03/28/1994 01:00 PM House JUD

  HB 356 LIVING WILLS AND MEDICAL CARE                                         
                                                                               
  REP. CYNTHIA TOOHEY explained HB 356 to be, "An Act relating                 
  to the living wills and `Do Not Resuscitate' orders; and                     
  providing for an effective date."  HB 356 compliments                        
  current statutes on the right of the terminally ill by                       
  adding specific recognition of "Do Not Resuscitate" (DNR)                    
  orders to the existing legislation on the rights of the                      
  terminally ill.  To make a declaration relating to the use                   
  of life sustaining procedures.  A new section allows                         
  attending physicians to issue DNR orders, requires the                       
  Department of Health and Social Services, with the approval                  
  of the State Medical Board, to issue regulations adopting a                  
  standardized protocol governing the withholding of CPR by                    
  physicians and other health care providers and establishes                   
  the requirements under which health care providers other                     
  than the physicians may comply with a DNR order.  Section                    
  18.12.037 requires the Department of Health and Social                       
  Services to develop the standardized design for DNR                          
  identification card, forms, necklaces and bracelets, to                      
  indicate that the possessor has executed a living will or                    
  that a DNR order has been issued by a physician.  Other                      
  provisions of the bill amend existing statutory provisions                   
  by including DNR's along with living wills in areas such as                  
  immunity for health care providers, acting under the                         
  provisions of the living will and DNR orders, and penalties,                 
  etc.  Do not resuscitate orders are issued only in the case                  
  of a terminally ill person.  Under existing practices,                       
  emergency response providers, (EMT's and paramedics) are                     
  required to institute CPR on site even if the sick person                    
  has a living will.  A properly executed DNR order and                        
  procedure protocol recognized by all concerned parties would                 
  help to avoid futile and unwanted interventions.  Similarly,                 
  within health care institutions, DNR orders are necessary in                 
  the absence of the living will, when attempts at                             
  resuscitation serve only to prolong the process of dying.                    
  She urged favorable consideration of this legislation."                      
                                                                               
  Number 557                                                                   
                                                                               
  REP. PHILLIPS asked Rep. Toohey if a person has to have a                    
  living will in order to get the DNR bracelet or necklace, or                 
  whatever, or can they could get one without having a living                  
  will.                                                                        
                                                                               
  Number 561                                                                   
                                                                               
  REP. TOOHEY said the only thing they must have in order to                   
  get one is the physician who originally signed the DNR.                      
                                                                               
  Number 566                                                                   
                                                                               
  REP. PHILLIPS said that on behalf of this bill, she had been                 
  requested by the senior centers in her district to put some                  
  legislation similar to this forward, and there has been                      
  support from her district for this legislation.                              
                                                                               
  Number 573                                                                   
                                                                               
  MR. JOHNSON said this DNR, as Rep. Toohey stated, does for                   
  people who are in the final stages of death, to put them                     
  through the agony and discomfort of resuscitation, this                      
  would allow them and their physician to agree, and it would                  
  allow us at the state level to have a standardized system                    
  and protocol across the state.  There are some good systems                  
  already in place in Anchorage and Juneau, and a few other                    
  places that he thinks work quite well, which will be used as                 
  models if this bill passes.  The main advantage is that it                   
  would be standardized across the state and the                               
  identifications and everything would be standardized, so                     
  everybody understands how the system works, and when the                     
  EMT's get there, they know what they are looking for.                        
  Sometimes, if it is a person who collapses on the street,                    
  the EMT's are not right now able to recognize the DNR                        
  patients, so this would help resolve some of those issues.                   
                                                                               
  Number 590                                                                   
                                                                               
  REP. PHILLIPS clarified that there has to be an actual                       
  physical piece of evidence that the EMT actually sees and                    
  reads in order to not do the resuscitation.                                  
                                                                               
  CHAIRMAN PORTER said you could also get a verbal order from                  
  a doctor in the hospital.                                                    
                                                                               
  Number 608                                                                   
                                                                               
  MR. JOHNSON said that sometimes they will have a person's                    
  home identified, or maybe a name at the nursing home, so the                 
  dispatch will already know the person has a DNR.  That works                 
  fairly well.                                                                 
                                                                               
  Number 613                                                                   
                                                                               
  REP. PHILLIPS made a motion to move HB 356 with individual                   
  recommendations and fiscal notes attached.                                   
                                                                               
  CHAIRMAN PORTER, hearing no objection, declared HB 356 moved                 
  from committee.