Legislature(2001 - 2002)
04/17/2001 03:02 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 197-HEALTH CARE SERVICES DIRECTIVES CHAIR DYSON announced that the first order of business would be HOUSE BILL NO. 197, "An Act relating to directives for personal health care services and for medical treatment." Number 0019 MELANIE LESH, Staff to Representative Bill Hudson, Alaska State Legislature, came forth on behalf of the sponsor of HB 197. She read to the committee a statement written by Representative Hudson: I was asked to support this legislation by people I respect and who have long proved worthy of representing good causes. This cause I find to be very civilized and humanitarian. You will hear testimony from several persons in agencies that wish to enable others to give a voice to others who can no longer offer their own through the preparation of a list of their wishes for their final days. This bill expands the options for people who want to prepare themselves for when they can no longer speak or act on their own behalf. These expanded directives do not interfere with the current statutes concerning living wills and "do not resuscitate" orders. They simply provide for a form to be circulated with which the patient[s] can determine what they will need in respect to their comforts - emotional, spiritual, and physical. This bill will enable agencies that assist terminally ill patients by providing a document contained in the bill that spells out choices for them to consider with their family and their loved ones. It is hope that this document will continue to gain attention, as it has in 37 other states, and broach a subject that is uncomfortable for most of us, but necessary for all of us. CHAIR DYSON asked what keeps people from doing this now. MS. LESH responded that she would rather somebody else spoke to that. She said there are limited allowances in statutes now that provide for living wills, but nothing sets forth a form providing choices and options. Number 0300 SIOUX PLUMMER, Juneau End of Life Task Force, came forth and stated that [HB 197] is easily a piece of legislation that can be supported by a variety of people in [Alaska]. She explained that this enables the legislature to aid Alaskans in having more clear and defined choices in how they want the end of their lives to be. She said 35 other states have laws that have a similar concept. This is based on the Five Wishes, a document of a few pages of statements that talks about what a person might want to think about and want the family or doctor to know when he or she is terminally ill. She stated that Five Wishes was created by an organization out of Florida called Aging With Dignity. The gentleman who formed the Five Wishes worked with Mother Theresa for several years. She added that the intent of HB 197 is good public policy. CHAIR DYSON asked why this needs to be in law. MS. PLUMMER responded that to her understanding this improves and expands existing state statutes so it is clearer as to what the choices are. This aids someone in thinking about these things and legally enables him or her to do it. CHAIR DYSON stated that the value of law is not to aid people in thinking. He asked who would go to jail if someone were to fill this out and it was not followed through. MS. PLUMMER answered that she does not know of any language in this law or the new proposed law that would say that if it weren't followed, somebody would go to [jail]. CHAIR DYSON asked why this should be put in law, then. MS. PLUMMER replied that she thinks the Department of Health & Social Services or the Department of Administration might have some suggestions that it merely be in regulation. CHAIR DYSON asked why the state needs to be involved in this. MS. PLUMMER remarked that she was hoping someone from Aging With Dignity could talk about what other states have done and why this was put it into law. She added that she wants to urge [the legislature] to understand and support the concept and the intent of [HB 197]. Number 0573 REPRESENTATIVE STEVENS stated that he thinks Chair Dyson is getting at a good point. He said he had just received from his mother a power of attorney and a living will and would like to know what [the proposed legislation] would do that the power of attorney and the living will do not do. MS. PLUMMER stated that she believes this language just expands on what already exists and gives a greater clarity to what a living will could include. REPRESENTATIVE STEVENS asked if there is a contradiction among the living will, the power of attorney, and this [proposed] form. He asked what legally would take precedence. Number 0671 JANE DEMMERT, Executive Director, Alaska Commission on Aging, Department of Administration, came forth and stated, in response to Representative Stevens' questions, that it might be helpful to take a look at some of the statements that begin on page 13 of the bill. She said: I'll just speak for myself as an individual. Acknowledging that I will die is a hard thing to come to grips with; it's even harder to think about how - to the extent that it could happen - I would like to be cared for and treated when I can no longer, through a discussion like this, tell people what I'm seeking. One of the steps that this takes is to - based on the experience of people in many different settings now - pose some statements here that would help me ... to anticipate the kinds of circumstances that I would experience. And then to, based on that, say, "And here's how I'd like you to support me as I'm going through these last stages of my life." CHAIR DYSON asked what would take precedence and if this has any legal standing. MS. DEMMERT explained that there is a reference on page 17 about how this would phase in. It states: ... a person who, by a statutory form power of attorney executed under AS 13.26.332 before the effective date of this Act, has been given powers to make health care decisions under and consistent with authority set out in the repealed provisions, may continue to exercise those powers under and consistent with the authority set out in the repealed provisions until the appointment made by the statutory form power of attorney with respect to health care services terminates or is revoked. MS. DEMMERT stated that she thinks this speaks to one of the considerations in terms of how this would articulate with current statutes. Number 0880 CHAIR DYSON remarked that there is no "or else." He asked if there is anything that binds the caregiver to obey it, besides helping people think this through. He asked what the penalty would be for disobedience. MS. DEMMERT responded that she does not know. She asked, "Philosophically, do you think there should be, if there's not?" CHAIR DYSON answered absolutely, if it is going to be put into law. MS. DEMMERT remarked that this is very interesting because it brings together a number of provisions as well as charts some new ground. She said she believes everyone is thinking about this in a more comprehensive fashion. Number 0981 REPRESENTATIVE CISSNA asked if this is a general power of attorney. She said that would mean the person who has been designated as having the power of attorney can do the things that are listed here; therefore, there would be some statutory strength. She also asked if there are additional things in [the proposed form] beyond a normal power of attorney MS. DEMMERT answered yes. REPRESENTATIVE CISSNA remarked that she personally thinks this is useful. She shared that her late husband had a power of attorney and a living will, and one of the horrendous things she went through was trying to figure out what he meant. She said she can see a real need for trying to make that very end decision a clear one. CHAIR DYSON stated that it certainly is a power of attorney and covers a lot of things. He said that he suspects [the committee] will pass the bill and let [the House Judiciary Standing Committee] wrestle with whether or not there should be a form in state law. MS. LESH commented that Representative Hudson has acknowledged that the directive could be maintained in the bill and that the form could be brought about through a regulatory direction through the legislature. She said Representative Hudson was willing to work with the national Dying with Dignity group because there is some legislation in other states that enables the state agency to create the form with the direction of the legislature. She added that Representative Hudson has also wrestled with the idea that the form's being in the statute may not be the best method. Number 1245 CHAIR DYSON stated that he appreciates that. He remarked that he is particularly interested in how the [medical] industry feels when somebody says, "I don't want pain killers," and yet the whole tradition has been to make the patient comfortable. He asked if [the industry] will be afraid of liabilities. MS. PLUMMER stated that the Juneau End of Life Task Force is a group of people that began talking with Representative Hudson about this legislation. She said she also serves on the Hospice Foundation Board for Juneau, which endorses HB 197. She read from a document from the Hospice Foundation Board: The meaning of HB 197 is really a gift to one's family members and friends so they won't have to guess what you want. The Hospice and Homecare of Juneau's board of directors urges approval of HB 197. CHAIR DYSON remarked that the two times he has been involved in cases like this, there weren't elderly people involved. He noted that nothing has been put in [the bill] that refers to children. MS. PLUMMER responded that those are the kinds of things that people often include in their durable powers of attorney or their wills. She said this is only addressing the very intimate end of life decisions a person makes. CHAIR DYSON stated that he is confused because page 2 [of the bill] lists a lot of important things such as banking transactions, real estate, claims, and litigation. MS. LESH responded that those provisions stay in statute just as they are. [House Bill 197] creates a new section that deals with health care directives. REPRESENTATIVE CISSNA stated that she is assuming the line here is between the [the person the] power of attorney that is in place while the person in question is alive and the executor of the will who is there after that transition. MS. PLUMMER responded that sometimes it is the same person [who is named in the durable power of attorney], but that is up to each individual. Number 1444 MOLLY EIDEM, Long Term Care Ombudsman, testified via teleconference on behalf of Suzan Armstrong. She read to the committee: The Office of the Long Term Care Ombudsman (OLTCO) supports HB 197, "An Act relating to directives for personal health care services and for medical treatment." Long Term Care Ombudsmen from around the country have been extolling the benefits of Five Wishes for some time now. Our clients, the elderly of Alaska, need clear tools, written in specific language, that [direct] our health care providers and others on how to administer to our clients' final needs. Too often, the OLTCO has attempted to help family and friends struggling to determine what their loved one would want and not want, and having little, if any, input from the elder. Sadly, acute conditions that inhibit worthwhile communication or chronic conditions such as dementia prevent our clients from expressing their wishes and desires during their final days and hours. The Five Wishes format would be a priceless gift to all of our Alaska families and would greatly enhance our capabilities to administer to our dying Alaskans' final wishes and to plan for our own. Number 1529 CHAIR DYSON called for an at-ease at 3:28 p.m. The meeting was called back to order at 3:40 p.m. [HB 197 was held over.]
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