Legislature(2015 - 2016)CAPITOL 106
04/09/2015 03:00 PM House HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| HB99 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 99 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 99-VOLUNTARY TERMINATION OF LIFE
3:04:33 PM
CHAIR SEATON announced that the only order of business would be
HOUSE BILL NO. 99, "An Act relating to the voluntary termination
of life by terminally ill individuals; and providing for an
effective date."
3:05:14 PM
REPRESENTATIVE HARRIET DRUMMOND, Alaska State Legislature,
paraphrased from the sponsor statement [original punctuation
provided], which read:
House Bill 99 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.
Oregon enacted the first "death with dignity" law in
1994 through a citizens approved ballot initiative.
The Supreme Court upheld the law in 2006. Washington
followed with another ballot vote in 2008. Vermont
passed the first death with dignity law passed by a
state legislature. Similar legislation has now sprung
up in twenty-five other states.
Death is a natural part of life. Providing dignity,
control and peace of mind during a patient's final
days with family and loved ones places a much greater
focus on a person's life than on the often painful and
agonizing process of dying. This bill specifically
requires the request process to stop immediately if
there is any evidence of coercion. The laws further
require the two physicians who work regularly and
closely with terminally ill patients to be involved
throughout the request process. These two qualified
and independent diagnoses ensure against coercion.
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.
3:07:28 PM
KRISTEN KRANENDONK, Staff, Representative Harriet Drummond,
Alaska State Legislature, briefly reviewed the sectional
analysis of the proposed bill, which read: [Included in
members' packets]
Section 1: Page 1: Lines 4-7 Amends AS 11.41.115
(defenses to murder) to allow an affirmative defense
for acting under 13.55.
Section 2: Page 1: Lines 8-10 Adds a new subsection to
AS 11.41.120 (manslaughter) to establish an
affirmative defense to a prosecution for manslaughter
for performing any action allowed in AS 13.55.
Section 3: Pages 1-14: Lines 11-24 Adds a new chapter
AS 13.55, which provides the process in which
terminally ill individuals may request medication to
terminate their life.
Sec. 13.55.010: Describes which individuals may
terminate their life under the new chapter. Lists the
criteria for being a qualified individual. Includes
state residency, being an adult, being capable, having
a terminal disease, and having voluntarily expressed
the wish to die. States that age or disability is not
sufficient by itself to qualify.
Sec. 13.55.020: Authorizes a qualified individual's
attending physician to dispense or write a
prescription for the necessary medication if the
physician complies with the chapter. Authorizes a
pharmacist to dispense the prescribed medication to
the qualified individual, the attending physician, or
an agent of the qualified individual.
Sec. 13.55.030: Requires a qualified individual to
make an oral request and a written request to their
attending physician to receive the necessary
medication. Requires the qualified individual to
repeat the oral request 15 days after the initial
request. Provides alternative request methods for
qualified individuals who are not able to speak or not
able to sign the request.
CHAIR SEATON asked for clarification that Section 13.55.020 was
permissive, and not a requirement, for a physician.
MS. KRANENDONK expressed her agreement and noted that a later
section clearly stated that medical professionals were not under
any obligation to provide these prescriptions. She moved on to
explain the next sections of the proposed bill:
Sec. 13.55.040: Directs the attending physician to
offer the qualified individual the opportunity to
rescind the initial oral request and the written
request when the qualified individual makes the second
oral request. Allows a qualified individual to rescind
a request at any time. Prohibits an attending
physician from dispensing or prescribing medication
unless the physician offers the qualified individual
an opportunity to rescind the request.
Sec. 13.55.050: Sets up the requirements for the
written request. Prohibits the attending physician
from being a witness. Requires the witnesses to attest
that the qualified individual is capable, acting
voluntarily, and not under undue influence to sign.
Sets limits on who may be witness.
Sec. 13.55.060: Lays out a form for the written
request to be signed by the qualified individual.
Sec. 13.55.070: Lays out the duties of the attending
physician. Includes determining whether the individual
has a terminal disease, is capable, and has made the
medication request voluntarily. Also includes
providing certain listed information to the individual
about the medical diagnosis and prognosis, the risks
and probable result of taking the medication, and
feasible alternatives. Requires the physician to refer
the individual to a consulting physician to confirm
the diagnosis and to determine that the individual is
capable and acting voluntarily. Requires the physician
to refer the individual for counseling if appropriate
under Sec. 13.55.090. Lists other duties of the
attending physician. Allows the attending physician to
sign the death certificate.
Sec. 13.55.080: Before an individual can qualify under
the chapter, it requires a consulting physician to
examine the individual and confirm the attending
physician's diagnosis of a terminal disease, and to
verify that the individual is capable, acting
voluntarily, and has made an informed decision.
Sec. 13.55.090: Requires the attending or consulting
physician to refer the individual for counseling and
prohibits the dispensing or prescribing of the
necessary medicine until the counselor determines that
the individual is not suffering from depression
causing impaired judgment.
Sec. 13.55.100: Prohibits the attending physician from
dispensing or prescribing medication unless the
qualified individual has made an informed decision.
Sec. 13.55.110: Prohibits the attending physician from
denying the medication request because the individual
declines or cannot notify next of kin.
Sec. 13.55.120: Requires certain waiting periods
before medication can be dispensed or prescribed.
Sec. 13.55.130: Requires that the medical record of
the qualified individual contains the items listed in
the section before the individual receives the
medication.
Sec. 13.55.140: Invalidates will or contractual terms
that require, prohibit, impose conditions on, or
otherwise addresses whether an individual may make or
rescind a request under this chapter.
Sec. 13.55.150: Provides a person with immunity from
civil and criminal liability or professional
disciplinary action for participating in good faith
compliance with the chapter. States that a medication
request by an individual or an attending physician
providing medication in good faith compliance with
this chapter may not provide the sole basis for the
appointment of a guardian or conservator.
Sec. 13.55.160: States that a health care provider has
no duty to participate.
3:13:47 PM
MS. KRANENDONK continued with her explanations:
Sec. 13.55.170: Under certain conditions allows a
health care provider to prohibit another health care
provider from participating in this chapter.
Sec. 13.55.180: Establishes the crime of abuse for
certain activities. Makes the crime a class A felony.
Sec. 13.55.190: States that the chapter does not limit
liability for civil damages resulting from a person's
negligent conduct or intentional misconduct.
Sec. 13.55.200: Allows a governmental entity to file a
claim against an individual's estate to recover
expenses incurred by the entity resulting from the
individual's termination of life under this chapter.
3:15:24 PM
MS. KRANENDONK moved on with her explanation of the next
sections:
Sec. 13.55.210: Directs the Department of Health and
Social Services to review a sample of the records
maintained under the chapter every year. Requires a
health care provider to file a record of dispensing
medication under this chapter with the department.
Directs the department to adopt regulations to
facilitate the collection of information about
compliance with the chapter. Makes the information
confidential but requires the department to provide
the public an annual statistical report about the
information collected.
Sec. 13.55.220: Prohibits construing the chapter to
authorize or require health care contrary to
applicable generally accepted health care standards.
Prohibits construing the chapter as authorizing the
ending of life by certain methods, including lethal
injection. Establishes that an action allowed by this
chapter is an affirmative defense to certain crimes,
including murder, manslaughter, and euthanasia.
Sec. 13.55.230: Prohibits a person from conditioning
the sale, procurement, issuance, rate, delivery, or
another aspect of a life, health, or accident
insurance or annuity policy, on the making or
rescission of a request for medication under the
chapter.
3:16:31 PM
MS. KRANENDONK explained the following sections:
Sec. 13.55.240: States that a request for medication
under this chapter is not an advance health care
directive under AS 13.52 and that AS 13.52 (Health
Care Decision Act) does not apply to an activity
allowed by the chapter.
Sec. 13.55.900: Defines the terms used in the new
chapter.
3:16:56 PM
MS. KRANENDONK explained the remainder of the bill, which
included:
Section 4: Page 14: Lines 25-29 Indicates that the
chapter applies to contracts, wills, and life, health,
or accident insurance or annuity policies delivered or
issued for delivery on or after the effective date.
Section 5: Pages 14-15: Lines 30-3 Allows the
Department of Health and Social Services to adopt
regulations for the new chapter.
Section 6: Page 15: Line 4 Makes the regulation
authority given under Bill Section 5 take effect
immediately.
Section 7: Page 15: Line 5 Makes the Act (except Bill
Section 5) effective January 1. 2016.
3:17:25 PM
REPRESENTATIVE STUTES asked how many states had already passed
this or similar legislation.
REPRESENTATIVE DRUMMOND replied that there were about six
states.
MS. KRANENDONK relayed that currently Oregon, Washington, and
Vermont had legislation in place, and that Montana and New
Mexico had provisions in law to allow certain types, which she
defined as "modified legislation to this." She reported that it
was moving in various parts in 25 other states.
REPRESENTATIVE STUTES clarified that there were currently only
five states with actual "laws on the books that relate to this."
REPRESENTATIVE WOOL asked how many people had used this
legislation.
MS. KRANENDONK replied that, although there was not data from
all five states, there was 20 years of data from Oregon, which
indicated that 1,173 residents had requested the medication,
with 752 individuals having used the prescriptions to end their
lives. She clarified that this did not include the
prescriptions through 2014.
REPRESENTATIVE WOOL relayed that this was fewer than 40 per
year. He asked whether 18 years was the age limitation, and
pointed out that, although this was the age for a legal adult, a
person could not buy cigarettes or alcohol, but could order this
prescription. He asked whether this was a contradiction.
REPRESENTATIVE DRUMMOND replied that the age of 18 allowed a
person to vote or to serve in the military. She shared that
there had been a lot of comments about this application to other
illnesses, and she acknowledged that there was still work to be
done on the proposed bill.
REPRESENTATIVE WOOL asked for clarification that individuals had
to be deemed terminally ill by two physicians.
REPRESENTATIVE DRUMMOND expressed her agreement, noting that the
time frame definition was for death within 6 months as well as
medicine was able to predict. She opined that about 70 percent
of the people requesting these prescriptions have various types
of cancer, and have "been through every conceivable kind of
treatment, and it's failed, and they know they're going to die."
She pointed out that often the pain was unbearable, and she
offered her belief that many people did not want to end their
lives in the fog of deep pain medication. She shared that,
although she had not been through this personally, she had read
that having the control to use this prescription allowed people
to focus on a new joy in living, with less concern for pain and
other issues.
REPRESENTATIVE FOSTER asked whether it was possible for a person
to shop around until they found two doctors who agreed to this.
MS. KRANENDONK explained that the primary physician determined
whether the medication could be prescribed, whereas a second
doctor only had to confirm the diagnosis for a terminal disease
with less than six months to live. As the bill was currently
written, if a second doctor did not agree with the diagnosis,
the process would be ended.
3:24:47 PM
TERRY BANNISTER, Attorney, Legislative Legal Counsel,
Legislative Legal Services, offered her belief that the proposed
bill could be clarified, as it did not state what would happen
should doctors disagree. She suggested that this could be
addressed in another bill version.
REPRESENTATIVE TALERICO directed attention to page 11, line 11,
and referenced the criminal penalties for the crime of abuse of
the life termination process. He stated that AS 11.41.100
defined murder in the first degree, which included the crime of
murder with the intent to cause the death of a person, or compel
or induce any person to commit suicide through duress or
deception. He asked whether the proposed bill was in conflict
with the statute.
CHAIR SEATON asked whether Representative Talerico was
referencing page 11, line 20, of the proposed bill, which
defined abuse of life termination as a class A felony. He
questioned whether this created any conflict.
MS. BANNISTER, in response, acknowledged that, although she was
not an expert on criminal matters, Sections 1 and 2 of the
proposed bill addressed actual homicides when death had been
achieved, whereas this penalty addressed "someone who attempts
to affect the person's choice of dying," and did not require
that the person had died. She noted that any penalty could be
selected.
REPRESENTATIVE TALERICO asked that this be flagged for later
consideration.
3:28:21 PM
CHAIR SEATON shared that he had received many e-mails requesting
that proposed HB 99 not be scheduled. He offered an anecdote
about his family, and how these issues had affected them. He
offered his belief that this proposed bill considered whether
people had the right to make these decisions for themselves, or
whether the state should make these decisions. He stated his
belief that people should be in control of their lives and be
able to make decisions for themselves. He suggested that this
proposed decision for whether people make their own final
decisions should be discussed. He declared that it was an
interesting dilemma, and he invited thoughtful testimony from
the committee and the public.
3:33:54 PM
REPRESENTATIVE STUTES offered a personal anecdote about a
terminally ill person who was not prepared to die.
CHAIR SEATON said that they wanted to ensure that this decision
was made by the individual, and not by others. He clarified
that he was not the sponsor of HB 99.
[Chair Seaton opened public testimony]
3:35:48 PM
PETER REAGAN, M.D., National Medical Director, End-of-Life
Consultation, Compassion & Choices, shared that he had spent a
lot of time in Alaska, and that he had retired as a family
practice doctor in Oregon, with extensive experience with
terminally ill patients and the Oregon Death with Dignity law.
He noted that, in 1998, he had written the first prescription
under this law. He offered his belief that the history in
Oregon, Vermont, and Washington had shown that patient
safeguards had worked as intended, and there had not been any
substantiated case of abuse or coercion during this time. He
addressed the slippery slope argument of the right to die
becoming a duty to die or another social harm, and stated that
this had not happened. He declared that doctors wanted the best
outcomes for their patients, and there was not any conflicting
motivation in these situations. He declared that doctors
advocated for what their patients wanted. He reported that,
after more than 1,500 prescriptions, there had not been any
instances for when the law had been inappropriately applied, and
there had not been any circumstances which had necessitated
comment or discipline. He emphasized that Oregon had a culture
of care focused on autonomy, self-determination, and increased
communication between doctors and the individuals they served,
as well as between dying patients and their families and
friends. He said that the law provided a useful framework to
aid with this decision making. He stated that proposed HB 99
contained the core patient safeguards of the Oregon Death with
Dignity law, which would provide Alaskans with true patient
autonomy, as well as the opportunity for more open and honest
communication between dying Alaskans and their care givers. He
clarified that this proposed bill was all about patient self-
determination, pointing out that it was not legal in Oregon for
anyone except the person who was dying to request or administer
the medication. That meant that the control was with the
patient from beginning to end. As these deaths were legal, they
were witnessed and experienced by loved ones and caregivers and
were not clandestine or mysterious. He reported that only two
per thousand patients have used the law since its beginning,
about 900 people, with most of these being people with end stage
cancer or end stage ALS. He shared that he had been deeply
moved by the gratitude and relief expressed by patients and
family members when they were allowed to have this choice of
death with dignity. He explained about doctor shopping, noting
that if one doctor did not agree that a patient qualified, then
that ended the process, unless another doctor more familiar with
the case discussed it with the first doctor. He declared that
all the doctors were working to obey both the spirit and the
wording of the law. He addressed the age of 18, pointing out
that this was the age of consent for medical procedures. He
reported that only a very small number of people under 21 years
of age were using this law, noting that he had only written one
prescription for anyone under 30 years of age.
CHAIR SEATON asked whether he had reviewed proposed HB 99, and
if there were any other parts of the proposed bill that needed
clarification.
DR. REAGAN replied that the proposed Alaska bill was very
similar to the Oregon law. He explained that the Oregon bill
clarified that if there were any concern for a mental health
issue clouding the patient's judgement, then the person was
required to have a psychiatric or psychological evaluation. He
acknowledged that someone could be unhappy with their situation,
but, as long as they were "thinking straight" and were clear in
their understanding of the request, the proposed Alaska law had
the same protections as the Oregon law.
3:43:46 PM
KAREN DECHMAN BOND, President, Midtown Community Council,
reported that the community council had passed a resolution
unanimously supporting proposed HB 99. She offered a personal
anecdote, and shared that she had not understood that terminal
illness meant pain day after day. She offered a plea that the
committee make this available to Alaskans, as it was very
Alaskan for people to have power over the way they can die.
3:47:56 PM
PETER BANGS, paraphrased from a prepared statement, which read:
My name is Peter Bangs and I would like to first
disclose that I am a state employee, but I am taking
leave today to share my personal opinions in support
of House Bill 99. I would like to briefly describe two
contrasting experiences that have helped shaped my
beliefs on this issue. Several years ago, my wife's
grandmother, Helen, was severely injured in an
accident. Her doctors told us in no uncertain terms
that she was dying from her injuries, but that it
could take a few weeks. Unfortunately, they were not
able to keep her comfortable. Helen had always been a
remarkably strong and tough woman, but she was in so
much pain and suffering that she kept telling her care
givers that it was time and that she begged them to
let her go. In an effort to speed up the process, she
refused to eat, drink, or take her medications. In
contrast, my wife and I recently lost two dogs - one
to cancer and another to liver disease. For each of
them, we made the decision to put them to sleep after
exhausting treatment options and when they were no
longer comfortable. As much as we hated to let them
go, I am grateful that we had the option to end to
their needless suffering. When it comes to people, I
don't understand why we can't provide our loved ones
with the same freedom to die with dignity and
compassion as we do for our companion animals. This is
an issue about allowing people to make their own
decisions according to their own desires and beliefs.
To put this issue in perspective, consider that Alaska
allows 19 year old kids to decide whether to use
tobacco, even though tobacco products cause cancer and
premature deaths for hundreds of thousands of people
in the US each year. One of the main reasons that
tobacco - and now marijuana - is legal is because
Alaskans value the right to make their own decisions,
even if you or I don't agree with their choices. That
is exactly what HB 99 is all about - empowering
terminally ill people with the right to die on their
own terms according to their own desires and beliefs -
not yours or mine. Thank you.
3:50:42 PM
KELLY BEHEN emphasized that this was a very important
conversation to have, declaring that every person had the right
to die with dignity and as painlessly as possible, when
suffering a terminal illness. She offered a personal anecdote
about the death of her fiancé. She expressed her desire that
people have control over "the last and most important decision
they do have in their life."
3:52:53 PM
SUSAN ARTHUR declared that this had been very important to her
for many years, and she offered an anecdote about the death of
her mother. She stated that her mother's death had been denied
"by others who were not related, not emotionally involved, nor
had ever felt such total anguish and helplessness." She
declared that there was not any moral justification for
prolonging misery on a fellow human being. She pointed out that
"this humane bill has many built in safety measures so it cannot
be misused." She said that it would be a comfort to Alaskans
who existed in pain and suffering to at least know they have the
choice to end it.
3:54:41 PM
RALPH FENNER asked that the proposed bill be passed, stating
that choice was the key. He offered an anecdote of his wife's
suffering and slow death from colon cancer. Even though her
family and her doctor wanted to help her with her suffering, the
law would not allow it. He emphasized that "we need to open our
eyes in this state and do all we can to prevent such a
horrendous occurrence."
3:57:04 PM
NANCY CLONAN read excerpts from a suicide note from her husband,
declaring that, if the proposed bill were passed, no one would
ever have to go through this again. She read:
If you are reading this, I am dead. I did not come by
this decision lightly. I didn't plan on getting
melanoma or brain cancer. These are horrendous things
I have no control over, but how I choose to live and
die I do have control over. Euthanasia, in Greek,
meaning good death ... I believe in this because
society does not. I could not discuss this you. I
wanted to protect you from all aspects of my death. I
do not believe that for me there is dignity in long
suffering and debilitating death. To know you would
see the suffering, pain and anguish I would have gone
through were not the memories I want for you to have
of me, nor do I want to suffer from them physically
with no possibility of recovery. My death is not fear
based, it is my choice. I think society is archaic to
put its values on something so personal. Let society
live like this and I believe the majority would choose
to let people decide for themselves. I get enraged to
hear other people tell me what I should do, ask if I
am doing enough, or worse, tell me that is not what
they would do. For a country that prides itself on
individuality it is amazingly overbearing in its views
of death and dying. I believe in life with dignity
and dying and the dying, me and millions like me,
should have dignity in the way we see fit, not what
politicians and family members who are not in the fray
wants, but what those suffering want, and what I want.
This is not a suicide. It is no momentary
hopelessness with terminal illness. Cancer killed me,
I did not kill me. I helped myself live with dignity
and a purpose I have not felt in a long while, and I
have helped myself die with a measure of control I've
not had in four years in an unending battle with a
disease that is robbing me of the things that I love.
MS. CLONAN continued to read:
I want what I have worked so hard to build with you to
be what I leave with you. Me at my best. I love you
very much and would never want to leave you with a
legacy of shame. This is a choice for me in my last
days to go on my terms. People can hold my hand and
feel bad, but they cannot know what it feels like to
have had cancer inside eating away at you, and you're
being able to physically feel it chew away your body
and eating your brain like a parasite eating its host
alive. I did not expect others to understand but I
expected others at a minimum to respect me as a human.
I deserve that. I am kind and only wanted kindness
back.
MS. CLONAN stated that the reality of losing her husband 30
years early to cancer was horrible, and it had forced him to use
the last of his own strength to die alone. She stressed that
the proposed bill could keep others from dying alone, protect
families from this trauma, and offer an opportunity to extend
quality time for the terminally ill without the threat of legal
consequences.
4:00:36 PM
J. R. MEYERS, Alaska Constitution Party, stated that the party
supported the right of life, as this was a paramount duty of
government to support. He stated that medical professionals
were licensed by the state, and that the medical community had
an historical position for not "doing active harm." The
proposed bill would make medical professionals the potential
agents for termination of life, which, he declared, would
reverse centuries of precedent. He offered the belief that this
would lead to degradation in the value of life. He stated that
this was different from "do not resuscitate" and from "declining
extraordinary medical interventions with informed consent." He
noted that this also was different from the way we treat our
pets, as many laws made this differentiation between humans and
animals. He testified against the proposed bill, stating that
it was "an affront against human life."
4:02:38 PM
LANCE ROBERTS said that he was representing himself and he
expressed his concern for the proposed bill. He reported that
he had sent out a local message when he first learned of the
proposed bill. He shared a response to his message, stating
that, decades ago, a person had wanted to commit suicide because
he had been determined to be terminally ill, but his family had
talked him out of it and he had lived an additional 20 years.
He declared that it was necessary to remember that science and
doctors were not perfect, and that people could get better. He
stated that it was important not to accept infallibility, even
with two doctors. He also pointed out that Alaska had the
highest suicide rate in the nation, and that a lot of people
were actively working to stop this. He declared that the
proposed bill was "telling people that suicide is okay. You're
telling them it's an acceptable alternative at some point in
time." He asked that the proposed bill not be passed out of
committee.
4:05:33 PM
JIM BECK stated his adamant opposition to the proposed bill. He
reported that the American Medical Association and 24 states had
also rejected this. He acknowledged that the personal stories
were very compelling, and he did not intend to minimize those
experiences. He expressed his hope that the Alaska State
Legislature would see that its duty was much broader, to all of
society, and that this bill should be rejected. He offered his
belief that "handing medical professionals the right to end life
is a recipe for disaster and nothing that our state should be
involved with." He offered an example that medical
professionals already devalue or undervalue the lives of people
with disabilities, and suggested that this same attitude toward
the quality of life would be extended to terminally ill people.
He said that this was a very dangerous mix that could
undoubtedly result in an incorrect and unfortunately very
irreversible outcome. He asked if doctors would rally around
someone who expressed the desire to die and use the best
practices and palliative care to ensure the last days were the
best. He stated that the proposed bill could end some people's
lives without their consent through mistakes and abuse.
Assisted suicide proponents confused bureaucracy with
safeguards. He stated that doctor shopping was common in
Oregon, and that Compassion & Choices would offer referrals for
assistance. He said that assisted suicide was a deadly mix with
our profit driven health care system, and, as it was the
cheapest treatment, it would save money for insurance companies.
He suggested that financial and emotional pressures could also
make people choose death, and he offered his personal opinion,
as a person with a disability, that he keenly felt the burden.
He asked how hard people would work to ensure that people
received best practice palliative care. He declared that it was
ludicrous to believe that there had never been coercion in the
Oregon experience. He stated that the Oregon experience lacked
data and transparency. He declared that the proposed bill was
unnecessary as everyone already had the right to refuse
treatment, and could receive palliative care which included pain
relief and sedation. He urged that the committee reject the
proposed bill.
4:10:00 PM
RICHARD ASHER, M.D., reported that he was a family physician,
and that he had been practicing in Alaska since 1982. He
expressed his agreement that taking care of patients at the end
of life was challenging, and that patients in Rural Alaska were
in control of life as much as their mental ability allowed. He
stated that physicians worked with the patients and their
families to provide terminal care and to prepare for death. He
suggested that the proposed bill would change the doctor,
family, patient relationship as it could cause dissension in the
family. He stated that the Hippocratic Oath was not mentioned
in the proposed bill, or why a healer should go in opposition to
this historical pledge for not taking life. He stated that it
took skill to provide superb, end of life care. He opined that
the proposed bill was dangerous as it gives a physician too much
power. He stated that he did not keep patients alive against
their will, as it was their right to refuse treatment, and that
he worked with hospice and palliative care physicians to give
better care in Rural Alaska, stating that it was more
compassionate to give care, than to assist suicide. He asked
how it could be determined whether someone was coerced, as it
was cloaked in a shroud of secrecy, which made it difficult to
ascertain any abuses. He pointed out that Alaska already had a
huge suicide rate, and they had worked hard telling people to
live and have hope. The proposed bill sent the wrong message to
depressed suicidal youth and adults. He asked that the
committee not pass the proposed bill. He stated that it was,
instead, necessary to become better at palliative, hospice, and
compassionate care.
4:13:47 PM
GEORGE STEWART stated that he was a retired physician and had
practiced intensive care medicine in Anchorage for 34 years. He
spoke in opposition to proposed HB 99, stating that it was not
about giving patients the right to die, but it was giving
physicians the right to kill. He stated that suicide was
tragic, but not illegal. He opined that the proposed bill was
dangerous for physicians, referencing the Hippocratic Oath, and
stated that it destroyed the trust, which was the foundation in
a doctor-patient relationship. He declared that it takes really
great skill to provide superb end-of-life care. He said that
the proposed bill was dangerous for families, as they don't have
to be informed. He offered his belief that it will open doors
for elder abuse by self-centered care providers or greedy
relatives. He said the right to die for elders will be
dangerous for patients as it will become a duty to die. He
reported that drugs used for end of life did not work 20 percent
of the time. He said that often patients live longer than the
guesstimate of six months. He said that physician assisted
suicide was dangerous for society, as statistics showed that
doctors would only get a second opinion from a doctor who they
knew would agree, and that, while under physician assisted
suicide laws, they were immune from malpractice. He asked for
the origin of the proposed bill.
4:17:54 PM
PATRICIA COLL FREEMAN stated her opposition to the proposed
bill. She said that a measure of quality in society was with
the treatment of family members who were dependent, defenseless,
and disenfranchised, which included people who were seriously
ill. She reported that, in 2001, the Alaska Supreme Court had
unanimously ruled that there was not a state constitutional
right for doctor prescribed suicide, writing that the
"terminally ill are the class of persons who need protection
from family, social, and economic pressures and who are often
particularly vulnerable to such pressures because of chronic
pain, depression, and the effects of medication." She stated
that these serious ill persons deserved real compassion and
better access to health care, and not death. She opined that
the proposed bill would limit health care choices. She said
that in Oregon, doctor prescribed suicide had limited access to
health care, as the state health plan would not provide certain
pain relieving and lifesaving medications, which included
recommended but costly cancer treatments. She offered an
anecdote of an Oregon cancer patient who was informed that her
chemotherapy treatment would not be covered but a doctor
prescribed suicide would be covered. She declared that the
choice to die would become the duty to die, and that advocates
for those with disabilities opposed the proposed bill. She
asked that the committee oppose the proposed bill.
4:21:12 PM
JANET MCCOY stated that she was opposed to HB 99. She relayed
that there was no way to protect the vulnerable and mentally ill
once this passed. She reported that, although supporters of
doctor prescribed suicide had long maintained that it was
necessary for those suffering from intractable pain, there was
no documented case in Oregon for its use because of untreatable
pain. She referenced a study of reasons cited for prescribed
suicide, and noted that pain or fear of pain was the least
offered reason. She stated that nearly all terminally ill
patients who desired death were suffering from treatable mental
disorders, yet only 6.7 percent were referred for a psychiatric
evaluation. She noted that many non-terminally ill patients had
received the prescription. She said that a network of doctor
prescribed "death proponents" ensured that patients received
legal prescription even when the family doctor knew that the
desire for death was transient and could be alleviated with
proper care and concern. She noted that there were cases when
family pressure was placed on patients. She declared that human
worth did not diminish as we weaken or age, or if we live with a
disability. She asked that the committee oppose HB 99.
4:23:50 PM
MARY LANZA, M.D., stated that she was in opposition of HB 99.
She reported that she had been a physician for 27 years,
practicing in Alaska for 21 years, as a board certified
anesthesiologist with training in pain management. She stated
that her research had found many falsehoods propagated by those
seeking physician assisted suicide, stating that pain was not
the driving cause, but was, instead, psychological distress,
including depression, hopelessness, and a fear of loss of
control. She stated that suicide was not rational. She shared
a statement that a person wanting to commit suicide would lead
the medical community to take the appropriate steps for
treatment. She said that her role as a physician was to
alleviate suffering, but that was "distinct from apportioning
death, even upon request." Autonomy alone can never be a
substitute for moral reason, and that implication was dangerous
to society. If interest in legalizing euthanasia was tied to
any trend in history, it was to the rise of individualistic
strains of thought that glorified personal choice. She stated
that no one was obligated to use extraordinary or heroic means
to stay alive, but to use ordinary and reasonable measures to
treat disease and sickness. She said that the recent actions
were a perverse incentive for insurance carriers to promote the
option of physician assisted suicide over lifesaving care. She
said that the focus of concern should be those individuals most
likely to be abused by physician assisted suicide, including the
poor, the poorly educated, and the disabled, as well as those
who could not speak for themselves. She suggested a re-doubling
of efforts in the education of patients, family members, and
loved ones, as well as physicians, to promote better end-of-life
care.
4:29:36 PM
CYNTHIA KIMBLEY shared an anecdote about her father, and his
recent loss of independence due to a terminal illness. He was
suffering from anxiety, as this was not the quality of life he
had always experienced. She pointed out that he had a health
care directive, which was allowed by law, and that he had
several times expressed to family members his desire for a death
with dignity law in Alaska. She pointed out that the Oregon law
was clear that the ability to choose was the patient's, and that
the patient must administer the medication themselves. She
asked who had the right to decide for someone else that they had
to remain alive, solely for our emotional well-being. She
stated her support for her father's choice of death with
dignity, pointing out that this was only specific to terminal
patients and their ability to choose quality and quantity of
life.
4:33:05 PM
CHRISTOPHER KURKA, Executive Director, Alaska Right to Life,
said that suicide did not dignify, it was surrender and despair,
and it was not the answer for pain. He said that this was a sad
state of affairs to come to as a culture. He directed attention
to euthanasia in Europe. He encouraged the committee to vote no
on HB 99.
4:36:52 PM
RON JOHNSON stated that he was in favor of the proposed bill,
pointing out that it was important to have this discussion. He
noted that a similar law in Oregon had not been abused. He
pointed out that 85 percent of Canadian health care
professionals supported similar legislation. He shared that he
is in a wheelchair, and he offered his belief that not having
proposed HB 99 was the discrimination against the disabled. He
stated that he was moved by the testimony of those with loved
ones who were suffering interminably in the last stages of life,
and how they had desired a means to help them. He noted that he
had not heard any personal encounters from those in opposition
to the proposed bill.
4:39:15 PM
MONTE JORDAN stated that she was in support of proposed HB 99.
She paraphrased from a letter that she had submitted: [Included
in members' packets]
I am writing in support of HB 99 by Rep. Drummond. I
believe it is referred to by many as the "the right to
die bill" although I personally consider it the "death
with dignity" bill. My fervent belief is that every
person has a right to die with dignity when suffering
a terminal illness and as painlessly as his/her
medical provider and family can arrange. This
conviction is the result of my experiences with the
end of life. As a hospice volunteer I have watched
people progress towards their death. No doubt, many
would not want to end their lives sooner. All are
given significant doses of pain relieving medication,
some to the degree that they are not aware of the
family or friends that may be at their bedside. Others
may welcome the choice of when and how the end of
their life would take place. The choice to be
conscious of their surrounding and the ability to say
goodbye. My Father died a painful cancer death in 1965
two days before his 52nd birthday and on my 22nd
birthday. Of course, he was deeply medicated that last
night that I sat in his hospital room therefore
oblivious to my presence. Perhaps he would have chosen
a different end, I don't know but the operative word
is "choice". We have many protections for our right to
choose how to live our lives, to be free to make
choices yet such freedoms are denied when dying. As
has been pointed out by many, our pets and other
animals are allowed more privilege than us. Four
months ago I was able to ask the kind veterinarian to
put my 16 year old cat down when his kidneys gave out
rather than try to keep him alive for an unknown but
likely short period of time. I wish for, ask for the
same option - to be "put down" at my request when my
body is giving out. Please bring this bill up for a
hearing so all views can be discussed. You may wish to
review this site: deathwithdignity.org
4:42:14 PM
MARGARET DORE, President, Choice is an Illusion, paraphrased
from a prepared statement which she had submitted to the
committee: [included in members' packets]
I am a lawyer in Washington State where assisted
suicide is legal. Our law is similar to a law in
Oregon. The proposed bill to legalize assisted suicide
in Alaska is similar to both laws. Problems with
legalization include the following: 1. the proposed
bill legalizes assisted suicide for persons with a
"terminal disease," which is defined as having less
than six months to live. In Oregon, which uses the
same definition, young adults with chronic conditions
such as diabetes are "eligible" for assisted suicide.
Such persons can have years, even decades, to live.
Consider also, Jeanette Hall, who was adamant that she
would do assisted suicide, but was convinced to be
treated instead. Today, nearly 15 years later, she is
"thrilled to be alive." 2. In Oregon, that state's
Medicaid Plan steers people to suicide through
coverage incentives. 3. Legalization is a recipe for
elder abuse. Your bill, like Washington's law, allows
one of two witnesses on the lethal dose request to be
an heir who will benefit from the patient's death.
Once the lethal dose is issued by the pharmacy, there
is no oversight. Even if the patient struggled, who
would know? 4. In Oregon, other conventional "violent"
suicides have increased significantly with the
legalization of physician-assisted suicide. In Oregon,
conventional suicides are a $41 million problem due to
hospitalization costs, etc. Legalization, regardless,
sends the wrong message to young people that suicide
is an acceptable solution to life's problems. Alaska
already has highest suicide rate in the nation.
Washington's mistake. Tell your legislators to say
"NO" to assisted suicide.
4:47:12 PM
ANDREW LESSIG stated that he was in support of the proposed
bill. He shared that he had reviewed these laws while currently
attending law school. He acknowledged that Alaska did have the
highest rate of suicide in the nation, and if viewed by age
demographics, the highest rate of suicide was by people over the
age of 70, who understood their health and their future
prospects and took it upon themselves. He stated that a death
with dignity law would help to lower this suicide rate, as it
would allow them to end their lives on their terms, and remove
the stigma. He directed attention to the suicide rates in
Oregon and Washington. He suggested that, should this fail in
the legislature, it should be put on the ballot. He pointed out
that a similar measure in the State of Washington had received
more than 58 percent support, even more popular than marijuana
on the same ballot, and that he supported the proposed bill.
4:49:54 PM
MARLENE EDENSHAW stated that she was in full support of HB 99.
She stated that she did not want to be medicated and left to
die, that she wanted to be able to die when she wanted.
4:51:45 PM
REPRESENTATIVE DRUMMOND shared the story that had inspired her
to bring this legislation forward. She relayed that a young,
newly married woman from California had been recently diagnosed
with brain cancer and had to move to Oregon to take advantage of
the death with dignity laws. She thought about the help this
legislation would bring to so many Alaskans who would otherwise
have to move away from their friends in Alaska to have any
control over the last days and weeks of their lives. She shared
that she had learned a lot in the brief time that she had been
researching this issue, and what transpires with death with
dignity bills.
CHAIR SEATON noted that some things needed to be clarified in
the proposed bill.
REPRESENTATIVE WOOL asked, after listening to the testimony, if
she shared any of the concerns with the non-supporters of the
bill, for example, what was the definition of terminal. He
asked if she shared any concerns for misuses or had she thought
about these concerns.
REPRESENTATIVE DRUMMOND relayed that she would research whether
the patient was to take the medication themselves, or have the
doctor administer it, and determine if this needed to be added
to the proposed bill. She offered her belief that the majority
of the bill was modelled on the Oregon law, where it did not
appear there had been any coercion or misuse. She stated that
she would work on the issues, and look into palliative care and
end of life care in Alaska.
4:55:28 PM
REPRESENTATIVE VAZQUEZ offered her belief that there were
several loopholes in the proposed bill, suggesting that there
was not any professional supervision after the prescription was
written. She opined that there were fewer safeguards in this
situation than when signing off on a will.
REPRESENTATIVE DRUMMOND said that she would look at these.
REPRESENTATIVE TARR thanked the testifiers for sharing their
emotional stories.
[HB 99 was held over]