Legislature(2001 - 2002)

04/17/2001 03:02 PM HES

Audio Topic
* first hearing in first committee of referral
+ 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                                                               
     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                                                               
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                                                               
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                                                               
     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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