HB 54-TERMINALLY ILL: ENDING LIFE OPTION  3:06:37 PM CHAIR SPOHNHOLZ announced that the first order of business would be SPONSOR SUBSTITUTE FOR HOUSE BILL NO. 54, "An Act providing an end-of-life option for terminally ill individuals; and providing for an effective date." 3:07:00 PM REPRESENTATIVE HARRIET DRUMMOND, Alaska State Legislature, paraphrased from the Sponsor Statement [Included in members' packets, which read in part: This bill allows patients to have important end-of- life discussions with the doctors they already know and trust. Without this discussion, well-meaning doctors are faced with prescribing painful procedures even when the patient does not want them and there is little or no hope for success. People in these conditions have already lost their health and often much, much more. This bill at least lets them control the last and most important decision they have left. House Bill 54 allows terminally ill patients to ease their suffering and hasten an inevitable and certain death. This bill preserves dignity and a person's right to live, and die, on their own terms according to they own desires and beliefs. REPRESENTATIVE DRUMMOND offered an update of the bill since the last hearing during the spring of 2017. She relayed that a survey had been conducted of more than 600 Alaskans which showed that more than 70 percent of voting Alaskans supported an end of life option, "such that this bill allows." She declared that community support was also rising, directing attention to a Kodiak Island Borough assembly resolution in support of the proposed bill. She encouraged support of the proposed bill. 3:08:52 PM REPRESENTATIVE SULLIVAN-LEONARD asked for more information about the survey. REPRESENTATIVE DRUMMOND explained that this survey by a private group was offered regularly on a quarterly basis and questions could be added. In response, she said that the cost, paid by her office account, was between $1600 - $1800. CHAIR SPOHNHOLZ pointed out that Representative Saddler, although present, was a committee alternate, and would not be needed to participate as a committee member. 3:10:02 PM CHAIR SPOHNHOLZ moved to adopt Amendment 1, labeled 30- LS0254\O.1, Laffen/Bannister, 1/29/18, which read: Page 2, line 21, following "request": Insert "and a written request" Page 2, following line 28: Insert a new subsection to read: "(c) Notwithstanding (a) of this section, if a qualified individual is not physically able to sign a written request, the qualified individual may direct another individual to sign for the qualified individual." Page 2, line 31, following "request": Insert "and the written request" Page 3, following line 4: Insert new sections to read: "Sec. 13.55.050. Written request requirements.  (a) A written request for medication under this chapter must be in substantially the form described in AS 13.55.060, signed and dated by the qualified individual, and witnessed by at least two other individuals. The attending physician may not witness the request. The witnesses shall, in the presence of the qualified individual, attest that, to the best of their knowledge and belief, the qualified individual is capable, acting voluntarily, and not under undue influence to sign the request. (b) Only one witness may be (1) a relative of the qualified individual by blood, marriage, or adoption; (2) an individual who, at the time the qualified individual signs the request, would be entitled to a portion of the estate of the qualified individual at death under a will or by operation of law; or (3) an owner, operator, or employee of a health care facility where the qualified individual is receiving medical treatment or is a resident. (c) If the qualified individual is an inpatient in a long-term care facility when the qualified individual signs the request, one of the witnesses shall be an individual designated by the facility who has the qualifications established by the department by regulation. In this subsection, "long-term care facility" includes an assisted living home as defined in AS 47.32.900 and a nursing facility as defined in AS 47.32.900. Sec. 13.55.060. Form for written request. A request for a medication under this chapter must be in substantially the following form: REQUEST FOR MEDICATION TO END MY LIFE I, _________________, am an adult of sound mind. I am suffering from _______________, which my attending physician has determined is a terminal disease and which has been medically confirmed by a consulting physician. I have been fully informed of my diagnosis, prognosis, the nature of the medication to be prescribed and potential associated risks, the expected result, and the feasible alternatives, including comfort care, hospice care, and pain control. I request that my attending physician prescribe medication that will end my life in a humane and dignified manner. INITIAL ONE OF THE FOLLOWING: _____ I have informed my family of my decision and taken their opinions into consideration. _____ I have decided not to inform my family of my decision. _____ I have no family to inform of my decision. I understand that I have the right to rescind this request at any time. I understand the full import of this request, and I expect to die when I take the medication to be prescribed. I further understand that, although most deaths occur within three hours, my death may take longer, and my attending physician has counseled me about this possibility. I make this request voluntarily and without reservation, and I accept full moral responsibility for my actions. Signed: _____________________ Dated: ______________________ DECLARATION OF WITNESSES We declare that the person signing this request (1) is personally known to us or has provided proof of identity; (2) in our presence signed or directed another person to sign this request; (3) is not an individual for whom either of us is the attending physician; and (4) to the best of our knowledge and belief, (A) has the ability to make and communicate health care decisions to health care providers; and (B) is acting voluntarily and not under undue influence. _______________________ Witness 1 Date: _____ _______________________ Witness 2 Date: _____ NOTE: One witness may not be a relative (by blood, marriage, or adoption) of the individual signing this request, may not be entitled to a portion of the individual's estate on death, and may not own, operate, or be employed at a health care facility where the person is an individual or resident. If the individual is an inpatient at a health care facility, one of the witnesses shall be an individual designated by the facility." Page 3, line 5: Delete "Sec. 13.55.050" Insert "Sec. 13.55.070" Page 3, line 22: Delete "AS 13.55.070" Insert "AS 13.55.090" Page 4, line 2: Delete "AS 13.55.110" Insert "AS 13.55.130" Page 4, line 20: Delete "Sec. 13.55.060" Insert "Sec. 13.55.080" Page 4, line 26: Delete "Sec. 13.55.070" Insert "Sec. 13.55.090" Page 5, line 2: Delete "Sec. 13.55.080" Insert "Sec. 13.55.100" Page 5, line 7: Delete "Sec. 13.55.090" Insert "Sec. 13.55.110" Page 5, line 10: Delete "Sec. 13.55.100" Insert "Sec. 13.55.120" Page 5, line 13, following "prescription": Insert "and more than 48 hours have elapsed between the qualified individual's written request and the writing of the prescription" Page 5, line 14: Delete "Sec. 13.55.110" Insert "Sec. 13.55.130" Page 5, following line 18: Insert a new paragraph to read: "(2) all written requests by a qualified individual for medication under this chapter;" Renumber the following paragraphs accordingly. Page 6, line 2: Delete "Sec. 13.55.120" Insert "Sec. 13.55.140" Page 6, line 6: Delete "Sec. 13.55.130" Insert "Sec. 13.55.150" Page 6, line 19: Delete "Sec. 13.55.140" Insert "Sec. 13.55.160" Page 6, line 28: Delete "Sec. 13.55.150" Insert "Sec. 13.55.170" Page 7, line 5: Delete "Sec. 13.55.160" Insert "Sec. 13.55.180" Page 7, line 9: Delete "Sec. 13.55.170" Insert "Sec. 13.55.190" Delete "AS 13.55.130" Insert "AS 13.55.150" Delete "13.55.140" Insert "13.55.160" Page 7, line 10: Delete "AS 13.55.150" Insert "AS 13.55.170" Page 7, line 11: Delete "AS 13.55.160" Insert "AS 13.55.180" Page 7, line 27: Delete "Sec. 13.55.180" Insert "Sec. 13.55.200" Page 8, line 12: Delete "Sec. 13.55.190" Insert "Sec. 13.55.210" Page 8, line 14: Delete "Sec. 13.55.200" Insert "Sec. 13.55.220" Page 8, line 18: Delete "Sec. 13.55.210" Insert "Sec. 13.55.230" Page 9, line 2: Delete "Sec. 13.55.220" Insert "Sec. 13.55.240" Page 9, line 12: Delete "Sec. 13.55.230" Insert "Sec. 13.55.250" Page 9, line 20: Delete "Sec. 13.55.240" Insert "Sec. 13.55.260" Page 9, line 26: Delete "Sec. 13.55.250" Insert "Sec. 13.55.270" Page 10, line 1: Delete "AS 13.55.220" Insert "AS 13.55.240" Page 11, line 11: Delete "AS 13.55.150" Insert "AS 13.55.170" Page 11, line 13: Delete "AS 13.55.150" Insert "AS 13.55.170" 3:10:28 PM REPRESENTATIVE TARR objected for discussion. CHAIR SPOHNHOLZ explained that proposed Amendment 1 would include in statute a requirement that a terminally ill individual's desire for life ending medication be written down and witnessed by two individuals. Of those two, only one could be related to an individual entitled to a portion of the estate of the individual whose life would be ending or be employed by the health care facility where the individual was living or receiving treatment. She clarified that two interested parties could not sign off on this. She shared that there was an exemption to the written requirement if the individual did not possess the capacity to physically sign the document. In that case, the individual could direct another person to sign on their behalf. She reported that pages 2 and 3 of proposed Amendment 1 spelled out the form of the written request and the witnessing aspect. She directed attention to page 5, lines 1 - 2, of proposed Amendment 1, where the written request waiting period was outlined. On page 5, lines 10 - 11, the documentation requirement was outlined. 3:11:38 PM REPRESENTATIVE TARR removed her objection. 3:11:47 PM REPRESENTATIVE SULLIVAN-LEONARD objected. REPRESENTATIVE EASTMAN asked about a request for medication by an individual as an option, as they may be unsure of their decision. He asked if these witnesses would have to be present during the administration of the medicine. CHAIR SPOHNHOLZ said no. 3:12:35 PM REPRESENTATIVE JOHNSTON directed attention to Page 2, line 7 and asked if the "by regulation" referenced the facility and not the person. CHAIR SPOHNHOLZ replied, "correct." REPRESENTATIVE EASTMAN acknowledged that the concerns for coercion had been raised in the last year. He asked if there were concerns for coercion regarding an individual, and whether that would prohibit the written request from going through or would it not have an effect. CHAIR SPOHNHOLZ offered her belief that the written request was to document and insure that coercion was not in place. REPRESENTATIVE EASTMAN asked if a situation of coercion would prohibit this as a second attempt. CHAIR SPOHNHOLZ questioned whether the reference of second attempt was toward an individual choosing to end their life. She opined that the individual would still have the autonomy for choice. 3:14:24 PM REPRESENTATIVE SULLIVAN-LEONARD maintained her objection. 3:14:33 PM A roll call vote was taken. Representatives Spohnholz, Johnston, Edgmon, Kito, and Tarr voted in favor of proposed Amendment 1. Representatives Sullivan-Leonard and Eastman voted against it. Therefore, Amendment 1 was adopted by a vote of 5 yeas - 2 nays. 3:15:27 PM REPRESENTATIVE EASTMAN asked what would appear on the death certificate if someone went through this process. REPRESENTATIVE DRUMMOND offered her understanding that the diagnosis on the death certificate would be the terminal illness which would have killed the person. REPRESENTATIVE EASTMAN mused that, from a legal perspective, it would appear that the person had not engaged entirely in this process, and they had died of natural causes. REPRESENTATIVE DRUMMOND replied, "I think so." REPRESENTATIVE SADDLER (alternate) asked to clarify that, although he was not allowed to vote on the proposed bill, he was not allowed to debate the issue, as well. CHAIR SPOHNHOLZ offered her belief that "an alternate is to make sure that you caucus is properly represented and that you're here for informational purposes." 3:17:59 PM REPRESENTATIVE TARR moved to report SSHB 54, Version 30- LS0254\O, as amended, out of committee with individual recommendations and the accompanying fiscal notes. 3:18:13 PM REPRESENTATIVE EASTMAN objected. He shared that his concerns were "squarely on the side of what happens when what is supposed to happen doesn't happen." He declared that a chief role of government was to protect an individual's right to life and he expressed his concern that within this intention of creating a path for things to happen, there would be abuse. He stated his concern that, if there was no requirement for any witnesses to be present when the drugs were administered, it would be very difficult for law enforcement to investigate if something criminal and illegal did take place which resulted in the death. He declared that this was not a fulfillment of the role to protect an individual's right to life, or to prosecute someone who took a life criminally. He expressed his concern that the age requirement for this process was very young. 3:20:46 PM REPRESENTATIVE SULLIVAN-LEONARD echoed the comments of Representative Eastman and stated that she did not support the proposed bill. She stated that she believed in the sanctity of life, from beginning to end. She shared a personal anecdote of death within her family. She declared that this was a very controversial bill. 3:21:44 PM REPRESENTATIVE TARR referenced the sad stories shared earlier. She declared that each individual had the right to make this decision. She expressed her concern for the more vulnerable populations, including seniors and those individuals with disabilities. She directed attention to page 2, line 7, that an individual did not qualify solely because of age or disabilities. She noted that many elders did feel themselves a burden on family, especially as their health deteriorated, they had more significant needs, and they did not have the resources or access to good health care. She offered her belief that, as the language of the proposed bill was restrictive, the issues had been addressed sufficiently. She stated her support of the proposed bill. She acknowledged that the witness aspect was "an interesting component" and she expressed her desire that the bill sponsor further address this as the bill moved forward. 3:24:11 PM CHAIR SPOHNHOLZ offered her belief that it was a fundamental right for an individual to make the decisions for their own body. She allowed that the proposed bill included numerous safeguards, including the written requirement. She said that it was important to document the process. She directed attention to page 7, line 27, which established AS 13.55.180, a new section establishing criminal penalties for anyone committing the crime of abuse of life ending process of a person. She pointed out that this was equivalent to murder and may be punished similarly. She declared that this proposed bill was not legalizing anything other than giving an individual the right to make their own choices with their bodies. This did not give anyone else the right to choose to end another's life. 3:26:32 PM REPRESENTATIVE EASTMAN maintained his objection. 3:26:37 PM A roll call vote was taken. Representatives Spohnholz, Johnston, Edgmon, Kito, and Tarr voted in favor of SSHB 54. Representatives Sullivan-Leonard and Eastman voted against it. Therefore, CSSSHB 54, Version 30-LS0254\O, was reported out of the House Health and Social Services Standing Committee by a vote of 5 yeas - 2 nays.