Legislature(2003 - 2004)

04/26/2004 08:06 AM Senate JUD

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
             HB  25-HEALTH CARE SERVICES DIRECTIVES                                                                         
                                                                                                                                
REPRESENTATIVE BRUCE  WEYHRAUCH, District  4, gave  the following                                                               
introduction of HB 25.                                                                                                          
                                                                                                                                
     HB  25 was  prefiled in  2002  and it  had roughly  six                                                                    
     hearings in  House Health and Social  Services and then                                                                    
     four hearings  in House Judiciary. And  then over here,                                                                    
     Chair Dyson  of the  Senate Health and  Social Services                                                                    
     Committee  held I  think, roughly,  eight hearings  and                                                                    
     it's gone  through substantial  revision in  the Senate                                                                    
     and I owe  a great deal of respect  and appreciation to                                                                    
     Senator Dyson for what that  committee did on this bill                                                                    
     in conjunction with our office.                                                                                            
                                                                                                                                
     This  bill is  a  significant piece  of legislation  in                                                                    
     that it  brings together programs that  deal with organ                                                                    
     donation,  the living  will program,  the comfort  one,                                                                    
     do-not resuscitate  provisions of statute,  the durable                                                                    
     powers of  attorney and advanced directives  for health                                                                    
     care decisions.  Death is a  critical part of  life and                                                                    
     we all  die. This  bill is intended  to provide  in one                                                                    
     place  the  information  available to  people  who  are                                                                    
     dying  and whose  families are  dying and  who want  to                                                                    
     plan for their deaths when that time comes.                                                                                
                                                                                                                                
     It's intended to help clarify  existing law and to help                                                                    
     bring  other  good  portions  of  laws  throughout  the                                                                    
     United  States into  one law  here in  Alaska and  it's                                                                    
     garnered a great deal of  attention from a multitude of                                                                    
     parties that are interested  in clarifying the statutes                                                                    
     on these  issues and allowing  the public who  needs to                                                                    
     deal  with  this  in   hospitals,  hospices  -  medical                                                                    
     providers, a  clear standard  to deal  with end-of-life                                                                    
     health care decisions.                                                                                                     
                                                                                                                                
     The bill gathered my interest  because of my father who                                                                    
     recently  passed away  and he  had a  durable power  of                                                                    
     attorney  and advanced  health care  directives but  he                                                                    
     didn't   advise  my   mother  of   it.  Therefore,   he                                                                    
     languished in a  state where he did not want  to be for                                                                    
     three years before he actually  passed away and when my                                                                    
     mother  was  advised of  the  situation  she was  upset                                                                    
     because  he was  living the  life that  he never  would                                                                    
     have  wanted. If  his advanced  health care  directives                                                                    
     had been simply acted upon,  he would have been treated                                                                    
     a lot differently  in terms of his  medical health care                                                                    
     decisions.                                                                                                                 
                                                                                                                                
     And so this  is something that all people  can use and,                                                                    
     Mr. Chairman, it is a  meaty bill. I want the committee                                                                    
     comfortable with  it as the other  committees have been                                                                    
     as they passed it out and  so what I was planning to do                                                                    
     was step  back and  let a lot  of other  people testify                                                                    
     who've had input on this.                                                                                                  
                                                                                                                                
SENATOR OGAN asked how a medical provider in Alaska would know                                                                  
if a visiting patient here had a do-not-resuscitate order in                                                                    
another state.                                                                                                                  
                                                                                                                                
REPRESENTATIVE WEYHRAUCH deferred to Dr. Wallington for an                                                                      
answer.                                                                                                                         
                                                                                                                                
SENATOR OGAN  said he also would  like an explanation of  the do-                                                               
not-resuscitate protocol on page 10 of the bill.                                                                                
                                                                                                                                
DR. MARIE WALLINGTON, medical ethicist  for the Providence health                                                               
system in  Alaska, told members  she has worked  extensively with                                                               
Representative Weyhrauch  and the  Senate HESS Committee  on this                                                               
legislation. She  told members  that regarding  a visitor  with a                                                               
do-not-resuscitate order  in another state, in  general, a person                                                               
with a do-not-resuscitate  order has some kind  of definition. If                                                               
the medical  staff can verify  that a  person has such  an order,                                                               
they are  relieved from providing  resuscitation. An  Alaskan who                                                               
does not  have a do-not-resuscitate  order identification  on him                                                               
will be resuscitated.                                                                                                           
                                                                                                                                
9:15 a.m.                                                                                                                       
                                                                                                                                
MR. PAUL  MALLEY, President of  Aging with Dignity,  a non-profit                                                               
organization in  Florida, gave the  following testimony.  He said                                                               
he  is familiar  with  what  is happening  with  the Five  Wishes                                                               
document  on  a national  level  and  how  it is  promoting  good                                                               
quality  care at  the  end  of life.  He  provided the  following                                                               
highlights of what is happening nationally.                                                                                     
                                                                                                                                
His  agency had  three goals  when it  developed the  Five Wishes                                                               
document. First,  it wanted to make  a document that was  easy to                                                               
understand and  use. Second,  it wanted  the document  to address                                                               
more than  medical issues because  when people are asked  what is                                                               
most important to  them at the end of life,  they most often want                                                               
to be at  home, with their family, without  pain, etcetera, along                                                               
with their preferences for life support treatment.                                                                              
                                                                                                                                
He  noted that  the popularity  of the  Five Wishes  document has                                                               
grown  rapidly, and  about 6,000  organizations are  distributing                                                               
it,  including   hospitals  and   employers.    However,   a  few                                                               
roadblocks remain on the national  level. In 15 states, including                                                               
Alaska,  mandatory forms  are  required and  those  forms do  not                                                               
provide  much "wiggle  room" for  people to  put their  wishes in                                                               
their  own  words,  which  can  deter  people  from  using  those                                                               
documents.  His understanding  of  HB  25 is  that  it makes  the                                                               
process much  more streamlined  and effective  by putting  all of                                                               
the requirements for durable powers  of attorney for health care,                                                               
living wills,  organ donation and  others under one  umbrella. It                                                               
also makes  it easier for Alaskans  to put their wishes  in their                                                               
own  words,  whether  in  a   Five  Wishes  document  or  another                                                               
document.                                                                                                                       
                                                                                                                                
SENATOR OGAN commented that had he  had a living will when he had                                                               
his full  cardiac arrest,  he probably would  not be  alive right                                                               
now because his prognosis was very  poor. He said although he had                                                               
a fantastic experience with Alaska's  medical community, he finds                                                               
physicians to be pessimistic in general.                                                                                        
                                                                                                                                
DR. WALLINGTON responded  that the fact that a  person has signed                                                               
an advanced directive does not mean  the person has agreed to not                                                               
be  resuscitated. The  physician must  be sure  of that  person's                                                               
medical situation  and if the  physician knows the  person cannot                                                               
be kept  alive, he might consider  writing a "Do-Not-Resuscitate"                                                               
order but  that would not  have been  the case when  Senator Ogan                                                               
had  his cardiac  arrest. She  said the  medical community  hopes                                                               
people will  spend a  lot of time  determining how  their advance                                                               
directives will read  so that they are telling  the medical staff                                                               
how to  decide. Had  Senator Ogan had  an advance  directive that                                                               
said he  wanted every effort to  be made to keep  him alive, that                                                               
would  have  given clear  direction  to  his medical  staff.  She                                                               
pointed  out  the old  form  was  terrible  in  that it  gave  no                                                               
direction in unclear situations.                                                                                                
                                                                                                                                
CHAIR SEEKINS noted  the committee had other  commitments at this                                                               
time and  stated his intent to  bring HB 25 before  the committee                                                               
on Thursday. He then adjourned the meeting.                                                                                     

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