Legislature(2017 - 2018)CAPITOL 106

04/06/2017 03:00 PM HEALTH & SOCIAL SERVICES

Note: the audio and video recordings are distinct records and are obtained from different sources. As such there may be key differences between the two. The audio recordings are captured by our records offices as the official record of the meeting and will have more accurate timestamps. Use the icons to switch between them.

Download Mp3. <- Right click and save file as
Download Video part 1. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to 4/8/17 at 3:00 PM --
*+ HB 10 CHILD IN NEED OF AID/PROTECTION; DUTIES TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+= HB 25 INSURANCE COVERAGE FOR CONTRACEPTIVES TELECONFERENCED
Scheduled but Not Heard
+= HB 54 TERMINALLY ILL: ENDING LIFE OPTION TELECONFERENCED
Heard & Held
-- Public Testimony --
+= SCR 2 SEXUAL ASSAULT AWARENESS MONTH:APRIL 2017 TELECONFERENCED
Moved SCR 2 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
            HB 54-TERMINALLY ILL: ENDING LIFE OPTION                                                                        
                                                                                                                                
4:08:20 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced that the  final order of business would                                                               
be SPONSOR  SUBSTITUTE FOR HOUSE  BILL NO. 54, "An  Act providing                                                               
an  end-of-life  option  for   terminally  ill  individuals;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
4:08:57 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  HARRIET   DRUMMOND,  Alaska   State  Legislature,                                                               
stated that  proposed HB 54  was "about patient's rights  and end                                                               
of life care.   It allows patients to have  important end of life                                                               
discussions  with their  own doctors,  doctors they  already know                                                               
and trust.  It allows a  patient to ease their pain and suffering                                                               
and  live and  die  on their  own terms  according  to their  own                                                               
beliefs."                                                                                                                       
                                                                                                                                
4:09:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN  asked how the proposed  bill would ensure                                                               
that patients  will not use  coverage for life  saving treatments                                                               
in  exchange for  the less  expensive option.   He  asked how  to                                                               
guarantee this would not occur.                                                                                                 
                                                                                                                                
4:10:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND  asked where  this had happened,  and she                                                               
directed  attention to  the section  of the  proposed bill  which                                                               
guarded against coercion.  She  said that these patients had been                                                               
dealing with their  illness for a long time,  and were surrounded                                                               
by  people who  cared about  them and  were not  going to  coerce                                                               
them.                                                                                                                           
                                                                                                                                
4:10:59 PM                                                                                                                    
                                                                                                                                
KRISTIN  KRANENDONK,  Staff,   Representative  Harriet  Drummond,                                                               
Alaska State Legislature, said that  there were provisions in the                                                               
bill prohibiting a person from  conditioning the sale of any type                                                               
of insurance.  She asked  for further clarification that this was                                                               
reflecting coercion by insurance  companies to push patients into                                                               
an end of  life act.  She noted that  Section 13.55.240 (page 12,                                                               
line 25)  of the  proposed bill had  language that  an insurance,                                                               
life, or health policy could not be conditioned.                                                                                
                                                                                                                                
4:12:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN suggested that  California and Oregon were                                                               
"going down  that road."  He  said there was a  human tendency to                                                               
prefer a less  expensive option to something that  could be life-                                                               
saving but more  expensive.  He asked about the  changes from the                                                               
original  version  of  the   proposed  bill,  specifically  about                                                               
documentation  and  paperwork.     He  asked  about  the  current                                                               
requirements for written documentation for verification.                                                                        
                                                                                                                                
4:12:45 PM                                                                                                                    
                                                                                                                                
MS.  KRANENDONK explained  that Alaska  currently has  palliative                                                               
care  and hospice  care providers  who work  with terminally  ill                                                               
individuals.   She said there  were several options  for terminal                                                               
patients.   The  section removed  from  the original  bill was  a                                                               
written  form required  to  be on  file.   She  relayed that,  as                                                               
Oregon  had found  this to  redundant,  it was  removed from  the                                                               
proposed bill.   She  noted that Alaska  had advance  health care                                                               
directives,  also known  as living  wills.   She  opined that  an                                                               
advance directive was more appropriate  for healthy patients, and                                                               
that  the state  already  provided a  complete  packet which  was                                                               
available  on  the  Division  of  Public  Health  website.    She                                                               
reported that  an individual had  the right to  give instructions                                                               
about their  own health  care to  the extent  as allowed  by law.                                                               
She  relayed  that Alaska  also  had  Medical Officers  for  Life                                                               
Sustaining  Treatment, which  offered  the  Comfort One  program,                                                               
also under the Division of Public  Health.  She clarified that it                                                               
was a set of medical orders  for the very seriously or terminally                                                               
ill, but  was not an advance  directive and not a  substitute for                                                               
naming a health care agent.   She added that Comfort One patients                                                               
could wear  an identifying  bracelet, which  included information                                                               
regarding  the   diagnosis,  treatment,  end  of   life  options,                                                               
hospice, and palliative  care.  She added  that state regulations                                                               
also  included  a Do  Not  Resuscitate  protocol, a  standardized                                                               
procedure.  She  stated that all patients who  qualified for this                                                               
proposed  legislation  would also  qualify  for  the Comfort  One                                                               
program.   She noted  that a  bill had been  passed in  1998 that                                                               
removed the  duty of a  peace officer  to respond to  an expected                                                               
home death.                                                                                                                     
                                                                                                                                
REPRESENTATIVE   EASTMAN   asked  about   written   documentation                                                               
available to verify that this was  supposed to occur, and was not                                                               
foul play.                                                                                                                      
                                                                                                                                
4:17:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DRUMMOND explained that  a terminal patient had to                                                               
personally  request the  medication  on  two separate  occasions,                                                               
more than 15  days apart, from their primary care  provider.  The                                                               
patient had  to be  determined to be  terminally ill,  and "would                                                               
most likely  be dead within  six months."   She added  that there                                                               
was appropriate paperwork to be filed  at that time, and that the                                                               
patient needed  to be declared  capable of making  this decision,                                                               
and being coerced.  If  the physician determined that the patient                                                               
was  in  a  psychological  state  which could  lead  to  a  wrong                                                               
decision,  the  patient  can  be referred  to  counseling.    She                                                               
reiterated that  there were  a number of  these safeguards.   She                                                               
declared,  if there  was  any actual  wrongdoing,  that would  be                                                               
tantamount  to murder.    She reminded  that  the medication  was                                                               
supposed to be self-administered by the patient.                                                                                
                                                                                                                                
MS. KRANENDONK pointed  out that AS 12.65.007  also required that                                                               
hospice have this  form on file, and she added  that more than 95                                                               
percent of the  patients were in hospice.  She  declared that any                                                               
suspicion  of foul  play  would  result in  a  call  to a  police                                                               
officer.  The proposed bill  only stated that the information was                                                               
not available to the public, but  a police officer was allowed to                                                               
review  the medical  records with  the required  documentation if                                                               
there was suspicion of foul play.                                                                                               
                                                                                                                                
4:20:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN  asked  what   the  minimum  standard  of                                                               
appropriate paperwork would be and how it could be verified.                                                                    
                                                                                                                                
MS. KRANENDONK replied  that all the patients  that qualified for                                                               
this option  were treated  by a physician  who had  their patient                                                               
files.   She  noted that  the files  for terminally  ill patients                                                               
included extensive  documentation of everything  since diagnosis.                                                               
She  offered her  belief  that  this was  not  usually the  first                                                               
option.   She explained  that the written  form had  been removed                                                               
from  the  proposed  bill  because the  physician  still  had  to                                                               
document that the patient had orally requested it.                                                                              
                                                                                                                                
4:21:59 PM                                                                                                                    
                                                                                                                                
CHAIR  SPOHNHOLZ  asked  if  other   states  required  a  written                                                               
documentation,  and why  the  sponsor had  opted  to not  include                                                               
this.                                                                                                                           
                                                                                                                                
MS. KRANENDONK explained that Oregon  had initially included this                                                               
requirement because  of concerns for coercion  or wrongful death,                                                               
but in  the 24 years  since its passage,  there had not  been any                                                               
cases needing the forms.  She  reported that, as more states were                                                               
doing  this  by  ballot  initiative, this  requirement  had  been                                                               
removed as it was determined to  be a redundant step.  She stated                                                               
that Washington  DC was the  only place which required  a coroner                                                               
notification,  as  most  states  had a  program  similar  to  the                                                               
aforementioned Medical Officers for Life Sustaining Treatment.                                                                  
                                                                                                                                
CHAIR  SPOHNHOLZ, reflecting  that 95  percent of  these patients                                                               
were under  the care of  hospice, asked how many  communities had                                                               
hospice available.                                                                                                              
                                                                                                                                
MS. KRANENDONK  clarified that this  was the  percentage reported                                                               
from  Oregon.   She stated  that the  Juneau hospice  facilitated                                                               
care for other SE Alaska communities.                                                                                           
                                                                                                                                
REPRESENTATIVE DRUMMOND  added that  they had not  researched the                                                               
availability of hospice  care throughout Alaska.   She noted that                                                               
a criticism  of the  proposed bill was  that palliative  care was                                                               
available.  She declared that,  if the proposed bill improved the                                                               
availability  and effectiveness  of palliative  care, then  there                                                               
would  be  progress.   She  explained  that  one reason  for  the                                                               
proposed bill was that currently people  had to move to Oregon to                                                               
be able  to take control  of their life.   She stated  that there                                                               
were options  that may need to  be worked into the  proposed bill                                                               
to allow  patients to  fully take  advantage of  the legislation,                                                               
should they feel that need.                                                                                                     
                                                                                                                                
CHAIR SPOHNHOLZ asked about those options.                                                                                      
                                                                                                                                
REPRESENTATIVE  DRUMMOND  noted  that,  as  many  communities  in                                                               
Alaska were inaccessible  by road and that  thousands of patients                                                               
were  not able  to travel  to see  doctors, an  option for  tele-                                                               
health  had been  discussed  to be  used in  lieu  of a  personal                                                               
appearance.                                                                                                                     
                                                                                                                                
4:27:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KITO  spoke of the  challenge for  getting medical                                                               
care  and the  potential cost  in  Alaska due  to the  geographic                                                               
disparity.  He  asked  if  the   proposed  legislation  would  be                                                               
insurance   eligible,  and,   if   not,  would   this  create   a                                                               
circumstance  where   only  having   enough  money   would  allow                                                               
participation in the program.                                                                                                   
                                                                                                                                
MS. KRANENDONK  said that the  current proposed bill  would allow                                                               
this as an  insurance option, although it was not  required as an                                                               
option.   She expressed  concern that the  program would  only be                                                               
available to people who could  afford to travel for medical care,                                                               
although this was  currently true for a lot of  health care.  She                                                               
declared  the  desire  to  make more  health  care  available  to                                                               
everyone in the state.                                                                                                          
                                                                                                                                
4:29:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  referenced  the  first  10  years  of  this                                                               
program in  Oregon, reporting  that there  were 541  requests for                                                               
the  medication,  with  341  uses.     He  suggested  that  in  a                                                               
comparison with  the Alaska population  over 10 years,  one might                                                               
expect about 100  requests and 60 uses.  He  pointed out that, as                                                               
people  could have  been moving  to Oregon  from other  places to                                                               
take advantage  of this  program, Alaska  could expect  even less                                                               
request.  He asked about the projected level of usage in Alaska.                                                                
                                                                                                                                
REPRESENTATIVE   DRUMMOND  expressed   her  agreement   with  the                                                               
figures, sharing  her research from Oregon,  which included about                                                               
750 requests  for the medication,  with about 340 usages  over 20                                                               
years.   She  stated that  she  had also  extrapolated for  small                                                               
numbers in  Alaska.  She pointed  out there was enormous  cost to                                                               
travel to Oregon for this  program, especially in the late stages                                                               
of a terminal disease.  She  declared that she wanted to make end                                                               
of life options easier for Alaskans, not harder.                                                                                
                                                                                                                                
MS.  KRANENDONK  said  that the  fiscal  note  reflected  similar                                                               
statistics,  as  it  anticipated  10  -  19  cases  annually  for                                                               
patients requesting the medication.   She pointed out that it was                                                               
necessary to establish  residency in Oregon to  take advantage of                                                               
the program.                                                                                                                    
                                                                                                                                
4:32:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EASTMAN asked about  the requirement for insurance                                                               
to provide  the service.  He  asked if this would  be optional or                                                               
included in every insurance plan.                                                                                               
                                                                                                                                
MS.  KRANENDONK  replied  that  polls  reflected  that  about  70                                                               
percent of Alaskans  would like this as an option.   She observed                                                               
that she  would personally be  more comfortable with  this option                                                               
in her insurance.                                                                                                               
                                                                                                                                
REPRESENTATIVE EASTMAN asked if an  insurance provider may or may                                                               
not offer,  and whether the  proposed bill  distinguished between                                                               
these options.                                                                                                                  
                                                                                                                                
4:35:00 PM                                                                                                                    
                                                                                                                                
MS. KRANENDONK offered to forward more insurance information.                                                                   
                                                                                                                                
4:35:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  stated that she did  not support                                                               
the  premise  of  the  bill.    She  expressed  her  concern  for                                                               
vulnerable   individuals,  for   those   not   close  to   health                                                               
facilities, and  for the  lack of a  requirement to  have written                                                               
approval for a  procedure.  She directed attention  to the fiscal                                                               
note  from  Legislative  Legal  Services  [Included  in  members'                                                               
packets] which read:                                                                                                            
                                                                                                                                
     The  legislation creates  a defense  to  murder in  the                                                                    
     first  degree,   murder  in  the  second   degree,  and                                                                    
     manslaughter  if  the  person   is  performing  an  act                                                                    
     permitted  by the  legislation. It  also establishes  a                                                                    
     new crime  of abuse  of life  termination process  if a                                                                    
     person  intends to  cause  another  person's death  and                                                                    
     falsely  makes,  completes,  or alters  a  request  for                                                                    
     medication or  destroys a rescission  of a  request for                                                                    
     medication. A person  may also be guilty  of this crime                                                                    
     if  they exert  undue  influence on  another person  to                                                                    
     request  medication  for  the purpose  of  ending  that                                                                    
     person's life.  Abuse of life termination  process is a                                                                    
     class A felony.                                                                                                            
                                                                                                                                
REPRESENTATIVE  DRUMMOND replied  that these  were safeguards  to                                                               
prevent abuse of  the process.  She declared that  the desire for                                                               
the proposed  bill was for the  patient to be fully  cognizant of                                                               
the  choice, of  the options,  and to  be able  to rescind  their                                                               
request at any point during the  process.  She offered her belief                                                               
that this was well covered in  the proposed bill, which was based                                                               
on the  experience from  other states.   She reiterated  that the                                                               
proposed bill had  been simplified because the  required form had                                                               
been  "just collecting  dust in  a file."   She  stated that  the                                                               
medical  community   would  figure  out  what   worked  for  each                                                               
individual practice.   She expressed her certainty  that it would                                                               
be resolved in a way to make  the most sense for both patient and                                                               
doctor records.                                                                                                                 
                                                                                                                                
MS. KRANENDONK said  that all the cases and  the medication would                                                               
be accounted for and tracked.                                                                                                   
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD said that  an oral argument would                                                               
not come into play in a legal proceeding.                                                                                       
                                                                                                                                
4:39:53 PM                                                                                                                    
                                                                                                                                
MS. KRANENDONK  replied that  the establishment  of qualification                                                               
was documented in the bill.                                                                                                     
                                                                                                                                
4:40:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO referred  to a  study for  the Oregon  Death                                                               
with Dignity  Act between  2004 and  2006, which  indicated that,                                                               
although  required   by  law  that  individuals   requesting  the                                                               
medication receive  counseling, 16  percent of  those individuals                                                               
suffered  from  clinical  depression  and were  not  referred  to                                                               
counseling.  He  asked if there were protections  in the proposed                                                               
law that  would ensure accountability  for not making  a referral                                                               
to counseling.                                                                                                                  
                                                                                                                                
MS. KRANENDONK  replied that,  although physicians  were required                                                               
to  refer  individuals for  psychiatric  care  if depression  was                                                               
diagnosed, there was no punishment written into the bill.                                                                       
                                                                                                                                
REPRESENTATIVE KITO expressed his concern  for a 16 percent error                                                               
rate, which could allow individuals,  with treatment, to continue                                                               
through their natural end of life.                                                                                              
                                                                                                                                
4:42:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  EASTMAN, in  reference  to a  move  to Oregon  to                                                               
participate in the  program, asked what was to  stop someone from                                                               
doctor shopping  in order to qualify  for the program.   He noted                                                               
that  the letter  of the  law allowed  broad qualification  of an                                                               
individual, and asked how to ensure that this would not happen.                                                                 
                                                                                                                                
4:44:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  DRUMMOND  pointed  out  that  the  proposed  bill                                                               
required that two  doctors, not in the same  practice, agree that                                                               
an individual was terminal within the prescribed amount of time.                                                                
                                                                                                                                
MS.  KRANENDONK added  that  diabetes would  not  qualify in  the                                                               
early stages.                                                                                                                   
                                                                                                                                
4:45:38 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ pointed to the  definition of terminal disease on                                                               
page 11, line 17, in the proposed bill, and read:                                                                               
                                                                                                                                
     means an  incurable and  irreversible disease  that has                                                                    
     been   medically  confirmed   and  that   will,  within                                                                    
     reasonable medical judgement,  produce death within six                                                                    
     months;                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ said that HB 54 would be held over.                                                                             
                                                                                                                                
4:46:50 PM                                                                                                                    
                                                                                                                                
KRISTEN HANSON,  Chair, Patients' Rights Action  Group, read from                                                               
a  prepared statement  by her  husband, James  Hansen.   He wrote                                                               
that he was  a marine war veteran,  a husband, and a  father.  He                                                               
did not want  to die, and, as he was  currently unable to travel,                                                               
he could  not make his  statement in person.   He shared  that he                                                               
was  suffering  from aggressive  brain  cancer.   He  shared  his                                                               
background prior  to his cancer.   He noted that he  had the same                                                               
brain cancer  as the  young woman  who had  moved to  Oregon from                                                               
California  in  order to  be  able  to take  her  own  life.   He                                                               
reported  that three  different doctors  had told  him there  was                                                               
nothing he could do about  his cancer, as surgery, radiation, and                                                               
chemo therapy rarely  worked.  He, instead, chose  to do standard                                                               
and experimental treatment.  He  expressed his thanks that he had                                                               
not accepted his initial prognosis,  even as the past three years                                                               
had not  been easy, with  a lot  of physical and  emotional pain,                                                               
countless  seizures, and  days with  the loss  of his  most basic                                                               
abilities, unable to talk, walk, read,  or write.  He shared that                                                               
he had  currently lived  two years and  eight months  longer than                                                               
his original prognosis.   If this legislation  had been available                                                               
at that  time, he could  have chosen  the medication, and  he did                                                               
consider  it.   He declared  that there  was no  going back  on a                                                               
decision to  end life.   He  stated that  he had  fought assisted                                                               
suicide  legislation for  the last  18  months.   He opined  that                                                               
legalized  suicide,  touted  as   death  with  dignity,  had  the                                                               
opposite effect.   He said that many  patients with circumstances                                                               
similar  to his  were offered  lethal  drugs and  were denied  or                                                               
delayed coverage  for the necessary  care.  He  acknowledged that                                                               
he had experienced  depression and had felt that he  was a burden                                                               
to his  family.  He  said it was a  very real danger  when people                                                               
could choose  death over care,  and that suicide became  a social                                                               
norm for people who were terminally  ill.  He said there had been                                                               
an  increase  of  general suicide  rates,  along  with  medically                                                               
assisted rates, in states which  had legalized suicide.  He added                                                               
that, as  he had  also suffered  post traumatic  stress disorder,                                                               
legalization of doctor prescribed  suicide sent the wrong message                                                               
to struggling veterans.  He  declared that mistakes would be made                                                               
and  lives would  be  tragically lost  if  assisted suicide  were                                                               
legalized.    He asked  if  one  person's perception  of  choice,                                                               
influenced by  hopelessness and fear  of being a burden,  put the                                                               
lives of those who want to survive at risk.                                                                                     
                                                                                                                                
4:53:52 PM                                                                                                                    
                                                                                                                                
WILLIAM  HARRINGTON stated  that  medication was  not defined  as                                                               
something  to kill,  but something  to heal.   He  stated that  a                                                               
different word  was necessary in  the proposed bill,  although he                                                               
did  support the  legislation.   He  pointed out  that  it was  a                                                               
sacrilege to  kill yourself.   He suggested  that this  should be                                                               
defined as self-termination, and not as suicide.                                                                                
                                                                                                                                
4:55:45 PM                                                                                                                    
                                                                                                                                
KARMELLE DEILLE  stated that she  was against the  proposed bill,                                                               
and opined  that the law  should always be  on the side  of life.                                                               
She  expressed her  agreement with  earlier  testimony, and  that                                                               
termination  of the  hindrances  would open  the floodgates,  and                                                               
would  keep people  from  respecting boundaries.    She shared  a                                                               
personal experience  with a  friend.  She  suggested that  it was                                                               
necessary to  look at  history instead  of emotion  when deciding                                                               
whether to  change laws.  She  declared that it was  not possible                                                               
to legalize  suicide if  we "felt accountable  to the  creator of                                                               
life."                                                                                                                          
                                                                                                                                
5:00:07 PM                                                                                                                    
                                                                                                                                
PAMELA  SAMASH,  President,  Right   to  Life,  stated  that  the                                                               
proposed  bill was  "a dangerous  bill."   She acknowledged  that                                                               
this was  a sensitive  subject.  She  declared that  the proposed                                                               
bill  was wrong  because "we  don't know  why some  circumstances                                                               
prolong death  but sometimes people  miraculously recover."   She                                                               
suggested to review the history  of euthanasia in other countries                                                               
and communities, which  began as a personal choice  but then slid                                                               
into death  as an  answer.   She asked  what message  the suicide                                                               
laws  would send.   She  stated  her opposition  to the  proposed                                                               
bill.                                                                                                                           
                                                                                                                                
5:02:24 PM                                                                                                                    
                                                                                                                                
JEANNE ANDERSON, MD, Katmai College,  paraphrased from a prepared                                                               
statement [Included in members' packets], which read in part:                                                                   
                                                                                                                                
     My  name  is  Jeanne  E  Anderson,  MD.  I  am  medical                                                                    
     oncologist in  private practice in Anchorage  at Katmai                                                                    
     Oncology  Group, LLC.  Specialists in  Medical Oncology                                                                    
     diagnosis patients with  cancer; counsel them regarding                                                                    
     prognosis  and  treatment  options;  prescribe  medical                                                                    
     (i.e.,   drug)  treatment;   and  provide   supportive,                                                                    
     palliative and end of life  care. I received my medical                                                                    
     degree from  Stanford University  in 1988.  I completed                                                                    
     internal  medicine  specialty  training  in  1991,  and                                                                    
     medical oncology  fellowship training in 1994,  both at                                                                    
     the University of Washington.                                                                                              
                                                                                                                                
     I am strongly against  HB54 for many reasons, including                                                                    
     1)  the   uncertainty  in  determining   an  individual                                                                    
     patient's  prognosis,  2)  improvements  in  palliative                                                                    
     care, and  3) hastening  death is not  the role  of the                                                                    
     physician or the medical system.                                                                                           
                                                                                                                                
     A critical feature of SSHB54  is that the patient has a                                                                    
     "terminal"  disease.  There  is no  definitive  way  to                                                                    
     determine  that a  patient has  less than  6 months  to                                                                    
     live.  Estimates of  survival  are  based on  published                                                                    
     data  and  a  physician's clinical  judgment.  Survival                                                                    
     data come  from studies performed years  earlier, often                                                                    
     using treatment  that is not  the most up to  date, and                                                                    
     is based on narrowly defined patient populations.                                                                          
                                                                                                                                
     Even  well informed  and well-meaning  oncologists make                                                                    
     drastic mistakes in their estimates of prognosis.                                                                          
                                                                                                                                
DR. ANDERSON  expressed her agreement with  the earlier testimony                                                               
in  opposition  of the  proposed  bill.   She  acknowledged  that                                                               
professionals often  made drastic mistakes in  prognosis, and she                                                               
shared three relative stories.                                                                                                  
                                                                                                                                
5:06:03 PM                                                                                                                    
                                                                                                                                
MARILYN   GOLDEN,  Senior   Policy  Analyst,   Disability  Rights                                                               
Education  and  Defense  Fund,   stated  her  opposition  to  the                                                               
proposed bill.   She said that, with  legalized assisted suicide,                                                               
some people's lives would be  ended without their consent through                                                               
mistakes and abuse, as no  safeguards could prevent this outcome.                                                               
She offered  her belief  that the health  care system  was broken                                                               
and  would, instead,  offer legalized  suicide  as "the  cheapest                                                               
treatment"   when  insurers   denied  or   delayed  approval   of                                                               
expensive, life sustaining treatment.   She stated that "assisted                                                               
suicide  was a  recipe  for elder  abuse."   She  said that  mis-                                                               
diagnosis  and  incorrect  prognosis could  analyze  prematurely.                                                               
She reported that  negligent personnel were not  liable for their                                                               
negligent actions.   She  said that  abuse was  not investigated,                                                               
and  she suggested  that the  Oregon  data failed  to show  abuse                                                               
because the system was set up not  to find it.  She declared that                                                               
suicide contagion was  also an issue, with an  increase in Oregon                                                               
after the passage of its assisted suicide legislation.                                                                          
                                                                                                                                
5:10:27 PM                                                                                                                    
                                                                                                                                
FRANK MCGILVARY  said that both he  and his wife were  opposed to                                                               
the proposed legislation, as life was really precious.                                                                          
                                                                                                                                
5:11:49 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ closed public testimony.                                                                                        
                                                                                                                                
[HB 54 was held over.]                                                                                                          

Document Name Date/Time Subjects
HB10 Ver D 1.30.17.PDF HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Sponsor Statement 1.30.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB10 Supporting Document - ICWA glossary and flowchart - NICWA 1.30.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB10 Supporting Document -CINA Flowchart - OCS Manual 1.30.17.PDF HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Sectional Analysis.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB025 Summary of Changes ver J 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Proposed Blank CS ver J 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-HB025 Support Emails 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Alaska Pharmacists Association 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter ANDVSA 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter APRN Alliance 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Tanana Chiefs Conference 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
SSHB 54 Supporting Document--Aderhold Letter of Support 4.5.2017.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54 Opposing Document--Dore Secondary Memo in opposition 4.5.2017.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54 Opposing Document--Anderson letter of opposition 4.5.2017.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54 Opposing Document--Dore First Memo in opposition 4.5.2017.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SCR 2 Version A.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR 2 Sponsor Statement A.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR 2 Support Materials Alaska Dispatch News 11.20.2016.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
Supplemental Crime in Alaska Report.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR 2 Support Materials Key Results from the 2015 Alaska Victimization Survey.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR 2 Support Materials CDVSA Annual Report 2015.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR 2 Support Materials ANDVSA 2016 Annual Report.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR2-LEG-SESS-02-27-17 FN.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR 2 Support Materials CDC National Intimate Partner and Sexual Violence Survey.pdf HHSS 4/6/2017 3:00:00 PM
SHSS 2/27/2017 1:30:00 PM
SCR 2
SCR 2 Fiscal Note LAA 3.9.17.pdf HHSS 4/6/2017 3:00:00 PM
HSTA 3/21/2017 5:30:00 PM
SCR 2
HB025 Sectional Analysis ver A 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Opposing Document-Letter NFIB 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Sponsor Statement 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-ADN Commentary 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Cost Savings Study 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Guttmacher Alaska Statistics 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Guttmacher Public Costs from Unintended Pregnancies 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-HB025 Support Emails 2.27.17.pdf HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Kachemak Bay Family Planning Clinic 2.23.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Unintended Pregnancies Study 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 ver A 2.16.17.PDF HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Planned Parenthood Votes Northwest & Hawaii 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DHSS-Medicaid Services 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DHSS-DHCS 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DCCED-DIO 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Opposing Document-America's Health Insurance Plans 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Dr. Tina Tomsen 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Support Emails 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-HB025 Support Emails 3.7.17.pdf HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Anne Green 3.3.17.pdf HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Alaska Nurses Association 3.6.17.pdf HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letters of Support 3.8.2017.pdf HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 25
HB025 Opposing Document-Letters of Opposition 3.8.2017.pdf HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
SSHB 54 Opposing Document--Letters 3.27.17.pdf HHSS 3/28/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54 Sectional Analysis ver O 3.27.17.pdf HHSS 3/28/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54 Sponsor Statement 3.27.17.pdf HHSS 3/28/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54 Supporting Document--Archbishop Tutu Opinion 3.27.17.pdf HHSS 3/28/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54 Supporting Document--Letters 3.27.17.pdf HHSS 3/28/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB 54.PDF HHSS 3/28/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HB 54
HB 10 Fiscal Note--DHSS-CSM 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Fiscal Note--DHSS-FCAR 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Fiscal Note--DHSS-CST 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Fiscal Note--DHSS-FCBR 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Fiscal Note--DHSS-FCSN 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Fiscal Note--DHSS-FLSW 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Fiscal Note--DHSS-FP 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
HB 10 Fiscal Note--JUD-ACS 4.5.17.pdf HHSS 4/6/2017 3:00:00 PM
HB 10
SSHB 54 Fiscal Note--DOL-CJL 4.5.2017.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB54 Supporing Document - Additional Letters.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB54 Supporting Document - Saturday Evening Post.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB54 Supporting Document - Skelton Op Ed.pdf HHSS 4/6/2017 3:00:00 PM
HB 54
SSHB54 Supporting Document Research 2007.pdf HHSS 4/6/2017 3:00:00 PM
HB 54