Legislature(2001 - 2002)

04/19/2001 03:07 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 0086                                                                                                                     
                                                                                                                                
PAUL MALLEY,  Program Manager, Aging with  Dignity, testified via                                                               
teleconference.    He  stated  that [Aging  with  Dignity]  is  a                                                               
national  nonprofit  organization   with  offices  in  Washington                                                               
[D.C.] and Miami.  The  headquarters in Tallahassee, Florida, are                                                               
where  the   Five  Wishes   advanced  directive   is  distributed                                                               
throughout the  country.  He  explained that within two  weeks of                                                               
Five Wishes being introduced in  Florida in 1997, there were more                                                               
than 50,000 requests from people  all over the country who wanted                                                               
a  copy of  the  Five Wishes.   So  many  people were  interested                                                               
because it  is easy  to use  and it includes  many of  the issues                                                               
that matter  most to  people, including  some of  the non-medical                                                               
issues.                                                                                                                         
                                                                                                                                
MR.  MALLEY  stated  that  once   [Aging  with  Dignity]  started                                                               
receiving  requests,  it began  to  work  with the  American  Bar                                                               
Association to  make the document  completely valid.  It  added a                                                               
commission  dealing  with  legal  problems  of  the  elderly  and                                                               
expanded the law  of 50 states regarding  advanced care planning.                                                               
He stated  that when Five Wishes  was introduced in 1998,  it was                                                               
valid  in 33  states.   All  of  the 33  states  had a  suggested                                                               
advanced  directive  form,  but  the  residents  were  given  the                                                               
opportunity to put  their wishes in their own words.   Since then                                                               
it  has  become legally  valid  in  an  additional two  states  -                                                               
California and West Virginia.   Both of those states enacted laws                                                               
in the past  two years that made Five Wishes  valid, but they did                                                               
not include Five Wishes in the  state statutes.  He noted that in                                                               
some  cases it  was  a matter  of changing  one  word, from  "the                                                               
advanced  directive  must  be  in the  following  form"  to  "the                                                               
advanced directive may be in the following form."                                                                               
                                                                                                                                
MR. MALLEY said  [Aging with Dignity] is now  working with people                                                               
in several states who are trying  to change their [state] laws to                                                               
make Five  Wishes legally  valid.  [Aging  with Dignity]  is also                                                               
working with  more than one  million American families  and 3,000                                                               
organizations, all  of which have  copies of Five Wishes  and are                                                               
using  it.   The greatest  interest  is coming  from some  states                                                               
where Five Wishes  is not legally valid.  He  stated, in closing,                                                               
that he  would like to  congratulate and thank the  committee for                                                               
even  considering this  legislation, which  [Aging with  Dignity]                                                               
believes will greatly help the  people of Alaska put their wishes                                                               
in their own  words and therefore get the kind  of care they want                                                               
at the end of life.                                                                                                             
                                                                                                                                
Number 0376                                                                                                                     
                                                                                                                                
CHAIR  DYSON asked  what forces  a hospital  to comply  [with the                                                               
advanced directive].                                                                                                            
                                                                                                                                
MR. MALLEY  responded that [hospitals]  are bound by the  laws of                                                               
the state, which require that  the advanced directive be followed                                                               
if it meets  requirements in the state statute.   He said counsel                                                               
for  the Council  of the  American Bar  Association believe  that                                                               
Five Wishes would  stand up in court in all  50 states because of                                                               
the  so-called   Patient  Self-determination  Act,  which   is  a                                                               
national Act that  requires health care providers  to be involved                                                               
with individuals'  wishes.   He added  that [Aging  with Dignity]                                                               
has not  had one instance in  which an individual who  filled out                                                               
Five Wishes did not have his or her wishes honored.                                                                             
                                                                                                                                
CHAIR DYSON asked what the penalty  is if an institution does not                                                               
[honor the Five Wishes].                                                                                                        
                                                                                                                                
MR. MALLEY answered that he  believes that would probably vary by                                                               
state.                                                                                                                          
                                                                                                                                
CHAIR DYSON  asked whether  Mr. Malley knows  of any  states that                                                               
have  criminal  or civil  penalties  if  the directives  are  not                                                               
followed.                                                                                                                       
                                                                                                                                
MR.  MALLEY  responded that  he  knows  there have  been  several                                                               
instances in which criminal suits  have been filed against health                                                               
care providers who have not  followed an individual's wishes that                                                               
were spelled out in a legally valid advanced directive.                                                                         
                                                                                                                                
CHAIR  DYSON stated  that it  appears to  him that  this form  is                                                               
directed to elderly  people and not necessarily to  those who are                                                               
facing life-threatening diseases earlier in life.                                                                               
                                                                                                                                
MR.  MALLEY stated  that this  is good  for anyone  who is  18 or                                                               
older.   He remarked  that [Aging with  Dignity] is  working with                                                               
companies to institute  a program that would  provide Five Wishes                                                               
as an employee benefit.   He said [Aging with Dignity] encourages                                                               
people  to  fill out  Five  Wishes,  or any  advanced  directive,                                                               
before they get seriously ill.                                                                                                  
                                                                                                                                
CHAIR DYSON  stated that in the  first hearing of this  bill [the                                                               
committee] discussed whether  or not the form itself  ought to be                                                               
put in state law, as opposed to being referenced in law.                                                                        
                                                                                                                                
MR. MALLEY stated that he thinks  it would be better to reference                                                               
the  form rather  than including  the actual  document, word  for                                                               
word, in the state's statute.   He said there hasn't been a state                                                               
to do that yet.   He explained that if there  were any changes to                                                               
Five  Wishes, [Aging  with Dignity]  would have  to come  back to                                                               
[the legislature]  and ask for  another statute to be  passed for                                                               
the revisions.                                                                                                                  
                                                                                                                                
[HB  197  was  suspended  temporarily  in  order  to  hear  other                                                               
legislative business.]                                                                                                          
                                                                                                                                
HB 197-HEALTH CARE SERVICES DIRECTIVES                                                                                        
                                                                                                                              
[CHAIR  DYSON returned  the committee's  attention to  HOUSE BILL                                                               
NO. 197, "An Act relating  to directives for personal health care                                                               
services and for medical treatment."]                                                                                           
                                                                                                                                
MELANIE LESH,  Staff to Representative Bill  Hudson, Alaska State                                                               
Legislature,   stated that Representative Hudson,  sponsor, would                                                               
like to continue to work on amending HB 197.                                                                                    
                                                                                                                                
Number 0370                                                                                                                     
                                                                                                                                
MARIE  DARLIN,  AARP  (formerly   the  American  Association  for                                                               
Retired  People),  came  forth  and stated  that  AARP  has  been                                                               
interested in  the additional  help given to  families by  use of                                                               
the  Five  Wishes outline.    She  said  it definitely  helps  in                                                               
planning  for  health  care needs  with  more  complete  advanced                                                               
directives from the  elderly or disabled person.   She added that                                                               
she  would also  like to  direct [the  committee's] attention  to                                                               
recommendation 10 of  the January 1999 Long Term  Care Task Force                                                               
Report,  which speaks  to the  importance of  advanced directives                                                               
and the need for public education regarding their availability.                                                                 
                                                                                                                                
LORILYN SWANSON,  Manager, Fireweed Place, came  forth and stated                                                               
that she is also a member of the Commission on Aging.  She said:                                                                
                                                                                                                                
     I am here  today to express to you,  from the viewpoint                                                                    
     of  a  service  provider, the  importance  of  advanced                                                                    
     directives  and  how  HB  197   will  meet  and  assist                                                                    
     Alaskans in  encouraging people  to discuss  with their                                                                    
     families  and friends  their personal  wishes for  care                                                                    
     prior to  ... becoming  incapacitated.  I  have watched                                                                    
     many families find it necessary  to make decisions with                                                                    
     regard  to loved  ones and  their care  at a  time when                                                                    
     they are  not prepared to do  so, due to death,  due to                                                                    
     the  imminent  prospect  of the  loss,  guilt,  denial,                                                                    
     grief,  or   family  dissention.    Many   times  these                                                                    
     decisions  needed to  be  made  immediately or  quickly                                                                    
     without  knowing or  having even  spoken to  the person                                                                    
     concerned because no one wanted  to address the subject                                                                    
     or  talk about  [it].   It  was just  too difficult  to                                                                    
     discuss.   When  it [it]  almost too  late and  all the                                                                    
     forms [needed]  to be  found, it's  extremely difficult                                                                    
     to find the forms in one place.                                                                                            
                                                                                                                                
     No  one  form  or  collection of  forms  at  this  time                                                                    
     addresses  the directives  as well  as HB  197.   It is                                                                    
     written and encourages discussions  with families in an                                                                    
     open  and dignified  way, with  options  one might  not                                                                    
     think   of  on   one's  own.     It   offers  a   clear                                                                    
     reconciliation at  the close  of life of  one's wishes.                                                                    
     It  prompts  one  to  think of  options  and  gives  an                                                                    
     opportunity to express oneself.                                                                                            
                                                                                                                                
Number 0612                                                                                                                     
                                                                                                                                
EUGENE DAU,  Volunteer, AARP,  came forth  and stated  that every                                                               
time people talk about this, they  think about money.  He said he                                                               
thinks filling out the form will  get more people to do what they                                                               
should do,  instead of  holding back because  they think  it will                                                               
cost them $300.                                                                                                                 
                                                                                                                                
LINDA  FINK,  Assistant  Director,   Alaska  State  Hospital  and                                                               
Nursing Home Association  (ASHNA), came forth and  stated that in                                                               
concept  [ASHNA] supports  the legislation  but does  not support                                                               
how it is drafted.  She said  [ASHNA] would like to work with the                                                               
sponsor over  the interim in order  for the bill to  work for the                                                               
providers who have  to deal with the forms as  well as the people                                                               
who are filling the forms out.                                                                                                  
                                                                                                                                
[HB 197 was held over.]                                                                                                         
                                                                                                                                

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