Legislature(1995 - 1996)
02/20/1996 03:04 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE February 20, 1996 3:04 p.m. MEMBERS PRESENT Representative Cynthia Toohey, Co-Chair Representative Con Bunde, Co-Chair Representative Gary Davis Representative Norman Rokeberg Representative Caren Robinson Representative Tom Brice MEMBERS ABSENT Representative Al Vezey COMMITTEE CALENDAR HOUSE BILL NO. 371 "An Act relating to the rights of terminally ill persons." - PASSED CSHB 371(HES) OUT OF COMMITTEE * HOUSE CONCURRENT RESOLUTION NO. 27 Relating to prevention of teenage pregnancy by implementation of the Sugar Baby project. - PASSED OUT OF COMMITTEE (* First public hearing) PREVIOUS ACTION BILL: HB 371 SHORT TITLE: RIGHTS OF TERMINALLY ILL PERSONS SPONSOR(S): REPRESENTATIVE(S) BROWN,TOOHEY,Finkelstein,Davies JRN-DATE JRN-PG ACTION 12/29/95 2363 (H) PREFILE RELEASED 01/08/96 2363 (H) READ THE FIRST TIME - REFERRAL(S) 01/08/96 2363 (H) HES, STATE AFFAIRS, JUDICIARY 02/06/96 (H) HES AT 3:00 PM CAPITOL 106 02/06/96 (H) MINUTE(HES) 02/13/96 (H) HES AT 3:00 PM CAPITOL 106 02/13/96 (H) MINUTE(HES) 02/20/96 (H) HES AT 3:00 PM CAPITOL 106 BILL: HCR 27 SHORT TITLE: TEEN PREGNANCY EDUCATION SPONSOR(S): REPRESENTATIVE(S) BUNDE JRN-DATE JRN-PG ACTION 02/12/96 2721 (H) READ THE FIRST TIME - REFERRAL(S) 02/12/96 2721 (H) HEALTH, EDUCATION AND SOCIAL SERVICES 02/20/96 (H) HES AT 3:00 PM CAPITOL 106 WITNESS REGISTER JOHN P. MONAGLE, President Alaskans for Life P.O. Box 210527 Auke Bay, Alaska 99821 Telephone: (907) 789-5910 POSITION STATEMENT: Testified in opposition to HB 371 DICK REGAN, Member Hemlock Society 825 Goldbelt Juneau, Alaska 99801 Telephone: (907) 586-6237 POSITION STATEMENT: Testified in support of HB 371 RITCHIE SONNER, Executive Director Hospice and Home Care 3200 Hospital Drive Juneau, Alaska 99801 Telephone: (907) 463-3113 POSITION STATEMENT: Testified in opposition to HB 371 SHIRLEEN RANNALS 1751 Westview Circle Anchorage, Alaska 99504 Telephone: (907) 333-9425 POSITION STATEMENT: Testified in opposition to HB 371 THERESE SYREN 7027 Lake Otis Parkway Anchorage, Alaska 99507 Telephone: (907) 349-5966 POSITION STATEMENT: Testified in opposition to HB 371 KENNETH HITCH, Representative Council 11558, Knights of Columbus 1706 Dimond Drive Anchorage, Alaska 99507 Telephone: (907) 563-6779 POSITION STATEMENT: Testified in opposition to HB 371 NANCY COLE 8231 Wilcox Anchorage, Alaska 99502 Telephone: (907) 248-0122 POSITION STATEMENT: Testified in support of HB 371 MARGUERITE McINTOSH, Family Doctor 35670 Spur Highway Soldotna, Alaska 99669 Telephone: (907) 262-6105 POSITION STATEMENT: Testified in opposition to HB 371 KAREN STROH, Representing Frontier Training Center P.O. Box 2110 Soldotna, Alaska 99669 Telephone: (907) 262-6331 POSITION STATEMENT: Testified in opposition to HB 371 AMY BOLLENBACH P.O. Box 3429 Homer, Alaska 99603 Telephone: (907) 235-6954 POSITION STATEMENT: Testified in support of HB 371 JULIE ABBOTT-JONES, Medical Social Worker Box 6286 Sitka, Alaska 99835 Telephone: Not Available POSITION STATEMENT: Testified on HB 371 JEANNE EVERHART P.O. Box 81269 Fairbanks, Alaska 99708 Telephone: (907) 479-2049 POSITION STATEMENT: Testified in opposition to HB 371 JIM EDE, Member Hemlock Society P.O. Box 870365 Wasilla, Alaska 99687 Telephone: (907) 376-4631 POSITION STATEMENT: Testified in support of HB 371 KIM BRYAN 817 West 6th Avenue, Number 207 Anchorage, Alaska 99501 Telephone: (907) 258-5199 POSITION STATEMENT: Testified in opposition to HB 371 PHIL REEMTSMA, Pastor Calvary Baptist Church 208 Lawton Drive Kenai, Alaska 99611 Telephone: (907) 283-4781 POSITION STATEMENT: Testified in opposition to HB 371 BOB BIRD, President Alaska Right to Life P.O. Box 3400, Suite 4 Anchorage, Alaska 99510 Telephone: (907) 776-5898 POSITION STATEMENT: Testified in opposition to HB 371 LYLE JONES P.O. Box 1946 Valdez, Alaska 99686 Telephone: (907) 835-4542 POSITION STATEMENT: Testified in opposition to HB 371 GLENN LITTLE P.O. Box 934 Valdez, Alaska 99686 Telephone: (907) 835-4898 POSITION STATEMENT: Testified in opposition to HB 371 PAUL BALL, Pastor Immanuel Baptist Church P.O. Box 1049 Kenai, Alaska 99611 Telephone: (907) 283-7873 POSITION STATEMENT: Testified in opposition to HB 371 GEORGE MARTIN P.O. Box 2920 Soldotna, Alaska 99669 Telephone: (907) 262-1381 POSITION STATEMENT: Testified in opposition to HB 371 LONI THIRLWELL P.O. Box 8182 Nikiski, Alaska 99635 Telephone: (907) 776-5716 POSITION STATEMENT: Testified on HB 371 KEITH CARNES, Pastor Church of the Nazarene P.O. Box 3351 Valdez, Alaska 99686 Telephone: (907) 835-2440 POSITION STATEMENT: Testified in opposition to HB 371 REPRESENTATIVE KAY BROWN Alaska State Legislature State Capitol, Room 517 Juneau, Alaska 99801-1182 Telephone: (907) 465-4998 POSITION STATEMENT: Sponsor of HB 371 ACTION NARRATIVE TAPE 96-13, SIDE A Number 001 The House Health, Education and Social Services Standing Committee was called to order by Co-Chair Toohey at 3:04 p.m. Members present at the call to order were Representatives Toohey, Bunde, Rokeberg and Robinson. Members absent were Representatives Davis, Brice and Vezey. A quorum was present to conduct business. HB 371 - RIGHTS OF TERMINALLY ILL PERSONS Number 138 JOHN P. MONAGLE, President, Alaskans for Life, testified in opposition to HB 371. He agreed with the woman who testified at the last meeting that the bill doesn't go far enough; maybe it should be a felony to die. He said that may sound ludicrous, but to him that's no more ludicrous than saying this is not assisted suicide legislation. Basically, people can commit suicide now, so why does the state need to become involved? It's tragic that the people who testified had to watch their loved ones die; we need to have concern for our fellow man. Certainly the way to handle that is for our loved ones to be with us to ease the pain of their dying. To bring the state into the position of overseeing and then placing the responsibility of the killing on caretakers and doctors is a cop-out. Number 346 DICK REGAN, Member, Hemlock Society, testified that as a longtime member of the Hemlock Society he has supported bills on the right to die issue which have been introduced in other state legislatures, but this bill is better drafted and better thought- out than any other that he has seen. Death lies ahead for all of us; even for little children. He has always thought we should be working on ways to make it as easy as possible for ourselves and each other. With present drugs and technology, the life span can be artificially extended, often causing lives to end with protracted painful dying, costly to the patient and to society. This legislation would permit a terminally ill person to shorten the period of suffering for himself or herself, which would be done by the patient; the physician would not do the killing, as Mr. Monagle suggested. The doctor, if his conscience permits him to do so, simply would prescribe a medication. Mr. Regan said for about the last year he has had an inoperable cancer; he may or may not wish to make use of the provisions of this bill if it's enacted. However, he feels that everyone should have the choice HB 371 affords. He said we, humankind, are in this life together and need to look out for each other. One way to do that is to work against laws and attitudes that condemn a person to needless suffering at the end of life. MR. REGAN read an excerpt from a letter sent to Representatives Toohey and Brown from Dr. Ken Moss of Juneau: "The question of whether this bill should be passed is a moral, an ethical and religious one, as well as legal. I have not yet discussed it with my clergyman, but will do so As far as my own moral principles are concerned, it comes down to two of the very strongest ones: one, that Christ taught that we should honor one commandment above all others, that is, to love one another; and the other is to do unto others as we would have them do unto us. Medical science has changed. Technology has increased to the point where life, death and dying have become prolonged and different than in previous times. The option to death with dignity, versus death without dignity and without relief, should be examined and offered." Number 590 RITCHIE SONNER, Executive Director, Hospice and Home Care of Juneau, testified she was representing the other hospices from around the state of Alaska. She commended Representative Brown and the co-sponsors for drawing attention to the needs of the terminally ill. She feels however, that it's the right problem, but the wrong solution. The hospice philosophy addresses death with dignity. There is a lot of pain, discomfort and suffering associated with some deaths and the hospice philosophy tries to address those needs, the needs of the family and the quality of life in the final days of the terminally ill. Unfortunately, the medical community is not altogether familiar with some of the hospice philosophies and they are not adequately educated about some of the alternatives to the suffering that happens with the terminally ill. She said she could share some very scary stories about people who have been in pain, people who have asked to die, but the pain was able to be reversed and hospice was able to provide a high quality of life in the final days, weeks or months of their lives. This legislation makes her a little nervous about a person who is in pain and requests death, but then the pain is able to be controlled. She added that if the patient was in that painful stage and requesting death, they may not know there is light at the end of the tunnel. In conclusion, she said the hospice community in Alaska rejects the practice of voluntary euthanasia and assisted suicide with the terminally ill and opposes HB 371. REPRESENTATIVE GARY DAVIS arrived at 3:14 p.m. Number 747 SHIRLEEN RANNALS testified from Anchorage via teleconference. She spoke of the attitude regarding the prevailing tendency to value life only if it brings pleasure and well-being. Suffering is viewed as an unbearable setback, something that a person must be freed from at all costs. That's because of a right (indisc.) life would be no longer meaningful because it is filled with pain. This is a distortion of what God meant for his people. She reminded committee members of the commandment "Thou Shalt Not Kill." She is strongly opposed to the passage of HB 371. Number 843 THERESE SYREN testified from Anchorage that she had two issues she wanted to address. The first issue was related to the argument that everyone should be allowed to make their own choice. She said Frederick Douglas made that same argument about slavery. He said the new territories coming into America should be allowed to choose for themselves whether to have slavery or not. She quoted Abraham Lincoln's answer that no one "has a right to choose one's wrong." Based on the Declaration of Independence, a suicide is greatly opposed to our human nature regardless of our particular religion. She commented that hospice played a big role in the final days of her brother's death, as opposed to her father who died ten years earlier without the help of hospice. Number 948 KENNETH HITCH, Representative, Council 11558, Knights of Columbus, testified from Anchorage in strong opposition to HB 371. He said the rights this bill purports to protect contradict every human's basic right to life. The right of life ensured to each of us by the constitution is being negated. Enshrining in law the alleged right to make one's own end of life decisions would provide the framework for the death of other than terminally ill persons, such as the mentally ill or physically handicapped. Rather, our efforts should be devoted to comfort and easing the pain of terminally ill persons so they have the opportunity to understand dying and make peace with the Creator. State government should not establish a new fundamental right equal to those in the U.S. Constitution - to have the right to commit a suicide. The precise role of the state is rather to protect the rights and dignity of those individuals unable to speak for themselves, as is often the case of the terminally ill. All human life must be valued, especially in its final and most vulnerable moments. The medical profession would be in a compromising position if required to obey the provisions of this legislation. Their ethical code requires them to do no harm to their patients. House Bill 371 would allow a bias in favor of death to pervade our society even more than it does now. The risks to already vulnerable members of our society would be extraordinary, especially considering the growing cost- consciousness prevalent in the health care industry. It was for these reasons the American Bar Association rejected euthanasia in 1992. He asked committee members not to put the state of Alaska in the forefront of anti-life legislation; the fate of so many otherwise innocent lives within their control. Number 1075 NANCY COLE testified via teleconference from Anchorage. She said her testimony was quite different than the previous speaker. Her daughter was that very moment at the bedside of her grandfather-in- law while he is dying of cancer. He is in pain and unable to care for himself; in fact, his daughter and son are caring for him as if he were a baby and has expressed his shame and embarrassment to all family members. Even though he has made his peace with God and is ready to die, he has to wait until his body stops functioning. She spoke of the pain for the family members waiting for the last breath; hoping on one hand it won't come, but on the other hand, hoping it will come so the pain will end. She commented she has worked for doctors, a pharmacy, and has been a real estate broker. Risk management is very important and without legal permission to prescribe medication to ease someone out of pain, doctors and pharmacists have no choice but to protect themselves, their businesses and their families from lawsuits. Malpractice insurance costs and terms prevent many doctors and pharmacists from doing what they feel would be the humane thing to do. Any law can be misused and this one is no different. But the ultimate good must be considered, not the ultimate bad fears. She concluded that if she could say goodbye to her family on her own terms, leave this earth and her body on her own terms, know that she has finished her own business and not caused extended pain to her loved ones as they watch her slowly become incapacitated and wait for the terrible sounds of her last breath, that would be her choice. Dignity is all that she asks for and permission legally, so those she trusts do not have to go to prison for helping her and don't suffer from watching her die with pain. She asked committee members to pass HB 371. MARGUERITE McINTOSH, family doctor, testified via teleconference that she is opposed to HB 371. She read comments from a letter written by Dr. Stephen Hileman, "This letter is to emphasize my personal and professional opposition to the proposals of HB 371. I believe that neither society nor any individual has the right to take human life at any point from its conception to its natural end. Life is a gift from God and it is not ours to bestow or withdraw. As a physician I took an oath to preserve life. I have sworn not to wilfully destroy it. How then can I participate in the execution of another human being. To refer that patient to another physician willing to accomplish that end would be no less an act of complicity on my part. I would relinquish my license to practice medicine rather than to be an accomplice of the state in the taking of human life. Events in our century have shown clearly how rapidly medical ethics can deteriorate in a society that countenance is killing. The Nazi era with its physician assisted and endorsed progression from sterilization of the imperfect to euthanasia for the suffering, to the comprehensive institution of programs to eliminate lives not worth living must serve to remind us that evil is a continuum, not a point on a curve, and that the best of intentions if based on a flawed premise lead to the most horrorific of consequences." She applauded the efforts of all the hospice workers in the state and around the world who have really started to educate doctors and other health care professionals on helping people to die with dignity and without pain. With the technology available today, no one should die a horrible, painful death. The medical profession has not done that well in the past, but can do better. It is up to the relatives of dying patients to take a proactive stance and request better pain control for their loved ones. Number 1367 KAREN STROH, Representative, Frontier Training Center, testified via teleconference. She said the Frontier Training Center provides a variety of services to disabled individuals in the community. She was asked to testify as a representative of the training center because they received several calls from consumers and family members of their consumers who are deeply distressed by this legislation and are adamantly opposed to HB 371. These individuals live daily with pain, with disabilities and with what many people would consider life without dignity. They wanted her to express to the committee that every moment of life has dignity and to allow a bill like this to pass in our state would be allowing murder and would be robbing people of dignity. Number 1436 AMY BOLLENBACH testified she has been a resident of Homer for three years and a resident of Alaska for 35 years. She thanked Representatives Brown and Toohey for introducing HB 371. She, herself, would like the right to request medication to shorten her life if she was terminally ill and in pain. She commented that most families have probably had an experience that prompts them to think about this issue. Her experience was with her father who at the age of 95 suffered a stroke. He was an intelligent man who was thinking and reading before the stroke and still was after the stroke. He was paralyzed on one side and in most cases, the staff of the nursing home couldn't understand him, but his three children could. Unfortunately, he wouldn't let her teach him how to use the buzzer to call the nurse because he had never been seriously ill in his life and hadn't suffered the indignities of hospitals, for the most part. The family would find him lying in feces sometimes when they went to visit because he couldn't call for help. He prayed constantly for Jesus to take him to Heaven. She had discussions with the social worker and the director of the institution about whether it was possible to give him medication that would help him die if he wanted it. They advised her it was not legal in the state and religious institutions wouldn't condone it. The family suffered watching him suffer. This was a man of dignity who at the age of 92 had spent 4 hours getting a trunk down from a closet so he could get his World War I uniform to march in the Desert Storm parade. She thought it was horrible for him to have to suffer and die not being able to control any of his functions. She concluded that her father may not have asked for medication if this bill had been a law, but she would and certainly others would. Number 1576 JULIE ABBOTT-JONES, Medical Social Worker, testified from Sitka via teleconference. She thanked the sponsors of this legislation for presenting it and opening the issue up for public discussion. She is looking forward to following it through the legislative process. Number 1616 JEANNE EVERHART testified from Fairbanks that she opposes this legislation. She said people enter this world through pain and have many painful life experiences. Pain is many times a part of death. Just a year ago, her father died of terminal cancer in a hospital, was given medication for the pain and died with dignity. She commented that pain, emotional and physical, should not be an excuse for any form of assisted suicide. Life should be encouraged, not death. She read an excerpt from a book entitled Two Old Women. She concluded that we as a society should not justify whose quality of life will benefit society and who should die. She questioned how long it will be before society is so desensitized to the sacredness of human life, like millions of aborted babies, the old or the disabled will be declared terminally ill and they will be submitted to some medical procedure prescribed by a doctor while society turns its head. She sees no dignity in taking one's own life. Number 1742 JIM EDE, Member, Hemlock Society, testified via teleconference that he is in favor of HB 371. He said most of the people who testified in support of the bill had basically expressed his views. He encouraged people to read the legislation before testifying. Number 1779 KIM BRYAN testified from Anchorage via teleconference. She wanted to comment on assisted suicide because she is concerned what the final outcome will be if this becomes law. She compared it to abortion and how when it was legalized, it was only under certain circumstances, but now it is widespread. She questioned how the human race could be improved if its weaker members are eliminated. She believes that society is persuading the elderly and handicapped that they are of no value. For the past five years she has been a volunteer at the Anchorage Pioneer Home where she has met some beautiful people who are terminally ill. She was very offended when she saw a sign in the elevator about assisted suicide, and wondered why the residents of the Pioneers' Home had to be subjected to something that could make them think they are a burden to society. Number 1870 PHIL REEMTSMA, Pastor, Calvary Baptist Church, testified via teleconference that he is strongly opposed to HB 371 and is speaking on behalf of a number of other individuals who weren't able to testify. He believes we do not have the right to make that decision. He commented that he has been with a number of people when they died, and it is not dignified to speed that death up. There is no dignity in taking life when we don't have the right to do so. He believes this is a door that shouldn't be opened. God is the author of life and He is the one who determines when life should cease. Number 1914 BOB BIRD, President, Alaska Right to Life; candidate for the U.S. Senate in 1990; and Government and History Teacher at Nikiski High School, testified via teleconference. He referenced a Time/Life Book which talked about all the things the Nazis did during World War II and to the film I Accuse which is the story of a physician whose wife persuades him to poison her. He referred to the Hippocratic oath taken by physicians that they will give no deadly medicine to anyone if asked, nor suggest any such counsel. As he was reviewing the bill, he thought about the physicians who refused to take part in an assisted suicide, but are required to make a referral. That creates a situation of forcing doctors to violate their oaths and their religious beliefs, not to mention over 2,000 years of jurisprudence which has decided that the pagan ethics of ancient times where a doctor had a dual function, which was to cure and to kill, was really not a good way for our culture and society to survive. Number 2051 LYLE JONES testified from Valdez that the original sin of man is what leads us to the point of even discussing a bill like HB 371. There has always been an innate desire in man to be equal with God and desire is one of the reasons that led to death being prescribed by God in the first place. Since God is the one that prescribed death, man has no business trying to play God and determine when and how a person should die. He believes with regard to dying with dignity, it is our society that decided that people suffering in certain ways have no dignity. He is a pastor who has sat with individuals who suffered terribly and had lost control of their body functions, yet died with great dignity because they had a faith in their Creator and knew what their end was going to be. One of his fears with this bill is that many will be sent into an eternity of much greater suffering than what they are experiencing on earth; that suffering will be eternal. Number 2114 GLENN LITTLE testified via teleconference from Valdez and stated from the day we are born, we all become terminally ill. Life is nothing but a process of dying. He is thankful for life. God gave him life and in God's time, He will take his life. For the legislature or anyone else to do otherwise is to place themselves in the position and exercising the authority of God. He emphasized we are One Nation Under God, not equal to God. Death with dignity is important, but dying demonstrates to our friends and family the final process of life. He commented that his father taught him to live life and as he died, his father taught him how to die, too. He doesn't believe this important process should be removed from life. It is the final process and a very important aspect of life. We were born not of our choice, and he doesn't feel we should have a choice about our death. Those choices belong to someone greater than us. He voiced his opposition to HB 371. Number 2184 PAUL BALL, Pastor, Immanuel Baptist Church, Kenai, testified his strong opposition to HB 371. He said he has always thought that you don't take something that cannot be restored with the same or better value than what it was. Look at where society has come from. Since we've started murdering the young, our society has deteriorated. Now we are at the other end where we want to take the lives of people who we feel have no quality of life. He questioned where it would stop. Number 2250 GEORGE MARTIN testified from Kenai in opposition to HB 371. He was speaking as a person who in a few years will be on the tail-end of his life span. He doesn't want to be in a position where his children, or he perceives that his children, are looking at him in such a way that implies he's a burden. He does not want to feel the pressures that he has a duty to take his life. He wants the freedom to say, "Let God's will be done." When his time is here, then it will be time. Number 2290 LONI THIRLWELL testified via teleconference that she has been a nurse in a hospital medical unit for 24 years and was going to play devil's advocate. She stated it was not her place to say if someone should live or die, but she doesn't believe in prosecuting someone who acts with an unselfish conscience. While she does not support this bill, she does support the decriminalization of those who act after long thought and prayer. She concluded there are worse things than death. Death is not a bad thing, but killing is. Number 2329 KEITH CARNES, Pastor, Church of the Nazarene in Valdez, testified in opposition to HB 371. He said the medical profession has the primary responsibility to heal and preserve life. To terminate life is simply to give us hope and he does not believe there is any dignity in ending one's life without any hope. Ending one's life, even with legal provision, is not and really cannot, add anything to the dying process. Medical science is continually searching for new treatments and cures for terminal illnesses. Perhaps the value of life should be emphasized; living life to its natural end with heads held high rather than losing hope. There are contributions to be made even by individuals who suffer from a terminal illness. Life is much more than a gift, it is a privilege; and a privilege for which we are accountable. TAPE 96-13, SIDE B Number 005 CO-CHAIR TOOHEY announced that would conclude the teleconference testimony. She asked the sponsor, Representative Kay Brown, to come forward. REPRESENTATIVE KAY BROWN, Sponsor of HB 371, expressed her appreciation for the committee's thoughtful consideration and patience in listening to Alaskans express their views on this difficult issue. She acknowledged there are many points of view and because there has been considerable testimony from the religious community, she wanted to share an additional point of view in the form of a resolution approved by the Episcopal Diocese of Newark. After a year long study by a task force, two-thirds of the delegates at the annual diocesan convention adopted a position supporting assisted suicide under some situations. She noted she would make the entire report available for the record, but wanted to bring this up just to point out that there are different points of view even within the religious community. Some of the points mentioned were: Christian theology demands respect for human life and recognizes that human life is sacred; modern science has created a situation where biological existence may be extended far beyond the point where reasonable quality of life exists; there are circumstances where involuntarily prolonged biological existence is a less ethical alternative than consciously chosen and mercifully termination of earthly life; in such exceptional cases, assisting a suffering person in accomplishing voluntary death can be morally justified as part of the healing process because it enables a person to die well. Representative Brown said she appreciated the different points of view and emphasized this legislation does allow people to act within their own moral convictions. She thinks much testimony heard against HB 371 is not part of the bill, but are fears about what the bill might lead to. She stated it is certainly not her intention to weaken the provisions of the bill. She views it as the choice of the individual consistent with our constitution. She urged the committee's action in moving the bill and added she had no objection to the amendment proposed by Representative Davis. REPRESENTATIVE GARY DAVIS said his amendment relates to the pharmacist who gets a prescription from a doctor who is prescribing a terminally effected medication. The amendment adds the provision that the prescription specify what it is for; that is to provide a strong enough medication for death. Representative Davis explained that line 5 of the amendment indicates "If a prescription for medication governed by this chapter is ordered telephonically, the person communicating the prescription shall orally include a notice that the prescription is being ordered at the request of a patient under this chapter." That language wasn't specifically ordered by him but he assumed it was included because existing statute allows for the availability of ordering a prescription telephonically. He didn't necessarily agree with that, but if there is a provision in existing statute, then it should probably be included. Number 176 REPRESENTATIVE DAVIS moved to pass Amendment 1. REPRESENTATIVE ROKEBERG objected for discussion purposes. He expressed concern with the concept of being able to order this type of medication over the telephone. He felt that a medication for poisonous material should be picked up in person. He suggested the language could be changed to read, "A prescription for medication governed by this chapter may not be ordered telephonically." CO-CHAIR TOOHEY commented she was offended by the word "poison" and added the medication would be a sleeping pill or a medication that would terminate life. REPRESENTATIVE DAVIS said he did not have a problem with Representative Rokeberg's suggestion other than he assumed it was used elsewhere in statute and perhaps even in the bill, so it may not be consistent. CO-CHAIR TOOHEY asked for clarification purposes if Representative Davis was withdrawing the language on line 5, "If a prescription for medication governed by this chapter...." REPRESENTATIVE DAVIS said he didn't specifically have the language for Representative Rokeberg's amendment to the amendment. REPRESENTATIVE ROKEBERG asked Representative Brown to comment. Number 277 CO-CHAIR BUNDE pointed out this is 1996 and prescriptions are delivered by facsimile machines which is probably the reason for the telephonic reference. He didn't think it was referring to the use of a telephone to order a life terminating medication. He added that all medications are potentially fatal; if a doctor transmits a prescription to a pharmacy via facsimile, people are depending on the pharmacist to prescribe the right medication and the proper dosage. Given that consideration, he didn't know if their concerns about the telephonic issue were merited. Number 339 REPRESENTATIVE BROWN suggested inserting "be in writing and must" on line 3 following the word "must" and deleting the entire last sentence of the amendment. She believed that would still allow for the facsimile transmission of a written prescription, but it would address the issue of having the prescription in writing and allow for communication from the Bush areas, for example. REPRESENTATIVE ROKEBERG stated that really was his point. He was of the belief that something of this nature should be a written order and eliminate the potential for any misunderstanding between the doctor and the pharmacist. CO-CHAIR TOOHEY verified that line 3 of the amendment would read "A prescription must be in writing for medication under this chapter and must include a notation on the prescription that it is issued at the request of the patient under this chapter." The entire last sentence would be deleted. Number 382 CO-CHAIR BUNDE pointed out deletion of the last sentence eliminates modern technology as it relates to transmission of information. Number 395 REPRESENTATIVE BROWN believed that the requirement for it to be in writing would not preclude facsimile transmissions. She suggested inserting "be in writing and must" after the word must on line 3 of the amendment. The amendment would then read, "(i) A prescription written for medication under this chapter must be in writing and must include a notation on the prescription that it is issued at the request of the patient under this chapter." REPRESENTATIVE ROKEBERG concurred with that language and withdrew his objection. Number 415 CO-CHAIR BUNDE voiced his objection for discussion purposes. REPRESENTATIVE DAVIS commented he had no objection to the amendment to the amendment. CO-CHAIR BUNDE said procedurally he did not object to the amendment to the amendment, but wanted to discuss it. He shared the concerns about the pharmacist, but wondered about the invasion of privacy of the individual who had AIDS for example, and the prescription stated that the medication was for someone with AIDS. If the pharmacist has any strong feelings about AIDS, he may choose to fill or not to fill the prescription. He believes that pharmacists should have a choice in the matter, but if they saw a legal dose of medication being prescribed, they'd probably have a pretty good idea of what was going on and since this legislation is being discussed as "death with dignity", should it be the topic of conversation at the local grocery store. CO-CHAIR TOOHEY understood his concern, but she didn't believe the connotation of AIDS as the reason for the request for medication had any relevance to this legislation. She explained this specific amendment just gives the pharmacist the choice to fill the prescription or not to fill it. The prescription doesn't need to say why it is being done, except it is being done under this chapter. CO-CHAIR BUNDE interjected that certainly says why it is being done; it's an assisted suicide. His concern is that it may be an invasion of privacy for the individual for whom the medication is being prescribed and doesn't want their illness advertised to the world. Pharmacists undoubtedly have a professional knowledge of the various medications and their general use so it doesn't have to be spelled out specifically. REPRESENTATIVE BROWN understood that state law does not require pharmacists to fill a prescription. She thought the amendment is consistent with the philosophy in the bill; that is people should not have to participate and she hoped the privacy of the individuals involved would be respected. CO-CHAIR BUNDE said he shared that feeling and didn't want anyone participating in any way if they chose not to if this bill becomes law. On the other hand, what are the rights of an individual who does choose to participate, as opposed to the rights of the pharmacist. CO-CHAIR TOOHEY noted the pharmaceutical industry should be invited to testify at the next hearing. REPRESENTATIVE DAVIS said this amendment, like this bill, addresses something that requires statute. Prescribing medicine to assist an illness does not need legislation. He, too, didn't want a prescription to indicate exactly what the medication was for. However, this case deals with something that requires legislation. CO-CHAIR TOOHEY said there is a motion on the table to move Amendment 1, with a friendly amendment. She asked the wishes of the committee. CO-CHAIR BUNDE maintained his objection and asked for a roll call vote. Voting in favor of the motion were Representatives Davis, Rokeberg, Brice, Robinson and Toohey. Representative Bunde voted against the motion. Number 658 REPRESENTATIVE ROBINSON asked Representative Brown to briefly summarize the safeguards in the bill and to discuss how she foresees the process on page 5, lines 14-23, being carried out. She noted the concerns of the Hospice Association and said she wanted to ensure that all attempts were made to include the appropriate people were informed and had the opportunity to speak with the individual. REPRESENTATIVE BROWN advised the committee that the safeguards were summarized in writing on the back of the sponsor statement. The option provided by the legislation would apply only to people who are terminally ill in the opinion of a physician. She added a definition of terminal condition already exists in AS 18.12.111; it's a progressive, incurable or irreversible condition that without the administration of life sustaining procedures will in the opinion of two physicians, when available, who have personally examined the patient, one of whom must be the attending physician, result in death in a relatively short time. She explained the patient must knowingly make a written request for life-ending medication. A second consulting physician must then confirm both the diagnosis and the patient's mental competence. The language referenced on page 5, subsection (e), spells out in detail what the attending physician shall inform the requester of: the diagnosis, the prognosis, the potential risks, probable results, and of irreversible consequences of taking the medication, and feasible alternatives including but not limited to comfort care, hospice care and pain control. She pointed out certainly it is the intent that the patient would have full knowledge and information available to him/her at the time, by discussing this as a private matter between that person and their doctor. After the second consulting physician has confirmed it, then the written request has to be witnessed by individuals who have nothing to gain from the patient's death and are not connected with the health care providers. A second request has to be made, at least 10 days subsequent to the first one. The administration of the medication is solely in the hands of the patient and that patient could change his/her mind at any time. She added that physicians in hospitals have the absolute and unquestioned right to decline involvement; however, they must refer the patient to physicians in institutions who are willing to proceed. Number 824 REPRESENTATIVE ROBINSON asked if Representative Brown had done any further thinking regarding the physicians who may not be willing. She asked if there would be a list of doctors who might be willing to assist in this. Also, what would happen if there were no willing doctors in the state. REPRESENTATIVE BROWN replied that based on conversations she's had with different people, there will be doctors willing to proceed and the medical community itself will work out a method for implementing the referral process. She referenced previous testimony regarding a survey which indicated that more than 70 percent of the doctors favored the option like the one presented in this legislation. She acknowledged that a significant amount of opinion exists on both sides and there are probably many doctors who will not wish to participate, but she believes there will be a number of doctors and institutions that are willing to assist people in the manner anticipated HB 371. CO-CHAIR BUNDE said a doctor who doesn't want to participate but refers the patient to another doctor, makes the referring doctor an unwilling participate. He asked Representative Brown if she envisioned the Hemlock Society or some other organization maintaining a list of doctors who are willing participants in order to eliminate even the referral participation for the unwilling doctor. REPRESENTATIVE BROWN responded that was a consideration. She hadn't thought of having an outside group maintaining a list, but was willing to entertain that possibility. She thought the removal of the required referral would lessen the concerns of the people opposed to the legislation. CO-CHAIR BUNDE encouraged further work in that area. CO-CHAIR TOOHEY advised that HB 371 has further referrals to the State Affairs and Judiciary Committees which should allow sufficient time for these issues to be addressed. REPRESENTATIVE ROKEBERG said he was of the understanding that no other state in the Union had a similar statutory provision right now. REPRESENTATIVE BROWN interjected the state of Oregon did have a law adopted by initiative that is now under appeal in the courts. It's not exactly like HB 371, but has some similarities. REPRESENTATIVE ROKEBERG asked if Representative Brown had considered the impact of any migration of people coming to Alaska to have access to this law if it were to pass. REPRESENTATIVE BROWN responded she had not given that any consideration. Number 1006 CO-CHAIR BUNDE made a motion to pass CSHB 371(HES) out of committee with individual recommendations. REPRESENTATIVES ROKEBERG AND DAVIS objected. Number 1027 REPRESENTATIVE DAVIS said there had been some extremely valuable testimony and discussion raised regarding HB 371, and if the bill passes out of the HESS Committee, he was sure there would be additional beneficial testimony and discussion. Based on the testimony he had heard, he could not support it. He thought some of they key testimony was that of Dr. Wilson relating to the physical state of the terminally ill and the effects of the medication they take. He pointed out that people in this physical state, especially to the degree where they may request the medication to end their life, have probably been on medication for some period of time. This raised a question in his mind regarding the requirement for an individual to be mentally competent. He addressed the issue of the future of medicine as it relates to pain medication and commented we need to have faith in the medical profession, the research field, that more emphasis will be placed on how to treat terminally ill patients so they can be free of pain. A personal note for him is the definition of dignity. It's been said this legislation is death with dignity, but dignity has a different meaning to different people. He asked who are we to say this is dignified, as opposed to anyone else saying this is dignified. He felt those were key areas of testimony that were presented. He reiterated that based on those testimonies and his interpretation and understanding of the testimony, he could not support this legislation. REPRESENTATIVE ROBINSON addressed Representative Davis' comment relating to the mental competency of an individual who has been on medication for a long time and said she thought he should rethink that issue. She is of the opinion there are a lot of terminally ill people who have been on medication for a very long time and are, without a doubt, extremely competent to make their own decisions. She noted that is a difficult issue, but she will get another opportunity to look at the bill in the next committee of referral. She believes it is important that members of all committees of referral get an opportunity to address the issues. Based on that perspective, she thought the bill should move on to the next committee. REPRESENTATIVE ROKEBERG said he was particularly struck with the testimony of the Alaska Nurses' Association, as well as the testimony regarding the high potential for abuse with this type of legislation, particularly as it relates to the more vulnerable population; the elderly, disabled and the poor. He feels it may create another alternative for the elderly, especially if an individual is depressed. Without even speaking to the ethical, moral or religious grounds, which he accepts as problems with the bill, he will be voting against HB 371. He complimented the sponsors for attempting to craft a workable piece of legislation. Number 1367 CO-CHAIR TOOHEY thanked Representative Brown for allowing her to be a co-sponsor of this bill. She asked for a roll call vote on the motion before the committee. Voting in favor of the motion to pass CSHB 371(HES) out of committee were Representatives Brice, Robinson, Toohey and Bunde. Voting against the motion were Representative Davis and Rokeberg. CO-CHAIR TOOHEY announced CSHB 371(HES) moved out of the HESS Committee with zero fiscal notes. HCR 27 - TEEN PREGNANCY EDUCATION Number 1478 CO-CHAIR TOOHEY passed the gavel to Co-Chair Bunde for HCR 27. CO-CHAIR BUNDE said this committee was probably more aware than any other committee in the legislature of the problems facing Alaska stemming from teen pregnancies. Alaska has an incredibly high teen pregnancy rate, higher than some Third World countries, and it is an ongoing challenge to deal with the problems created by teen pregnancy. Pregnant teens are more likely to have children who then become pregnant teens and pregnant teens are more apt to be on welfare and have economically depressed circumstances. One thing that has worked quite well in encouraging young people to understand just what a major experience it is to have a child is a project at Mears Junior High in Anchorage called "Sugar Baby." The project provides students the opportunity to experience some of the difficult responsibilities involved in being a parent. A "Sugar Baby" is a 10 pound bag of sugar which the student must be responsible for the total care and protection for a week. Students may not lose, break or drop the baby, and they may not cause the child to be taken away. It is the students responsibility to make sure the baby is protected from hazardous situations at all times, and they must plan to include their baby in all activities, dates, and shopping sprees. The project prohibits hiring a baby-sitter. Co-Chair Bunde said this resolution not only recognizes the work done at Mears Junior High, but commends this project to high schools and junior high schools in the state and encourages them to look at the project for their school. REPRESENTATIVE ROBINSON said she was aware of other projects that used eggs as the baby and wondered if the project should be expanded to include other programs, or did Co-Chair Bunde think the Sugar Baby concept was the best. CO-CHAIR BUNDE thought the Sugar Baby project worked well because the weight and bulk are most closely associated with a child. REPRESENTATIVE ROBINSON asked if the project required young men and women both to participate in the project. CO-CHAIR BUNDE responded yes. REPRESENTATIVE ROBINSON asked if there was a particular grade level involved. CO-CHAIR BUNDE replied the project had been done in the junior high school. His personal opinion was that the project needed to be conducted at the impressionable age, but not the terribly vulnerable age. REPRESENTATIVE ROBINSON asked if there were other aspects of parenting that were taught. CO-CHAIR BUNDE said the entire lesson teaching plan was available in committee members' packets. It is an entire research project that deals with clothing, feeding, costs involved, etc. CO-CHAIR TOOHEY directed the attention of the committee to comments made by the boys involved in the project. She thought it was an excellent tool in getting boys to recognize what it was like to be a teen-age father. REPRESENTATIVE ROKEBERG pointed out that Mears Junior High School was in his district and he is particularly proud they did such a wonderful job implementing this program in spite of the fact they have very few computers, no Close Up program and no travel budget for their high school sport team. Representative Rokeberg was very supportive of the resolution. REPRESENTATIVE DAVIS referenced the responses from the children regarding the project and said one student indicated she was definitely not having any children after having to tote the "Sugar Baby" around for a week. On the other hand, one student indicated she was definitely waiting to have a child. CO-CHAIR BUNDE referenced the report in the committee packets on the percentage of students having sexual intercourse; 30 percent are sexually active starting in the 7th grade. CO-CHAIR TOOHEY said that many of them were unplanned pregnancies and every unplanned pregnancy is a potential AIDS victim. Unprotected sex is like playing Russian Roulette. Number 2035 REPRESENTATIVE ROKEBERG moved to pass HCR 27 out of committee with accompanying fiscal note and individual recommendations. Hearing no objection, HCR 27 was moved out of committee. CO-CHAIR BUNDE announced that on Thursday the committee would be hearing a bill on the WICHE/WAMI program and would begin hearings on the Juvenile Code Revision. ADJOURNMENT CO-CHAIR BUNDE adjourned the House HESS Committee meeting at 4:38 p.m.