Legislature(2003 - 2004)

03/08/2004 01:33 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                    ALASKA STATE LEGISLATURE                                                                                  
SENATE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE                                                               
                         March 8, 2004                                                                                          
                           1:33 p.m.                                                                                            
                                                                                                                                
TAPE(S) 04-12                                                                                                                   
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Senator Fred Dyson, Chair                                                                                                       
Senator Lyda Green, Vice Chair                                                                                                  
Senator Gary Wilken                                                                                                             
Senator Bettye Davis                                                                                                            
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Senator Gretchen Guess                                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
HOUSE BILL NO. 282                                                                                                              
"An Act  relating to contracts  between the University  of Alaska                                                               
and  its employees  involving research  or  other development  of                                                               
intellectual property  and to the  authority of the  president of                                                               
the  University  of  Alaska   regarding  employee  contracts  for                                                               
development of intellectual property."                                                                                          
                                                                                                                                
     MOVED HB 282 OUT OF COMMITTEE                                                                                              
                                                                                                                                
CS FOR HOUSE BILL NO. 25(JUD)                                                                                                   
"An  Act relating  to  health care  decisions,  including do  not                                                               
resuscitate   orders,  anatomical   gifts,   and  mental   health                                                               
treatment  decisions,  and  to powers  of  attorney  relating  to                                                               
health  care,  including  anatomical   gifts  and  mental  health                                                               
treatment decisions; and providing for an effective date."                                                                      
                                                                                                                                
     HEARD AND HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 282                                                                                                                  
SHORT TITLE: UNIVERSITY EMPLOYEE RESEARCH CONTRACTS                                                                             
SPONSOR(s): REPRESENTATIVE(s) FATE                                                                                              
                                                                                                                                
04/23/03       (H)       READ THE FIRST TIME - REFERRALS                                                                        
04/23/03       (H)       HES, L&C                                                                                               
05/15/03       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
05/15/03       (H)       Scheduled But Not Heard                                                                                
01/22/04       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
01/22/04       (H)       Moved Out of Committee                                                                                 
01/22/04       (H)       MINUTE(HES)                                                                                            
01/23/04       (H)       HES RPT 3DP 1NR                                                                                        
01/23/04       (H)       DP: CISSNA, SEATON, WILSON; NR: GATTO                                                                  
02/02/04       (H)       L&C AT 3:15 PM CAPITOL 17                                                                              
02/02/04       (H)       Moved Out of Committee                                                                                 
02/02/04       (H)       MINUTE(L&C)                                                                                            
02/04/04       (H)       L&C RPT 4DP 3NR                                                                                        
02/04/04       (H)       DP: CRAWFORD, ROKEBERG, GUTTENBERG,                                                                    
02/04/04       (H)       ANDERSON; NR: LYNN, GATTO, DAHLSTROM                                                                   
02/19/04       (H)       TRANSMITTED TO (S)                                                                                     
02/19/04       (H)       VERSION: HB 282                                                                                        
02/20/04       (S)       READ THE FIRST TIME - REFERRALS                                                                        
02/20/04       (S)       HES                                                                                                    
03/03/04       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
03/03/04       (S)       Heard & Held                                                                                           
03/03/04       (S)       MINUTE(HES)                                                                                            
03/08/04       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
BILL: HB  25                                                                                                                  
SHORT TITLE: HEALTH CARE SERVICES DIRECTIVES                                                                                    
SPONSOR(s): REPRESENTATIVE(s) WEYHRAUCH                                                                                         
                                                                                                                                
01/21/03       (H)       PREFILE RELEASED (1/10/03)                                                                             
01/21/03       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/21/03       (H)       HES, JUD, FIN                                                                                          
02/13/03       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/13/03       (H)       Heard & Held                                                                                           
02/13/03       (H)       MINUTE(HES)                                                                                            
02/27/03       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
02/27/03       (H)       Heard & Held                                                                                           
02/27/03       (H)       MINUTE(HES)                                                                                            
03/06/03       (H)       HES AT 3:00 PM CAPITOL 106                                                                             
03/06/03       (H)       Moved CSHB  25(HES) Out of Committee                                                                   
03/06/03       (H)       MINUTE(HES)                                                                                            
03/10/03       (H)       HES RPT CS(HES) NT 7DP                                                                                 
03/10/03       (H)       DP: GATTO, WOLF, HEINZE, SEATON,                                                                       
03/10/03       (H)       CISSNA, KAPSNER, WILSON                                                                                
03/26/03       (H)       JUD AT 1:00 PM CAPITOL 120                                                                             
03/26/03       (H)       -- Meeting Canceled --                                                                                 
03/28/03       (H)       JUD AT 1:00 PM CAPITOL 120                                                                             
03/28/03       (H)       Heard & Held                                                                                           
03/28/03       (H)       MINUTE(JUD)                                                                                            
03/31/03       (H)       JUD AT 1:00 PM CAPITOL 120                                                                             
03/31/03       (H)       Moved CSHB 25(JUD) Out of Committee                                                                    
03/31/03       (H)       MINUTE(JUD)                                                                                            
04/07/03       (H)       JUD RPT CS(JUD) NT 5DP                                                                                 
04/07/03       (H)       DP: SAMUELS, HOLM, GARA, OGG, MCGUIRE                                                                  
04/07/03       (H)       FIN REFERRAL WAIVED                                                                                    
05/06/03       (H)       TRANSMITTED TO (S)                                                                                     
05/06/03       (H)       VERSION: CSHB 25(JUD)                                                                                  
05/07/03       (S)       READ THE FIRST TIME - REFERRALS                                                                        
05/07/03       (S)       HES, JUD                                                                                               
05/16/03       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
05/16/03       (S)       Heard & Held                                                                                           
05/16/03       (S)       MINUTE(HES)                                                                                            
03/08/04       (S)       HES AT 1:30 PM BUTROVICH 205                                                                           
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                              
REPRESENTATIVE HUGH FATE                                                                                                        
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT:  Sponsor of HB 282.                                                                                     
                                                                                                                              
MR. JIM POUND                                                                                                                   
Staff to Representative Fate                                                                                                    
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT:  Answered questions pertaining to HB 282.                                                               
                                                                                                                              
REPRESENTATIVE BRUCE WEYHRAUCH                                                                                                  
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT:  Sponsor of HB 25.                                                                                        
                                                                                                                                
DR. MARIA WALLINGTON                                                                                                            
Providence Alaska Medical Center                                                                                                
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Supports HB 25.                                                                                          
                                                                                                                                
FRANCIS NOLAN                                                                                                                   
Anchorage Emergency Medical Services                                                                                            
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Supports HB 25, with expressed concern.                                                                  
                                                                                                                                
MS. CAROLE EDWARDS                                                                                                              
Alaska Nurses Association (ANA)                                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Supports HB 25.                                                                                          
                                                                                                                                
MS. MARIE DARLIN                                                                                                                
AARP Alaska Capital City Task Force                                                                                             
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Supports HB 25.                                                                                        
                                                                                                                                
MS. LINDA SYLVESTER                                                                                                             
Staff to Representative Weyhrauch                                                                                               
Alaska State Capitol                                                                                                            
Juneau, AK  99801-1182                                                                                                          
POSITION STATEMENT: Answered questions pertaining to HB 25.                                                                   
                                                                                                                                
MR. CHIP WAGONER                                                                                                                
Alaska Catholic Conference                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Supports HB 25, with suggested amendments.                                                               
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
TAPE 04-12, SIDE A                                                                                                            
                                                                                                                              
CHAIR FRED DYSON  called the Senate Health,  Education and Social                                                             
Services  Standing  Committee  meeting  to  order  at  1:33  p.m.                                                               
Senators Green,  Wilken, Davis, and  Chair Dyson were  present at                                                               
the call  to order.   Also present were Representatives  Fate and                                                               
Weyhrauch.  He  announced the committee would take up  HB 282 and                                                               
HB 25 and  that his intention was to hear  public testimony on HB                                                               
25 and to hold the bill in committee for resolution of issues.                                                                  
                                                                                                                                
                                                                                                                                
         HB 282-UNIVERSITY EMPLOYEE RESEARCH CONTRACTS                                                                      
                                                                                                                                
REPRESENTATIVE  HUGH FATE,  the bill  sponsor, testified  that HB                                                               
282 allows  the president of  the university to contract  with an                                                               
employee of the university for  intellectual property specific to                                                               
the   research  done   by  that   employee.     This  contractual                                                               
arrangement benefits not only the  university, but also the state                                                               
because  of  the  potential  for   accrued  proceeds  from  these                                                               
business relationships through profit  and royalties.  This takes                                                               
pressure off of  recruitment and helps to  retain top professors;                                                               
it supplements  their incomes, but  also supplements  the income,                                                               
regard, and prestige of the university  for which they work.  The                                                               
bill has  been held up  before because of  regulations concerning                                                               
ethics,   as  it's   not  allowed   under  current   statute  and                                                               
regulation.   Many  universities have  done this.   For  example,                                                               
there were over 500 patents  from Stanford alone, this past year.                                                               
This also  takes pressure off  of the  general fund in  the event                                                               
that business enterprises are wildly successful.                                                                                
                                                                                                                                
SENATOR LYDA GREEN expressed concern.   She referred to the third                                                               
paragraph  of President  Mark Hamilton's  letter  of support  and                                                               
read as follows:  "Such  constraints tend to force researchers to                                                               
choose  between  exporting  their intellectual  property  without                                                               
continuing support,  and giving  up their  university employment.                                                               
This climate  provides little incentive for  researchers to focus                                                               
on  technologies that  are subject  to  commercialization."   She                                                               
said  it seems  simple  that  during an  employee's  tenure as  a                                                               
professor  or researcher  - whether  through  grant, federal,  or                                                               
state funding  - that the  information gained would  certainly be                                                               
the university's property  as well.  She remarked  that the issue                                                               
is that  an employee  can leave  with that  intellectual property                                                               
without the university  accruing anything.  "I have  an idea that                                                               
problem is bigger  than we are, and that's probably  a subject of                                                               
debate all  across universities in  the world."  She  pointed out                                                               
that in the private market this would never be allowed.                                                                         
                                                                                                                                
REPRESENTATIVE  FATE said  he couldn't  specifically answer  that                                                               
concern,  but those  items  would  probably be  taken  up in  the                                                               
contracts and  agreements.   "In our  particular case  because we                                                               
have not done much of this, it would be uncertain in my mind."                                                                  
                                                                                                                                
SENATOR GREEN responded  that this was a very  important issue to                                                               
be   taking  up,   emphasizing  that   the  protection   of  that                                                               
information and the benefit accruing  to the university - if it's                                                               
done in  the university  lab, on computers,  with help,  with the                                                               
whole thing that goes with it - was her main concern.                                                                           
                                                                                                                                
CHAIR  DYSON asked  if contrary  or negative  testimony had  been                                                               
heard on this bill.                                                                                                             
                                                                                                                                
MR.  JIM  POUND, Staff  to  Representative  Fate, responded  that                                                               
negative  comments  had not  been  offered  in the  other  body's                                                               
committee process.                                                                                                              
                                                                                                                                
SENATOR GARY  WILKEN moved to  report HB 282 from  committee with                                                               
individual recommendations  [and zero fiscal notes,  as mentioned                                                               
by the Chair].                                                                                                                  
                                                                                                                                
CHAIR  DYSON  asked if  there  was  any  objection.   Seeing  and                                                               
hearing none, it was so ordered.                                                                                                
                                                                                                                                
1:50 p.m.                                                                                                                       
                                                                                                                                
             HB 25-HEALTH CARE SERVICES DIRECTIVES                                                                          
                                                                                                                              
CHAIR  DYSON  began  the  hearing  on HB  25  [CSHB  24(JUD)]  by                                                               
mentioning  that Representative  Weyhrauch had  made considerable                                                               
improvements on  the bill and  that it was [the  Chair's] opinion                                                               
that the  "do nothing" option  was not a  good one.   He informed                                                               
members that after hearing  from Representative Weyhrauch, [Chair                                                               
Dyson] would  outline six policy  questions for the  committee to                                                               
focus  on, followed  by public  testimony  - with  the intent  to                                                               
incorporate and accommodate  concerns - and to move  the bill out                                                               
of committee in the next 10 days or two weeks.                                                                                  
                                                                                                                                
SENATOR  GREEN moved  to adopt  version  U [labeled  23-LS0137\U,                                                               
Bannister, 2/11/04] as the working document.                                                                                    
                                                                                                                                
CHAIR DYSON asked if there was  any objection.  There being none,                                                               
version U was before the committee.                                                                                             
                                                                                                                                
SENATOR WILKEN  asked if there  was a referral to  Senate Finance                                                               
and received confirmation that there was not.                                                                                   
                                                                                                                                
CHAIR DYSON pointed out that there was a zero fiscal note.                                                                      
                                                                                                                                
REPRESENTATIVE BRUCE  WEYHRAUCH, sponsor  of HB 25,  told members                                                               
that if it  were not for Chair Dyson's  spiritual, emotional, and                                                               
policy  insights,  the bill  would  be  "poor  for  it."   As  an                                                               
editorial  comment, he  said HB  25  was difficult  to deal  with                                                               
because  it addresses  fundamental questions  of life  and death,                                                               
and of losing a loved one.   He testified that HB 25 was inspired                                                               
by a  concept called the five  wishes, and reflects how  a person                                                               
is treated at the end of  life according to those wishes in areas                                                               
such as  who will be  making those decisions, which  decisions to                                                               
make, the  relative comfort  during the  dying process,  and what                                                               
loved ones  should know  about end-of-life  healthcare decisions.                                                               
The policy  issues are significant  and affect decisions  such as                                                               
withholding  of   food  and  water,  and   determining  that  the                                                               
environment is - as much as possible  - a loving one that is free                                                               
of judicial  intervention.   There have been  major cases  in the                                                               
U.S.  (Florida, Missouri,  and  elsewhere)  dealing with  whether                                                               
treatment should be withheld from  someone who is in a vegetative                                                               
state.   He said that at  some point policy decisions  need to be                                                               
made  and  he  is  glad  to  have  the  debate  on  record.    He                                                               
acknowledged that this  bill has been in the  Senate before, that                                                               
he has worked  very hard on it, and welcomes  dialogue and debate                                                               
to address concerns.                                                                                                            
                                                                                                                                
CHAIR DYSON then outlined six questions as follows:                                                                             
                                                                                                                                
     1.   Do we want  this legislation to always  start with                                                                    
     the  presumption  that  when   in  doubt,  we  work  to                                                                    
     preserve life?                                                                                                             
                                                                                                                                
     2.  At  what point can an advance  directive, an agent,                                                                    
     or the  surrogate direct that artificial  nutrition and                                                                    
     hydration - food and water - be withheld?                                                                                  
                                                                                                                                
CHAIR DYSON  commented that  before looking  into this  issue, he                                                               
would  have  said  "of  course" [to  providing  food  and  water]                                                               
because to  do otherwise would  be involved with  euthanasia, and                                                               
he is not personally willing to go there.                                                                                       
                                                                                                                                
     3.   Reciprocity.    How do  we  handle an  end-of-life                                                                    
     directive that comes to us  from another state that may                                                                    
     have  different   rules,  different   constraints,  and                                                                    
     different assumptions?                                                                                                     
                                                                                                                                
     4.   Who is  qualified?  What  is a  qualified patient?                                                                    
     If you  were to push  the logic, all  of us are  in the                                                                    
     process of dying, and with  the present technology, are                                                                    
     terminal.   At  what  point in  that  process does  the                                                                    
     definition of 'being qualified' kick-in?                                                                                   
                                                                                                                                
     5.  Anatomical  gifts.  That's when parts  of the dying                                                                    
     or  dead person  will be  transplanted to  help someone                                                                    
     who is living.                                                                                                             
                                                                                                                                
     6.   Authority of  decision-makers.   When you  have an                                                                    
     incompetent  patient,  no   longer  capable  of  making                                                                    
     decisions on  [his/her] own,  and those  decisions have                                                                    
     been given to  a third person.  You'll see  in the bill                                                                    
     a hierarchy  of presumption regarding who  those 'third                                                                    
     persons'  are who  will make  those  decisions and  how                                                                    
     authority  or position  is  gained,  and whether  there                                                                    
     ought to be any appeals to that.                                                                                           
                                                                                                                                
CHAIR  DYSON  said he  probably  knows  of more  reprobates  than                                                               
others  do, and  cited three  instances in  Alaska from  the last                                                               
year.   He mentioned one  example as that  of an 87-year  old man                                                               
who  had not  been out  of bed  for three  years, was  marginally                                                               
conscious, and who all of a  sudden fell in love with his 34-year                                                               
old  caretaker  and  demanded  a  marriage.    The  marriage  was                                                               
performed  with almost  no witnesses  present, and  the man  died                                                               
five  days later.   The  estate  went to  the new  bride, at  the                                                               
exclusion of  the family.  "And  lo and behold her  boyfriend was                                                               
the doctor  prescribing the medicine."   He emphasized  that care                                                               
needs  to be  taken in  situations involving  people with  vested                                                               
interests.  He  referred to two situations in which  the will was                                                               
predicated  on death  order, meaning  who  died first  determined                                                               
"where the  estate went."   Manipulation can  occur so  that "who                                                               
becomes an heir depends on who dies first."                                                                                     
                                                                                                                                
DR.  MARIA WALLINGTON,  a medical  ethicist at  Providence Alaska                                                               
Medical Center,  testified in support  of HB 25, saying  that she                                                               
has been working with Representative  Weyhrauch's office and that                                                               
she was  available to  answer questions of  a medical  or ethical                                                               
nature that might come up.                                                                                                      
                                                                                                                                
FRANCIS  NOLAN, Anchorage  Emergency Medical  Services, testified                                                               
in support  of HB 25.   He expressed  concern about a  section of                                                               
the bill no longer included in  the bill's current version U.  He                                                               
also mentioned support for Alaska's Comfort One Program.                                                                        
                                                                                                                                
MS.  CAROLE EDWARDS,  an oncology  nurse  in Juneau  for over  20                                                               
years  and  board  member of  Alaska  Nurses  Association  (ANA),                                                               
expressed  ANA's  strong  support  of  HB  25  and  testified  as                                                               
follows:                                                                                                                        
                                                                                                                                
     Death is something that we all  must face.  The type of                                                                    
     death we  have can be  in a  large part within  our own                                                                    
     control.  HB  25 allows us to outline  the treatment we                                                                    
     do - or don't want - in our  last days.  Death can be a                                                                    
     beautiful and  peaceful experience  for the  patient as                                                                    
     well  as  the  family  and  friends.    Or  it  can  be                                                                    
     extremely  traumatic,  painful  and stressful  for  all                                                                    
     involved.  I  have been with many patients  at the time                                                                    
     of death and have seen both.                                                                                               
                                                                                                                                
     I  would like  to tell  you  two stories  about a  good                                                                    
     death  and a  bad death.   The  first occurred  several                                                                    
     years ago  for a gentleman  who was dying  from cancer.                                                                    
     He had made his wishes known.   He was in the hospital.                                                                    
     As death  was imminent, family and  friends gathered at                                                                    
     his bedside.   I entered  the room  to feel a  sense of                                                                    
     peace  wash over  me.   Friends  and family  were in  a                                                                    
     circle,  holding hands  with  each other  and with  the                                                                    
     patient, and  one member was strumming  a guitar gently                                                                    
     as  the  group softly  sang,  "May  the Circle  Not  be                                                                    
     Broken."   The patient died in  this beautiful setting.                                                                    
     This death  made a huge  impact on  me, as I  know that                                                                    
     this is  how it  should be.   No  fear, no  writhing in                                                                    
     pain, and  no dissention among  the family members.   I                                                                    
     think of this experience often  and I would wish it for                                                                    
     everyone.                                                                                                                  
                                                                                                                                
     The other  death was  far different.   The  patient had                                                                    
     terminal  cancer.   Treatment was  extremely difficult,                                                                    
     uncomfortable,   and  the   patient  was   clearly  not                                                                    
     responding.    This  was a  woman  with  several  adult                                                                    
     children.   The patient  wanted to stop  her treatment.                                                                    
     One  child  supported this;  the  two  others did  not.                                                                    
     Major arguments,  even screaming  matches broke  out in                                                                    
     the  hospital halls  and in  the patient's  room, among                                                                    
     the siblings and  with the patient.  If  this woman had                                                                    
     filled out  advance directives and  a durable  power of                                                                    
     attorney, we  as health care providers  could have more                                                                    
     easily stepped  in.  This  woman died a  very stressful                                                                    
     death.   The children  were not  even speaking  to each                                                                    
     other as they left the hospital.   I don't even know if                                                                    
     they ever reconciled.  Nobody deserves this.                                                                               
                                                                                                                                
2:10 p.m.                                                                                                                       
                                                                                                                                
     I have also  been asked to speak today  about fluid and                                                                    
     nutrition   and  pain   control   for  terminally   ill                                                                    
     patients.   First I will  address fluid  and nutrition.                                                                    
     Nutrition  in this  instance refers  to a  feeding tube                                                                    
     being placed; IV,  fluids.  If a person, at  the end of                                                                    
     life,  in terminal  care, desires  something to  eat or                                                                    
     drink, this does not mean  that we would not allow them                                                                    
     to have  it.  They  would certainly be allowed  to have                                                                    
     whatever they want.                                                                                                        
                                                                                                                                
     Withholding  fluid and  nutrition allows  a patient  to                                                                    
     die  naturally.    Before  we  had  the  technology  to                                                                    
     provide IVs  and feeding tubes,  patients in  the dying                                                                    
     process  naturally  ate  less  and drank  less.    This                                                                    
     allowed  the  organ  systems to  slowly  shut  down  in                                                                    
     preparation  for death.    Therefore,  it follows  that                                                                    
     giving food  and nutrition unnaturally can  prolong the                                                                    
     death process.   If we are concerned about,  as we say,                                                                    
     "playing  God"  and  making  these  decisions,  we  are                                                                    
     actually  doing it  by giving  fluid  and nutrition  in                                                                    
     some   instances   and   therefore   prolonging   death                                                                    
     unnaturally.                                                                                                               
                                                                                                                                
     Fluid and nutrition can  cause increased discomfort for                                                                    
     a dying  patient by increasing  respiratory secretions,                                                                    
     coughing  and   shortness  of  breath,   increasing  GI                                                                    
     secretions  causing   nausea  and  vomiting   for  this                                                                    
     patient,  and it  can  also  increase the  peri-tumoral                                                                    
     edema - the edema around  the tumor - causing increased                                                                    
     pain.                                                                                                                      
                                                                                                                                
     As  for pain,  nobody needs  to die  in pain  - nobody.                                                                    
     More  cancer patients  fear dying  in  pain than  dying                                                                    
     itself.  Families   of  cancer   patients  consistently                                                                    
     express  the fear  that their  loved ones  will die  in                                                                    
     pain.   Almost  every  cancer patient,  and I've  taken                                                                    
     care  of  hundreds,  that I've  ever  seen,  and  their                                                                    
     family, has  expressed this  fear to me.   The  same is                                                                    
     true  for my  oncology colleagues  across the  country.                                                                    
     Many  people  try  to  set   out  guidelines  on  pain.                                                                    
     Leading pain  researchers give  the definition  of pain                                                                    
     as:   "pain is whatever the  patient says it is."   And                                                                    
     it should be treated appropriately  so that the pain is                                                                    
     alleviated.   Cancer  patients  often  need very  large                                                                    
     amounts of  pain medication to relieve  their pain, and                                                                    
     as much as is needed should be given.                                                                                      
                                                                                                                                
     I will  tell you another  story about a friend  who was                                                                    
     dying from  cancer down South.   She had  extreme pain.                                                                    
     She  was  at home  with  hospice  care.   Hospice  kept                                                                    
     increasing her morphine to control  the pain during her                                                                    
     last  few days.   Finally  the pain  was controlled  so                                                                    
     that  she was  able to  focus  on her  family, who  had                                                                    
     gathered, and  even exchange intimate moments  with her                                                                    
     husband.  They even joked about  a few things.  She was                                                                    
     fully awake.  She was  getting over 300 milligrams (mg)                                                                    
     of  morphine an  hour.   That  is a  huge  dose!   Most                                                                    
     people would expect it to  cause instant death.  It did                                                                    
     not.  Unfortunately the end  of this story is not quite                                                                    
     so peaceful.   As  death was  imminent she  became non-                                                                    
     responsive.   She was taken  to the local  hospital and                                                                    
     seen in the  emergency room.  When they  saw the amount                                                                    
     of morphine that she was  being given, they immediately                                                                    
     dropped it  to 20 mg  an hour.   She had  extreme pain,                                                                    
     was  screaming  in  pain  at the  time  of  her  death,                                                                    
     begging  her family  to do  something.   The family  is                                                                    
     upset to  this day about  the experience.   This should                                                                    
     never have happened.                                                                                                       
                                                                                                                                
     Pain medications  are given in  large amounts  with the                                                                    
     intention  of alleviating  pain.   Narcotic medications                                                                    
     do  not have  a  therapeutic ceiling.   Terminally  ill                                                                    
     patients do  not become addicted.   Alleviating pain is                                                                    
     not assisted suicide.  It  is pain control and at times                                                                    
     will allow a  patient to actually live  a little longer                                                                    
     with  much improved  quality  time  with their  family.                                                                    
     They can  complete unfinished business with  the family                                                                    
     - and this  is very important at the end  of life - and                                                                    
     they can die  in peace.  Adequate  pain medication will                                                                    
     allow  a  patient  to breathe  more  easily,  not  stop                                                                    
     breathing.                                                                                                                 
                                                                                                                                
     Every individual  has a right  to a peaceful  death and                                                                    
     society should insist on this right.                                                                                       
                                                                                                                                
     I also  wanted to add  two other things because  of the                                                                    
     questions that  you raised.   Ideally,  everyone should                                                                    
     have advance  directives.  Passing  this bill  will not                                                                    
     guarantee that everybody  is going to have  those.  So,                                                                    
     the way I see it, when  this bill passes - which I hope                                                                    
     it does  very quickly - it's  not the end of  our work.                                                                    
     We  need   to  follow  up   on  that,  get   this  well                                                                    
     advertised,  and get  the message  out  so that  people                                                                    
     fill  out  their  advance  directives.    When  they're                                                                    
     filled  out, then  we  can act  on them.    To me,  the                                                                    
     passing  of this  bill  is just  the  beginning of  our                                                                    
     work.                                                                                                                      
                                                                                                                                
     The  other comment  I  have  is that  as  far as  other                                                                    
     states and advance directives, I  want to tell you that                                                                    
     I have  had my advance  directives filled out  for many                                                                    
     years because of my many experiences.   I keep a set in                                                                    
     the safe  at my parents house  in New Jersey -  both my                                                                    
     husband  and  I  -  I   also  have  a  set  of  advance                                                                    
     directives in my  carry-on luggage that I  take with me                                                                    
     at all times,  no matter where I'm traveling.   I guess                                                                    
     that's  one of  the hazards  of being  a nurse  in this                                                                    
     business.                                                                                                                  
                                                                                                                                
CHAIR DYSON remarked that version  U, which his office has helped                                                               
to  write,  helps  to  clarify   that  regarding  a  comatose  or                                                               
incompetent pregnant  woman patient, the presumption  would be to                                                               
preserve the  life of the woman  as long as possible  to give the                                                               
developing child as much time in  the womb as possible to mature,                                                               
thereby enhancing the chances of survival.   He asked if this was                                                               
standard practice in hospitals.                                                                                                 
                                                                                                                                
MS.  EDWARDS  replied that  she  has  not worked  extensively  in                                                               
ob/gyn but  believed this to  be true.   She reported  that ANA's                                                               
board  and legislative  committee  supports this  issue, as  does                                                               
she, saying  "if there's a  chance of  saving that child  then we                                                               
should  definitely  keep  the mother  alive  on  life-support  or                                                               
whatever it  takes to allow  that child  to be born  and survive.                                                               
It  would certainly  comfort the  family  to have  that child  if                                                               
they're losing a member."                                                                                                       
                                                                                                                                
CHAIR  DYSON  said this  clarification  has  been done  with  the                                                               
agreement of  the bill's sponsor.   He stated he  was irrevocably                                                               
pro-life regarding the abortion issue,  yet he was not aware that                                                               
this was  necessarily strengthening the pro-life  position in the                                                               
courts or  in the debate.   He said  he thought one  could deduce                                                               
that this  would be a wanted  child if a woman  had been carrying                                                               
that child  and had not  previously elected the  abortion option;                                                               
it would  be her  and the  family's intention  for that  child to                                                               
survive if  at all  possible.  He  acknowledged that  the sponsor                                                               
was nodding in agreement.                                                                                                       
                                                                                                                                
DR. WALLINGTON offered support of this issue, as well.                                                                          
                                                                                                                                
The committee  took a brief  at-ease at 2:18, at  Senator Green's                                                               
request.                                                                                                                        
                                                                                                                                
MS. MARIE DARLIN,  Coordinator for AARP Alaska  Capital City Task                                                               
Force, testified  that after six  years of working on  this bill,                                                               
AARP is  glad that  it has gotten  this far.   She referred  to a                                                               
letter  of support  from  the AARP  office  indicating that  "all                                                               
states should have  this type of legislation."  The  aim has been                                                               
to put a  lot into one bill,  to bring things up to  date, and to                                                               
address  outdated legislation.   She  said considerable  work has                                                               
been  done on  this  bill and  attempts have  been  made to  meet                                                               
everyone's concerns.   She said  that in  the past three  or four                                                               
years, she  has been  involved with  her own  family's situations                                                               
and that  different things  happen at the  time of  death; what's                                                               
included in this bill would make all of that much easier.                                                                       
                                                                                                                                
MS. DARLIN told  members that her sister passed  away last spring                                                               
after  having  cancer for  several  years  and after  losing  her                                                               
husband  about one  year prior  to that  due to  a massive  heart                                                               
attack.    Her  sister,  who had  six  children,  and  inoperable                                                               
cancer, had completed  the forms so that her  children would know                                                               
exactly how  she wanted  to be  treated at the  end of  her life.                                                               
Things  went according  to  her wishes  in  a hospice  situation,                                                               
which really  was the best.   One  month before she  died, things                                                               
were well taken care of and  nobody had to worry about how things                                                               
were going  to be handled.   Ms. Darlin then gave  the example of                                                               
her  son-in-law,  who  had  an inoperable  brain  tumor  and  had                                                               
already verbally given  instructions about how things  were to be                                                               
handled.  With the family knowing  of his wishes, it was possible                                                               
to do things "the best for him, right up until the very end."                                                                   
                                                                                                                                
MS. DARLIN continued  that she lost a brother about  two or three                                                               
years ago who  had not filled out  any directives.  He  died of a                                                               
massive heart  attack while duck hunting  - which was the  joy of                                                               
his life - and in that  situation no decisions needed to be made.                                                               
She said she has another  elderly relative who is currently going                                                               
through  this process,  whose kids  want  to know  how to  handle                                                               
things.   She [the  relative] is  planning to say  - on  her next                                                               
trip to Fairbanks - "All right,  now is the time, and we're going                                                               
to make some decisions, and I'm  going to make them."  Ms. Darlin                                                               
said that  passing HB 25  would make this process  easier because                                                               
"all of it will be in one place."                                                                                               
                                                                                                                                
CHAIR  DYSON  asked if  she  was  familiar  with version  U,  and                                                               
requested that she circulate it to anyone wanting to have input.                                                                
                                                                                                                                
MS.  DARLIN  replied  that  AARP remains  supportive  of  HB  25,                                                               
appreciates  the work  done by  Representative Weyhrauch  and his                                                               
staff and  will notify the  committee if there are  problems with                                                               
the current version.                                                                                                            
                                                                                                                                
CHAIR DYSON asked  if it was customary in  other jurisdictions to                                                               
have  the actual  document  in  the law  rather  than having  the                                                               
provisions in the law and the documents in regulation.                                                                          
                                                                                                                                
MS. EDWARDS replied she didn't know.                                                                                            
                                                                                                                                
DR. WALLINGTON responded  that she wasn't so  familiar with other                                                               
states.                                                                                                                         
                                                                                                                                
MS. EDWARDS  asked if people  who already had their  paperwork in                                                               
order would have  to make changes or if  existing documents would                                                               
be grandfathered-in.                                                                                                            
                                                                                                                                
REPRESENTATIVE  WEYHRAUCH responded  that  statutory language  is                                                               
intended  to cover  the basics  and that  having forms  different                                                               
from those  in statute would not  be illegal.  He  said he'd have                                                               
to  get back  to  the  committee to  answer  the  question as  to                                                               
whether  it's customary  to have  the documents  included in  the                                                               
law.                                                                                                                            
                                                                                                                                
CHAIR DYSON said  he questioned the wisdom of  including this and                                                               
asked to  be directed to the  part of the bill  clarifying that a                                                               
specific document in the law doesn't  have to be used, but can be                                                               
modified or substituted.                                                                                                        
                                                                                                                                
MS. LINDA SYLVESTER, Staff  to Representative Weyhrauch, referred                                                               
to page 22,  line 17, "Optional form.  The  following sample form                                                               
may be used  to create an advance health care  directive ... this                                                               
form  may be  modified to  suit  the needs  of the  person, or  a                                                               
completely  different   form  may  be  used   that  contains  the                                                               
substance of the  following form or otherwise  complies with this                                                               
chapter."  She  told members that one benefit of  this statute is                                                               
that  it  creates an  optional  form,  whereas an  impediment  of                                                               
current statute  is that no  options are available for  the power                                                               
of attorney and the living will.                                                                                                
                                                                                                                                
CHAIR DYSON asked  if the language was carefully  crafted to make                                                               
the  directives   clear  and  to  avoid   possible  conflicts  of                                                               
litigation.                                                                                                                     
                                                                                                                                
MS. SYLVESTER  said a lot of  work had been done  on the language                                                               
in the form, and that other  states' options have been looked at,                                                               
as well.  As an example,  she mentioned the situation of a family                                                               
outside of the  hospital room of a family member,  trying to come                                                               
up with ways to address the use of pain therapy.                                                                                
                                                                                                                                
TAPE 04-12, SIDE B                                                                                                            
                                                                                                                              
MS. SYLVESTER continued that there  are several options available                                                               
to the  person who  is expressing  his/her attitudes  toward pain                                                               
medication and  also towards artificial hydration  and nutrition.                                                               
One individual may desire that  every option be exercised because                                                               
of wanting  to stay  alive, while  another individual  might want                                                               
the  provision of  artificial hydration  and  nutrition to  allow                                                               
time to determine  what his/her recovery will be and  to have the                                                               
option to  decide at a later  point, when it seems  like death is                                                               
imminent.  There  are a number of scenarios and  options in which                                                               
attitudes  can  be expressed  and  conclusions  can be  drawn  by                                                               
surrogate decision-makers.                                                                                                      
                                                                                                                                
REPRESENTATIVE WEHRAUCH  offered that the  intent of the  form is                                                               
to  make  the  directives  as  clear as  possible  and  to  avoid                                                               
litigation   and  uncertainty   at   the  end-of-life,   although                                                               
experience  indicates that  litigation will  never be  completely                                                               
avoided.    He  said  he  would like  to  hear  Dr.  Wallington's                                                               
response as to whether the form is clear enough.                                                                                
                                                                                                                                
DR.  WALLINGTON said  she had  a lot  to do  with suggesting  the                                                               
wording,  and  directed the  committee's  attention  to page  28,                                                               
"artificial nutrition  and hydration" and  gave the example  of a                                                               
family struggling  with this question  prior to finding  out that                                                               
there  was a  living will.    The will  revealed that  artificial                                                               
hydration and  nutrition were not desired  indefinitely.  Knowing                                                               
that a choice  had been made was  helpful and took a  load off of                                                               
the family.                                                                                                                     
                                                                                                                                
CHAIR DYSON relayed  that recently one of his staff  had a parent                                                               
who died; in this situation  the woman was obviously terminal and                                                               
almost never conscious  and the continuing of food  and water was                                                               
producing great discomfort  and a lot of complications.   He said                                                               
if  a   living  will  was   executed  by  someone  "not   in  the                                                               
circumstance, and a long ways away  from it", there ought to be a                                                               
way for someone  who previously said, "sure, keep  giving me food                                                               
and water" but  after becoming incompetent, and  from among those                                                               
seeing the  needless suffering  being endured  by someone  who is                                                               
dying and  who is beyond being  able to communicate, it  seemed -                                                               
"and I  won't use the  word torture" - but  really inappropriate.                                                               
His  understanding was  that the  document  before the  committee                                                               
makes the living  will the guiding document and  perhaps does not                                                               
make it easy enough, in a  case that is perhaps obvious, for that                                                               
to be over-ruled.  He asked Dr. Wallington to comment on this.                                                                  
                                                                                                                                
DR. WALLINGTON  responded that  this was an  example of  how "the                                                               
world  is  gray and  not  black  and white."    She  said it  was                                                               
interesting to  hear the recognition of  artificial nutrition and                                                               
hydration as not being the end all  and be all of existence.  She                                                               
said  she has  had  a  lot more  difficulty  with families  being                                                               
unwilling  to give  up artificial  nutrition  and hydration  than                                                               
recognizing that  "they're doing  bad things  to people  by using                                                               
it."  She said she would  be open to suggestions regarding how to                                                               
properly   give  an   option  for   evaluating  people's   stated                                                               
preferences, recognizing that perhaps it  was not known what life                                                               
would be like  under those preferences and that  perhaps a change                                                               
is desired.   She stated she didn't  want to make it  too easy to                                                               
do away  with what somebody has  chosen because the point  of the                                                               
living will  is to have one's  choices followed.  She  brought up                                                               
the difficulty  with a person  unfamiliar with the  medical world                                                               
who is making  decisions based upon what he/she  thinks is right,                                                               
and then experiencing the consequence of that choice.                                                                           
                                                                                                                                
CHAIR DYSON  alluded to  the well-publicized  case in  Florida in                                                               
which the  patient was not in  danger of dying from  other causes                                                               
but  was  questionably comatose  and  the  husband, who  had  the                                                               
authority  to make  the decisions,  also had  a vested  financial                                                               
interest in  her dying sooner rather  than later.  He  asked, "Is                                                               
medical science capable with reasonable  certainty of saying this                                                               
person will never again be conscious and competent, or not?"                                                                    
                                                                                                                                
DR. WALLINGTON replied that there  would be very few neurologists                                                               
(the specialty making that decision)  who wouldn't think that the                                                               
statistics regarding  their abilities  firmly say  that somebody,                                                               
after a year, can have a very  good sense of whether or not "they                                                               
will  wake up."   She  stated she  had a  different take  on this                                                               
particular  case, remarking  that  she was  "about  10 years  out                                                               
from"  the incident  and the  chances  of her  changing would  be                                                               
miniscule.  To  answer the question, she said it  was possible to                                                               
make  mistakes but  there are  very, very,  very few  [instances]                                                               
when after a  significant length of time, a  person's status will                                                               
change.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  WEYHRAUCH  referred   to  Chair  Dyson's  earlier                                                               
comment about  a person who is  living, who has the  authority to                                                               
make decisions regarding someone  else's healthcare and who would                                                               
be the heir  to assets when that other person  dies, depending on                                                               
the timing  of the  death.   He said  this was  very common.   He                                                               
mentioned that when  his own father passed away,  the assets went                                                               
to his mother, whereas if she  had died first, her assets and the                                                               
trust would have  gone to his father.   He asked if  this was the                                                               
type of scenario in question.                                                                                                   
                                                                                                                                
CHAIR DYSON responded that the situation  he had in mind was, for                                                               
example,  that  of the  father  and  the  oldest son  both  being                                                               
terminal but still  alive.  If the father dies  first, the estate                                                               
goes to the eldest  son and when he dies, the  estate goes to the                                                               
eldest son's  children.  However,  if the eldest son  dies first,                                                               
the  estate  goes  to  the  second child  (a  woman).    In  this                                                               
situation, the  eldest son's child  was making the  decisions for                                                               
the grandfather.                                                                                                                
                                                                                                                                
REPRESENTATIVE WEHYRAUCH suggested that  in those decisions, many                                                               
factors go into  analyzing the nature of the  relationships:  was                                                               
it  loving,  close,  continuous,  supportive,  adversarial;  were                                                               
there connections, hobbies,  work projects; or was  this a person                                                               
who  just  interjected  him/herself.    He  said  that  in  these                                                               
situations  people  can  always  repair   to  the  courts  for  a                                                               
determination but  analyzing this  goes to the  fundamental issue                                                               
of, "Where  do we come from  in adopting this kind  of statute in                                                               
our approach to these kinds of  health care decisions?"  Is it to                                                               
continue life, or  to make the person as  comfortable as possible                                                               
in death?   And how  to trust  a person's decisions  while he/she                                                               
was conscious?  "It's tough all around."                                                                                        
                                                                                                                                
CHAIR DYSON  said the following question  has also come up:   "If                                                               
we  do  not  have  a  living will  directive  and  the  agent  or                                                               
surrogate is  making those  decisions, should  we have  an appeal                                                               
process for  other related adults  to appeal the decision  of the                                                               
agent or  the surrogate and  have that appeals process  such that                                                               
it  would work  in  a real  time?  You know,  hours  and days  as                                                               
opposed to months and years."                                                                                                   
                                                                                                                                
REPRESENTATIVE  WEYHRAUCH  responded  that many  of  those  cases                                                               
become  moot.    He  said  they  have to  be  in  real  time,  or                                                               
expedited, otherwise the factual basis for having the case dies.                                                                
                                                                                                                                
CHAIR DYSON  concurred, "Exactly right,  and time might  work for                                                               
the bad guys,  or it might work for the  good guys." He suggested                                                               
that in quite a few situations,  one could go to a magistrate and                                                               
get a  stop order to buy  some time to get  the decision changed.                                                               
He asked, "Do we have a remedy like that if this law passes?"                                                                   
                                                                                                                                
REPRESENTATIVE WEYHRAUCH said a remedy  already exists.  "You can                                                               
always repair to the courts under this statutory scheme."                                                                       
                                                                                                                                
CHAIR DYSON asked if this was a readily available remedy.                                                                       
                                                                                                                                
REPRESENTATIVE WEYHRAUCH said, "Yes sir."                                                                                       
                                                                                                                                
MS.  SYLVESTER  offered  that  currently  there  is  a  power  of                                                               
attorney for health care.  In HB  25 this would be the agent, and                                                               
there is the option of having  a substitute agent as well.  There                                                               
is  also guardianship  and under  current law  one can  nominate,                                                               
through the courts, that guardian.   The new law being brought in                                                               
by  HB 25  is the  concept of  a surrogate,  somebody (such  as a                                                               
wife)  who  is the  next  logical  candidate to  make  healthcare                                                               
decisions;  the   hierarchy  is  laid   out.    If  there   is  a                                                               
disagreement and something is not  right, a person or institution                                                               
can bring  the case to a  higher authority.  The  public guardian                                                               
is  most likely  assigned  well  in advance  of  an actual  court                                                               
hearing.   Guardianship statutes  in Alaska don't  authorize that                                                               
person to make decisions authorizing withdrawal of life-                                                                        
sustaining measures,  so there's  also that  protection currently                                                               
in place.   Catholic Conference of Alaska suggests  that if there                                                               
is a  disagreement, that the  diverse opinions of  the surrogates                                                               
be  considered  by  the  healthcare   provider  before  making  a                                                               
decision.   Of  course  anybody  in that  group  can  take it  to                                                               
superior court  and rectify  the situation.   She added  that she                                                               
didn't think the remedy would be  as easy in a situation in which                                                               
someone actually signed and was made an agent.                                                                                  
                                                                                                                                
DR.  WALLINGTON   commented  that  if  the   healthcare  provider                                                               
community  sensed  that  the  decisions  being  pushed  for  were                                                               
inappropriate,  particularly  in  the  realm  of  stopping  care,                                                               
rights  would  be   exercised  under  current  law   to  ask  for                                                               
[guardianship].   It takes  up to  six weeks  for the  process of                                                               
full guardianship  to take place;  temporary guardianship  can be                                                               
done rather  quickly.  The  family can also exercise  that right,                                                               
it doesn't have to be the health system.                                                                                        
                                                                                                                                
CHAIR DYSON  said it appears  that the  law and the  consent form                                                               
assume that anatomical gifts will  be exercised unless the person                                                               
has  explicitly declined  wanting this.    He asked  if this  was                                                               
correct, and if this was the proper way to proceed.                                                                             
                                                                                                                                
DR. WALLINGTON said she had  recalled that the agreement was that                                                               
it was "inappropriate to have the process be one of [indisc.]."                                                                 
                                                                                                                                
REPRESENTATIVE WEYHRAUCH said the  intent was, "You're not forced                                                               
in at all.  You have to opt in."                                                                                                
                                                                                                                                
CHAIR DYSON  clarified that this related  to page 16, lines  14 -                                                               
17.                                                                                                                             
                                                                                                                                
MS. SYLVESTER  pointed out that  there was a drafting  error, and                                                               
that   updates  had   been  submitted.      She  explained   that                                                               
[subsection] (k) was inadvertently included  by the drafter.  She                                                               
said  there was  a  change  from the  1984  to  the 1987  Uniform                                                               
Anatomical  Gift Act,  except  for a  provision  that would  make                                                               
Alaska an  opt-out state.   Alaska's new  form has the  option to                                                               
reject this,  which was not  previously included.   She mentioned                                                               
that  hospitals and  hospital staff  encourage and  solicit organ                                                               
donations, and approach family members  to seek an opinion.  That                                                               
is currently law, and it will stay in.                                                                                          
                                                                                                                                
CHAIR DYSON  asked, "If  a person had  made an  advance directive                                                               
and opted  out and  said 'I don't  want to be  a donor'  then the                                                               
relatives or surrogates could not over-rule that?"                                                                              
                                                                                                                                
MS. SYLVESTER replied, "The decision's  made by the principal and                                                               
that's that."                                                                                                                   
                                                                                                                                
CHAIR DYSON  asked if in the  absence of that -  unless there's a                                                               
record of  desires clearly being  made known  - the agent  or the                                                               
surrogate could make that decision.                                                                                             
                                                                                                                                
MS. SYLVESTER said, "Correct."                                                                                                  
                                                                                                                                
MR. CHIP  WAGONER, representing  the Alaska  Catholic Conference,                                                               
testified that the church remains as  an advocate of the life and                                                               
human dignity of  every person.  As stated  by Cardinal Bernardin                                                               
of  Chicago who  has since  died of  cancer, the  church supports                                                               
that "seamless web of life  from conception to natural death" and                                                               
opposes  mercy killing,  assisted  suicide, and  euthanasia.   He                                                               
said that  all statutes touching on  this area of the  law should                                                               
have a strong presumption for life.   ACC favors passage of HB 25                                                               
given that amendments are made;  ACC will continue the good faith                                                               
efforts in  working with the  sponsor, this committee  and others                                                               
to devise a  bill that is worthy of having  the word, "Alaska" at                                                               
the top of it.                                                                                                                  
                                                                                                                                
2:58 p.m.                                                                                                                       
                                                                                                                                
MR. WAGONER  expressed concern regarding the  intent language and                                                               
did  not offer  specific suggestions  but said  he would  like to                                                               
continue working with the sponsor to make improvements.                                                                         
                                                                                                                                
CHAIR DYSON mentioned that the  intent language pertaining to the                                                               
presumption of  life is pretty  good, but  "is watered down  in a                                                               
couple of the sections further on."                                                                                             
                                                                                                                                
MR. WAGONER concurred.   He said with regard to  an exception for                                                               
mental  health  treatment for  decisions  by  the surrogate,  ACC                                                               
thinks  there   should  also  be  exceptions   when  abortion  or                                                               
sterilization  decisions  are  made.   That  is,  when  there  is                                                               
nothing  in  the advance  care  directive  by the  principal;  he                                                               
referenced page 5,  line 15.  He said clarification  is needed on                                                               
page  6, line  8, subsection  (d), dealing  with individuals  who                                                               
have  "exhibited  special  care  and  concern  for  the  patient"                                                               
because  of the  vagueness of  the language.   He  said there  is                                                               
concern regarding  some of the  sections on "do  not resuscitate"                                                               
pertaining  to someone  who  has  made the  decision  of "do  not                                                               
resuscitate" to be able to withdraw  that decision.  He said this                                                               
was for the principal but  not for surrogates or possibly agents,                                                               
and  he  wanted  to  ensure   that  "if  someone  says,  'do  not                                                               
resuscitate' that we have that."                                                                                                
                                                                                                                                
MR. WAGONER continued that ACC  is concerned about protocols that                                                               
are  not  considered  to  be   healthcare  decisions.    He  said                                                               
protocols  seen in  regulations  deal with:  1)  knowing who  the                                                               
patient is, and 2) having  correct identification of that patient                                                               
as a 'do  not resuscitate' patient.  He said  there is nothing in                                                               
the  protocols  indicating  how to  decide  to  not  resuscitate.                                                               
Those  are all  concerns.   Mr. Wagoner  remarked that  it's been                                                               
excellent  working  with  the  sponsor's   staff  and  that  many                                                               
amendments have  already been incorporated.   He  then referenced                                                               
page 12, lines  17 - 24, which includes the  language, "and other                                                               
life-sustaining  procedures" noting  that ACC  would like  to see                                                               
that  deleted.   Mr. Wagoner  stated concern  with the  language,                                                               
"... to  the extent prohibited  by other statutes of  this state"                                                               
on page 13, line 27, subsection (f).                                                                                            
                                                                                                                                
MR. WAGONER  concluded that probably  the most complex  moral and                                                               
legal issue  is that of  artificial nutrition and hydration.   He                                                               
distributed  a statement  from the  United  States Conference  of                                                               
Catholic  Bishops [Nutrition  and Hydration:  Moral and  Pastoral                                                               
Reflections  (1992)], and  reiterated that  this is  just "not  a                                                               
black and  white issue."   He continued that ACC  recommends that                                                               
the best interest  definition be slightly amended,  and also that                                                               
definitions of "qualified" and "terminally  ill" be included.  He                                                               
then referred  to artificial hydration and  nutrition, suggesting                                                               
that this  belongs in a  different category than  most healthcare                                                               
decisions because it results in  death, and therefore should have                                                               
a  different  standard  than  other  healthcare  decisions.    He                                                               
repeated that  ACC supports the concept  of HB 25 and  hopes that                                                               
work can get done this session so it can become law.                                                                            
                                                                                                                                
CHAIR  DYSON said  he wanted  each committee  member to  indicate                                                               
what questions remain to be  answered before passing the bill out                                                               
of committee.                                                                                                                   
                                                                                                                                
SENATOR GREEN said she didn't have comments at this time.                                                                       
                                                                                                                                
SENATOR WILKEN said he was ready to move the bill.                                                                              
                                                                                                                                
SENATOR DAVIS  said she  wanted time to  read and  understand the                                                               
suggested changes.                                                                                                              
                                                                                                                                
CHAIR  DYSON  suggested  that Representative  Weyhrauch's  office                                                               
work with his office to  address concerns, resolve issues, and to                                                               
isolate  what  cannot be  resolved.    After that,  to  circulate                                                               
copies  of the  proposed  solutions on  these  specific issues  -                                                               
including Mr.  Wagoner's concerns -  to committee members  and to                                                               
others who are  interested.     He asked if it  seemed do-able to                                                               
vote this out of committee at the end of next week.                                                                             
                                                                                                                                
REPRESENATIVE WEYHRAUCH concurred.                                                                                              
                                                                                                                                
CHAIR DYSON said  he thought there would be very  few things that                                                               
there wouldn't be closure on.                                                                                                   
                                                                                                                                
SENATOR WILKEN mentioned that next  week's focus on POMV [Percent                                                               
of Market Value] might affect scheduling.                                                                                       
                                                                                                                                
CHAIR DYSON asked to be kept informed of scheduling conflicts.                                                                  
                                                                                                                                
MR. NOLAN  then added to  his previous testimony, saying  he just                                                               
received a copy of version U.  He  referred to the top of page 8,                                                               
AS  13.52.045,  and  said,  "pregnancy  is back  in  here."    He                                                               
commented  that [subsection]  (c) does  not apply  to EMTs  or to                                                               
ambulance  drivers  when  providing  emergency  services  in  the                                                               
field. He suggested  that under the definitions,  a better phrase                                                               
might be "health  care providers" because depending  on where one                                                               
is  in  the state,  a  field  emergency  medical service  may  be                                                               
performed by  an emergency  trauma technician,  an EMT,  a mobile                                                               
intensive  care  paramedic,  an  RN,  PA,  or  in  some  cases  a                                                               
physician.    He said  that  under  field  conditions it  can  be                                                               
extremely  difficult  to  determine   pregnancy,  and  even  when                                                               
determined, it  is difficult to  determine fetal viability.   His                                                               
suggestion was that "everybody gets covered."                                                                                   
                                                                                                                                
MS.  SYLVESTER  said  that  consideration   was  being  given  to                                                               
deleting  everything  after "does  not  apply  to" and  inserting                                                               
"health care  providers or  emergency trauma  technicians trained                                                               
in accordance with AS 18.08.080  when providing emergency medical                                                               
services."   She  said  this  would cover  all  of the  emergency                                                               
technician-type individuals in the field.                                                                                       
                                                                                                                                
MR.  NOLAN responded  that he  thought this  language would  work                                                               
because  under the  definition of  certified or  licensed "health                                                               
care provider,"  everyone is covered except  for emergency trauma                                                               
technicians.                                                                                                                    
                                                                                                                                
SENATOR GREEN questioned if the  language "in the field" would be                                                               
included at the end of the sentence.                                                                                            
                                                                                                                                
MS.  SYLVESTER said  she believed  so because  this would  not be                                                               
applied in a hospital setting.                                                                                                  
                                                                                                                                
Before  adjournment, CHAIR  DYSON said  that during  the meeting,                                                               
the many good things said  about Representative Weyhrauch and his                                                               
staff had been understatements.                                                                                                 
                                                                                                                                
CHAIR  DYSON held  CSHB 25(JUD)  in committee  and adjourned  the                                                               
Senate Health,  Education and Social Services  Standing Committee                                                               
at 3:10 p.m.                                                                                                                    

Document Name Date/Time Subjects