuits for
not having done end of life decisions the way inheritors might
have wanted.
MS. SYLVESTER replied that currently there is always the option
of judicial relief if there is a dispute. The primary concern is
if there is a dispute over someone, for instance, a mother who
is in a vegetative state and will not recover, they can die
naturally or linger "as little balls of pain." Medical
facilities are in the state of helplessness.
CHAIR DYSON said he understood that, but his question was if a
hospital had been sued after the fact.
MS. SYLVESTER asked if he meant if someone has made decision to
terminate life support and a family member disagreed with that.
CHAIR DYSON replied it could be one person whose inheritance
would change radically depending on who dies first. He suspected
there were cases like that and he wanted to know if this
legislation gave the hospital some clear guidelines and perhaps
some protection if they follow the procedure.
MS. SYLVESTER responded that there is an immunity section on
page 9, line 30.
MR. RON COWEN, Long Term Care Ombudsman, said they have been
involved in the evolution of this legislation and support the
current language. It is an important law and this makes it more
understandable to both consumers and providers. In recent
scoring of our state in the area of advance directives and
health care decisions, we didn't do very well and this is a good
step in the right direction.
CHAIR DYSON asked what happens if, for instance, an elderly
tourist off a boat collapses in the street and emergency
personnel transports them. He wanted to know what procedure a
hospital had to go through to find out if there are any existing
end-of-life or care provisions for that person.
MR. COWEN replied if someone came in completely alone, the
hospital would see if there was any documentation on their
person that speaks to their advanced directives, which is rarely
found. If someone is with them, the hospital is bound to
determine what authority, if any, that person has, in making
decisions on that person's behalf, especially if the patient is
unable to speak for himself. Short of that, hospitals typically
defer to attending physicians in terms of their estimation of
the likelihood or potential for that person to survive.
Sometimes a person is put on life sustaining measures until
advanced directives can be sought.
MS. SHELLEY OWENS, Community Health and Emergency Medical
Services, said she administers the Comfort One Do Not
Resuscitate Program for the state. The department supports HB
25, which consolidates existing provisions in law and expands
the content of the previous living will provisions. The Comfort
One program is the pre hospital program that provides for a
terminally ill person to have a do not resuscitate order that is
very simple and easily identified by pre hospital medical
personnel. She asked them to think of the pre hospital providers
as they consider sections in this bill. The Comfort One bill was
established in 1996 and their two goals are to honor the wishes
of a terminally ill patient not to be resuscitated when his
heart or breathing stops and to help develop a system where the
patients' wishes can be clearly and unambiguously communicated
to health care providers.
MS. OWENS explained when a person's heart stops, they are
clinically dead and the issue is do they attempt to resuscitate
him. Regarding their question about when a tourist arrives, the
EMT would look to see if there is an I.D. bracelet with
instructions and make sure it matches the patient.
CHAIR DYSON asked if the state was well equipped to deal with
organ donations.
MS. OWENS replied that she couldn't really answer that. Under
current law, a person is resuscitated until their organs are
harvested, if that's their primary wish.
MS. MARIE DARLIN, AARP, supported HB 25; it is one of the issues
they have been involved in for many years. In regards to
reciprocity among states, one of the big problems is educating
people who have all their information to carry it with them when
they travel. Another recommendation is that the hospital has a
copy of it.
MS. SIOUX PLUMMER DOUGLAS, Juneau Hospice Foundation, formerly
the Juneau End of Life Task Force, originally got this
legislation moving. This legislation has passed the House twice
and is a better bill than before. It's intended to be useful and
helpful and was originally based on the concept of the five
wishes: 1. The kind of person you want to make decisions for you
when you can't, 2. The kind of medical treatment you want or
don't want, 3. How comfortable you want to be, 4. How you want
people to treat you, and 5. What you want your loved ones to
know.
She is a passionate supporter of end of life planning, having
lost six of her closest family members in four years. There is
no question that people knowing what your wishes are will
improve your last moments. She pointed out that it isn't only a
senior issue, but an issue for Alaskans of all ages.
CHAIR DYSON thanked her for her work.
DR. MARIA WALLINGTON said she has been working with the group on
this bill and it handles so many problems that she has to deal
with daily at Providence Hospital. She asked if there was
anything in particular that they wanted her to address.
CHAIR DYSON said they are pretty well up to speed.
DR. WALLINGTON encouraged them to pass the legislation so
patients and hospitals don't have to wait another year.
SENATOR GUESS said she is also passionate about this issue, but
she thought there might be some inconsistencies in definitions
like adult child and adult brother or sister. She was interested
on page 5, line 25, and addressing domestic partners. Often
people decide not to go through the marriage process again, but
have partners for life and those aren't addressed. She didn't
see any definitions of an adult parent or adult sibling and she
thought that needed to be clarified.
MS. SYLVESTER said it would be fine to include the extra
definitions. Although the basic five wishes come from the
Uniform Health Care Decisions Act, there are variations. The
main consideration with a spouse is that they would have the
utmost priority and inheritance issues must be delineated.
TAPE 03-28, SIDE B
SENATOR GUESS suggested having a work session on this issue
during the interim to work on technical issues.
CHAIR DYSON said he would be delighted to do that.
MS. SYLVESTER noted that they also need to address women who are
pregnant and how this will impact them, because there are
circumstances where suddenly there is not one patient, but two.
CHAIR DYSON thanked everyone for the work they had done and held
CSHB 25(JUD) in committee.
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