Legislature(1995 - 1996)
02/06/1996 03:05 PM House HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HB 371 - RIGHTS OF TERMINALLY ILL PERSONS Number 104 CO-CHAIR TOOHEY asked Representative Kay Brown, prime sponsor of HB 371 to come forward and present the sponsor statement. REPRESENTATIVE KAY BROWN, Prime Sponsor, said she, along with several other representatives including Representative Toohey as a joint sponsor, had introduced HB 371 which would strengthen the rights of terminally ill patients. She emphasized this legislation applies in situations where the person's death is inevitable and near at hand. The bill would establish a law that would allow terminally ill patients to request their physicians to prescribe life-ending medication for self-administration by the patient, subject to safeguards that are built into the bill such as a diagnosis by two physicians and the signature of the requester must be witnessed by two disinterested individuals who would not have any benefit from the decision. Number 190 REPRESENTATIVE BROWN feels this is a compassionate approach, which upholds the dignity of terminally ill citizens by allowing them sole and exclusive control over their final stage of life. It does promote the philosophy that government should stay out of this matter, which should be exclusively decided between the physician and the patient. It is based on principles of autonomy, self- determination and privacy. Number 230 REPRESENTATIVE BROWN said she recognizes there are different points of view and she respects those. She also respects the right of each person to live out their life in the way they believe is appropriate and true to their own moral beliefs. She feels this legislation is consistent with that approach because it would allow all citizens to do that. It also allows those citizens who choose not to participate not to be involved in any manner. CO-CHAIR TOOHEY asked if there were any questions of Representative Brown. Hearing none, she announced we would go to the Kenai teleconference site. Number 314 DICK BOGARD testified via teleconference from Kenai. He believed the main intent and purpose of this legislation was spelled out on page 2, Section 2, "....a fundamental right to make their own end- of-life decisions." He thought this was an important statement to keep in mind. He expressed concern that if a person makes out a Do Not Resuscitation (DNR) order and the Request for Medication, the Request for Medication has to be made out a second time. He pointed out this is fine for an individual who has a slow advancing terminal disease, but for the individual who is caught off guard, 10 days is a long time. He referenced page 5, line 20, and said he thought it was rather redundant for a person to have to be told what the "potential risks, probabe results, and irreversible consequences of taking the medication" are after having made out the "Request For Medication." He added that if he made the decision to terminate his life, he wouldn't want someone giving him the kindergarten description. Number 461 MR. BOGARD referred to page 5, lines 24-26, and said he could see a problem. His concern is that after having complied with the provisions of section (3), there is nothing to compel the attending and consulting physicians to move within a certain period of time. The patient must have 10 days between the date of the execution of the Request for Medication form and the actual request for the medication to end their life and he felt that language should be added to require a physician to act within a certain time period. Number 669 MR. BOGARD referenced Section 19, page 11, line 29, "do not resuscitate order means an order from a licensed physician...." and asked if this precluded having a durable power of attorney and a living will. He felt rather than having less government involved, this would have government even more involved. CO-CHAIR TOOHEY pointed out that Section 19 only changes the word from "Directive" to "an order." MR. BOGARD realized that, but he felt it was giving a licensed physician the power over a durable power of attorney, living will and his agent to have a DNR order. REPRESENTATIVE BROWN interjected that was part of the current law. She said this is a very minor change with regard to the wording; it is not a substantive change from the current law regarding the living will or the DNR order. MR. BOGARD stressed that it precludes the durable power of attorney and the DNR that has already been given to an agent. CO-CHAIR TOOHEY emphasized again the only change being made is the deletion of "A Directive" and insertion of "an order." MR. BOGARD suggested the committee take this under consideration because it could now be said that his living will and his agent don't have any power over a DNR order. CO-CHAIR TOOHEY asked Mr. Bogard to contact Representative Brown's office regarding those changes. She asked Mr. Bogard if that concluded his testimony. MR. BOGARD said he was waiting for an explanation from Representative Brown regarding the requirement for two physicians. REPRESENTATIVE BROWN responded the requirement to have two physicians involved is a safeguard to ensure there is no abuse of this provision. Relating to Mr. Bogard's statement regarding no time requirements for the doctors, Representative Brown said she would take that suggestion under advisement. MR. BOGARD concluded by saying this is a real life situation, and we are trying to give people the fundamental right to make their own end-of-life decisions. He didn't feel it was a level playing field if doctors are standing in the way of a person who has made that decision. Number 822 LOTTE BOGARD testified from Kenai that she is a retired professional nurse and has been a hospice volunteer for the past nine years. She has seen many people suffer from a terminal illness. She's had sympathy for their pain as well as for the suffering of their loved ones who had to stand by helplessly. She dreaded the thought that such a thing should befall her and she wanted death with dignity. However, in recent times it has become possible and more common to allay suffering by medication when given in sufficient quantity to completely control pain, even though it might shorten the process of dying. To her, this is a welcome way of treating the terminally ill. The proposed additions and amendments to HB 371, Section 14 or any similar language not withstanding are, in her opinion, a form of assisted suicide which she cannot support. MRS. BOGARD pointed out several weaknesses in the proposed legislation: 1) There is no provision for the disposition of the medication in cases where the request for the medication has been revoked after the medication has been issued; 2) there is no provision for certification by a psychiatrist or mental health clinician about the absence of clinical depression, a condition that is not readily recognized by the attending or consulting physicians. Depression is not ruled out by the findings of mental competence. Receiving the diagnosis of a terminal illness may well cause a person to go into depression and that condition could last a long time; 3) what if death does not result as expected from taking the prescribed medication, but it causes deterioration to the extent that the patient is unable to make further decisions. She commented that she would leave these considerations for the committee to ponder. Number 972 CO-CHAIR TOOHEY referred to the disposition of medication and said that if hospice nurses are in attendance at the time of death, they will dispose of the drugs. MRS. BOGARD responded it doesn't say that in the statute. Number 1005 SHIRLEY DEMIENTIEFF testified from Fairbanks that she is on the Tanana Chiefs Conference Regional Health Board and the Board of Directors of the Fairbanks Native Association. Her testimony is based on her personal opinion, and not as a result of any of the boards she sits on. She applauds Representative Brown for introducing HB 371. During the past 12-14 years, she has been with approximately 20 people who have died as a result of having a terminal disease. She commented this is not the answer for everyone, but it is an answer for a few people. She believes there are terminally ill people who know when they are approaching the end of their life and want to alleviate the suffering of their family. They should have the right to take care of themselves and die with dignity. She mentioned her father, who died two years ago in May, had always told her that if he ever got a terminal disease, just to let him take care of it. When he got cancer, they discussed the situation and she told him it was his right to die as he chose, and she would support his decision. Coincidentally, during this same time period, there was a suicide in Nenana where they were from. Her father said he couldn't put his family through that; it just wasn't a good way to go. Her father was in a lot of pain before his death. Ms. Demientieff said if she is ever faced with this situation, knowing the pain it causes families, she believes this is the choice she would make and would want this choice available to her. Number 1177 ARTHUR HIPPLER, Executive Director, Alaska Right to Life, testified from Anchorage via teleconference. He said this is a badly named bill; it's not a bill relating to the rights of terminally ill persons, because anybody can commit suicide. It is, however, a protection for providers of this service of killing. The principal reason for any of these kinds of euthanasia-type bills is to reduce the issue of pain for people who are in a terminal condition. With contemporary, modern medical procedures, there is simply no problem of pain which is insoluble. But if for some unique individuals this was true, statutorily enabling suicide is a bad procedure because it goes against the fundamental dictum that "hard cases make bad laws." MR. HIPPLER addressed some of the specific problems he had with HB 371. He referred to page 7, Section 18.12.050, and said this seems to say that the physician cannot withdraw from such a case if another physician does not want to deal with it. Thereby it forces physicians, some of whom may be completely at odds with this kind of approach to medicine, to remain with the case if they cannot find someone else to take care of it. He pointed out there also seems to be a conflict between 18.12.070 and 18.12.060. In 18.12.060(c) it talks about if a professional organization (indisc.) subject to disciplinary measures, if somebody refuses to participate; i.e., a doctor who refuses to participate, but it seems strange to him that under 18.12.070, it is plausible that a physician who refuses to undertake these activities, can be placed in the position of receiving a civil penalty. MR. HIPPLER continued that page 10, lines 19-24, appears to define suicide out of existence. Also, page 10, lines 26-31 seem to eliminate the possibility of a suicide clause in validating a life insurance policy. He said while those are specific and serious problems, there is a much more general problem. We are not the first to try this. Over a decade ago in Holland, many people who were concerned, much in the same way as those who drafted this legislation, about the difficulties that faced people who were undergoing terminal illnesses initiated legally that which had been covertly practiced in the Netherlands; the power of a physician to assist someone to end their life. There were tremendous constraints in the law, but bit by bit that law was chopped to pieces not only by court decisions, but mostly by practices which nobody could figure out how to stop. They have reached a point now that according to the Netherlands press, one of the most serious problems facing aged people in Holland is their terrifying fear of going to a hospital or to a physician. That is because now the Dutch courts refuse to intervene if a physician decides completely on his own to kill someone, whether he tells the individual or not. The corruption of this kind of legislation has reached the inevitable, logical outcome; that the physicians, or at least some of them feel they have the right to take the life of someone whose quality of life is not up to par. There are serious health care problems for old people in the Netherlands, because there are large numbers of these people who are absolutely terrified to go to a physician. MR. HIPPLER concluded obviously, that is not the intent of this legislation, but good intentions pave the road to hell. The problem of how to deal with suffering is an ancient one. We do not best deal with sufferings by killing people. Number 1440 MARY SOLTIS testified via teleconference from Sitka. She has been nursing in Alaska for the past 15 years. She has been present at a lot of deaths and has taken care of a number of dying people, both in and out of the hospital. She said truthfully, she has not seen a single person die without adequate pain control. If anything, there's been too much medication ordered rather than too little. She couldn't think of anyone who would want their loved ones or their patient to die an undignified death. Both her mother and her best friend chose to die at home. The both had ample supplies of morphine and could have committed suicide, but neither did. They both preferred to die naturally at their own time and not by self-induced chemicals. In fact, her friend refused to go to the hospital because she feared she would be given too much morphine and would die involuntarily. She said after working in the mental health unit for the past six years, a lot of people contemplating taking their own life with an overdose of prescription pills are already depressed and have lost the will to live. They are in a way terminal, if the depression goes untreated. She commented in a sense we are all terminal; we are all dying, just at different rates. If someone is suicidal, it means they have an emotion or spiritual need that is not being met and they are in great pain. That is our chance to offer them hope, not death. MS. SOLTIS pointed out we could all choose death by suicide; many have and many are, simply by their lifestyles - smoking, drinking, etc. If someone is determined to commit suicide, nothing or no one can stop the person. The question is: Is it right to take our own life in our hands because we're afraid to die, afraid to live or afraid of pain? What if a lethal dose of chemicals was prescribed for someone who had the AIDS virus, but did not yet have the symptoms. What if that person wanted to avoid the pain or the embarrassment of HIV, MS, cancer or cystic fibrosis? What if the legal dose of chemicals was taken 24 hours, 24 days or 24 months before a cure was found? What if the person changed their mind after having taken the lethal dose? To her, that would not be a humane and dignified death. By helping someone die, we are also helping them to not desire life. That makes her wonder who is next - the handicapped, the elderly, the weak, the homeless, babies with Down's syndrome or babies of the wrong sex. She concluded that as a health care provider, it is her job to uphold the dignity of human life. She will promote life whenever possible and make the sick and dying comfortable, not dead. Only those who are afraid of living, afraid of dying or afraid of pain seek to end their own life prematurely. Let's keep the focus on the living - the healthy, natural choice. Number 1650 ROBERTA FOSTER testified from Naknek that she echoed the comments of Mary Soltis. She added that life is given to us by God; therefore, we don't have the right to take our own life. This legislation makes it just that much easier for people to commit suicide. The government, by making these allowances, is in fact encouraging other people to take the easy way out instead of looking at the option of life. Being terminally ill today doesn't necessarily mean being terminally ill tomorrow. For those reasons, she does not agree with the intent of the legislation. Number 1707 MARIE DOYLE testified from Homer that HB 371 amends the existing chapter in the Alaska Statutes entitled Rights of the Terminally Ill to include a voluntary request for medication where a terminally ill person can end his or her own suffering. The Request for Medication is in addition to the living will and does not (indisc.) the orders which are part of the chapter. A straw poll that was conducted in Homer indicated that of 13 randomly chosen people on the street, 12 were in favor of the bill, 1 was opposed. She supports it because as a psychologist she has worked with people who are dying. It is interesting to her that when our pets get old and sick, we can take them to the veterinarian and they can be put to sleep when they are suffering. There was no such provision made for her mother when she was suffering with terminal cancer and heart problems. She said she wanted everyone to understand this was not a bill to permit suicide; this is a bill for someone who is suffering and terminally ill to make a request for medication which is carefully monitored. It gives a physician the opportunity to help someone without implicating himself. It is not an opportunity for people in the medical profession to murder anybody. In conclusion, she reiterated the purpose of the bill is to enable someone who is terminally ill and suffering severely to make their own decision. This is not a decision for everyone to make, but it is a decision she wishes to make. Number 1863 JENNY DICKINSON testified from Anchorage that she is just an ordinary citizen who feels compelled to speak about a subject of extraordinary importance to everyone. She said we've all experienced trials and tribulations in our lives. She lost her best friend, who took her own life. But nothing can compare with the despair Ms. Dickinson felt having to stand by helplessly and watch her mother endure a slow, dehumanizing death. She has a deep reverence for all life. She believes in God and she's pro-life; but when quality life is gone, when all the hope of recovery is gone, when the terminally ill awaken each day with the prospects of only more pain and suffering, she questions if it is not then time to let them go peacefully. She loved her mother deeply, but she was not the same vibrant, proud, fun and creative, life loving person Ms. Dickinson knew. What she and her family saw the last year of her mother's life was a soul trapped in a dead shell called her body; a spirit that should have been set free. MS. DICKINSON concluded that change is often hard, but changes must be made. The needless suffering must stop. She commends the advocates of this "death with dignity" bill. She believes this is well-written, well-thought out legislation, which includes safeguards to avoid misuse. She referenced the comments of a prior speaker regarding depression and said we are not talking about depression; this is a physical, terminal illness. She strongly favors the passage of this legislation, which she feels is long overdue. JOSEPH RAYFIELD testified from Anchorage that he did not agree with some of the comments that had been made about suicide. God not only gave us our life, but He will take it whenever He wishes. He has now given us an avenue whereby we can eliminate the terrible suffering and pain that our loved ones have. He also believes that God says, "I will help those who help themselves." This bill is now doing God's work. He said both he and his wife had experienced the terminal pain suffered by their former spouses and watched helplessly as they were dying. He commented that we don't let our pets suffer when they can't function any longer; we put them to sleep. Yet why is it we insist that our loved ones have to suffer the pain of an incurable disease. CO-CHAIR TOOHEY announced that Representative Bunde arrived at the meeting. Number 2094 AILEEN RAYFIELD testified via teleconference from Anchorage. She shared the story of her former spouse who was diagnosed with terminal bladder cancer with a life expectancy of up to six months; he lasted five months. The doctors were not going to operate as it was inoperable, but because he wanted to live so desperately, they performed an operation and put drains in his back going directly to his kidneys with tubes going in a bag. That apparatus took care of the urine, but his digestive system and bowels had quit working. She commented how amazing it is that the body can still live. She cleaned the kidney tubes everyday and after a month had gone by, he asked her for the keys to the gun cabinet. She refused to give him the keys. The tubes caused additional pain whenever he moved, but he was alive. She played God - he made a decision and she denied him. She will live with that on her conscience until her dying day. MR. RAYFIELD finished testifying for his wife. He commented we are all only one breath away from meeting our Maker and he hopes none of us will have to suffer. He implored the committee to pass HB 371. Number 2167 FRANCENA SALVAGE testified from Anchorage that she is 82 years of age and if and when she should become terminal, she wants to have the right to make the decision to end her life with dignity and avoid unnecessary pain and the outrageous expenses associated with keeping a person alive. She supports this legislation. Number 2198 SYLVIA SHORT testified via teleconference from Anchorage. She has lived in Anchorage since 1967. She is speaking as one of the nine people who worked very hard on HB 371. The group consisted of three doctors, two attorneys, two ministers and two lay persons who reviewed the nine bills that are currently before state legislatures. They also considered the Oregon bill that became law and is now on appeal. The reason the nine people of disparate backgrounds came together was because they were united in a single purpose. They were bound by the realization and knowledge that this kind of bill was necessary; that we have regressed so far in our civilization and in our medical knowledge that people can live indefinitely, when sometimes left to nature itself, they would die. Each one of the nine people had a story to tell about how they came to that realization. MS. SHORT shared her personal story. Her son-in-law was strickened with multiple myeloma two years ago in December. He was hospitalized in January, briefly released, and then hospitalized again. The disease had progressed rapidly and he was deformed, unable to walk or help himself. His body still functioned, but his bones were broken and crumbled and he suffered intolerable pain. His doctors would not say how long he would live, but he knew he would never leave the hospital. Meanwhile, his pain medication, while it helped momentarily, was incapable of giving him real relief. Ms. Short's daughter never left his bedside. She helped the nursing staff care for him, feed him, clean him and make him as comfortable as possible. She was there when he awakened from fitful drowsing with screams, when he bit his lip through in an effort to keep from crying aloud. She was there when he begged the doctors to give him something to end (indisc.) vigil. She was there when he finally decided to starve himself to death. It took 10 days, but she never left his bedside. Ms. Short said her daughter is the ultimate victim. She is a changed person; no longer is she the happy, laughing mother of four children. Now she is tired and quiet and introspective; a caricature of herself. She works when she is able to and cares for her children and grandchildren. She still wakes up screaming, is undergoing therapy and suffers ill health and depression. She relives the horror everyday; he wanted help and she couldn't give it to him. MS. SHORT concluded with "Our bill is our cry to you our legislators. Please don't let it happen any more." TAPE 96-7, SIDE B Number 007 ROBERTA STEVENS, testified via teleconference from Anchorage. She has lived in Alaska since 1948. She explained that her mother who suffered from (indisc.), heart erythema and diabetes finally starved herself to death to relieve herself from her pain and the pain she watched her family go through. There was no other alternative. It took her about 15 days to starve herself to death. It was difficult for the family to watch this slow process. Ms. Stevens said one of the reasons she would like to see this bill enacted into law is because she realizes how difficult it is for family members to actually pull the plug that ends the life of a loved one; something her entire family has sworn to do for each other, if necessary. However, that is an awful burden to place on family members. If she ever becomes terminally ill, she wants the ability to make that decision herself and not put the burden on family members. She urged committee members to pass HB 371. Number 080 LYNN STIMLER, Executive Director, ACLU, testified from Anchorage that the ACLU believes the right to the enjoyment of life, liberty and privacy gives an individual freedom of control over his or her own body. Bodily integrity is a basic privacy right. These rights give individuals the ability to control decisions concerning their own medical care, including the withholding or withdrawing of life- sustaining medical procedures. The ACLU believes that HB 371 is a responsible account to said limits and (indisc.) procedures for all Alaskans suffering from terminal illnesses, and the government should not bar personal autonomy in this matter. The right of an Alaskan with a terminal illness to end his or her own life is a legitimate extension of the right to control his or her own body. The individual may wish to end his or her own life after suffering from a terminal illness, but may be unable to do so without assistance. If an individual is physically incapacitated while remaining able to comprehend and to render informed judgments, that individual should be able to enlist others to provide aid in dying. There should be no consequences, criminal or otherwise for those assisting. However, the ACLU recognizes the right of the medical care provider to refuse to render aid in dying when requested. They support those provisions of the bill which permit a physician to withdraw from treating a patient after explaining to the terminally ill patient their right under the law and after transferring the care of the patient to another physician. The ACLU urges passage of HB 371. Number 152 JERRY GANAPOLE testified from Anchorage that he has been an Anchorage residence since statehood. He said HB 371 merely allows an individual on his or her deathbed to have some say in the manner of their death. He commented this is a subject that younger lawmakers will have given very little consideration unless they have already been in the sad position of having watched a loved one die. He said the only opposition will be from those who wish to impose their personal religious beliefs upon others or from those who believe they may be personally, economically or socially disadvantaged in some manner. Mr. Ganapole stated in no conceivable way should the beliefs of others preclude the possibility of his asking for and receiving a humane death with dignity. At the present time, he does not have that basic right. Number 210 AL SUNQUIST testified via teleconference from Anchorage that he is retired, age 74 and he and his wife live in mid-town Anchorage. His interests and concerns in this legislation stem from the difficult and cancerous deaths of his parents. Current medical technology and practice often force a patient to remain in life longer than nature intended. He said the people who support death with dignity legislation assert the right to die free of pain in a humane manner, no less than the right granted under most capital punishment procedures. The principles of autonomy and privacy require that decision making power rest with the individual. It is up to each individual to evaluate their own level of pain and capacity to endure it. Because physicians and medical professionals adhere to the principle of benevolence, they are naturally in a position to give aid to the dying. By providing lethal medication to the terminally ill patient, they are mitigating suffering and adding dignity to the dying process. Legislation allowing a right to die with physician assistance would absolve medical professionals from any culpability in a patient's free choice of death. Providing safeguards for physicians and pharmacists assisting in a death is an important feature of this proposed legislation. He said that legislators may decide that additional safeguards would be appropriate or conversely that more leeway be provided for doctors to react to so-called "last attempts." He acknowledged the state's interest in the sanctity of life: It increases day, month and year at the beginning of life; it decreases each year, month and day at the end of life. To condemn a person to the probability of a long-suffering death when they would rather die in their sleep is to him grossly unfair. He asked the legislature to lighten up on the suffering of the terminally ill. Number 296 HERB BERKOWITZ testified from Anchorage that he has lived there for 26 years and has been a registered Republican all his life. He mentioned that because he wanted to stress this is a bi-partisan bill, which has support from across the political spectrum. Everyone who supports the bill firmly believes that humanitarian measures are going to eliminate suffering, but from a conservative viewpoint, the bill is also important because it loosens the grip of government on our lives. This is a bill that expands the rights of Alaskans, one individual at a time. The most important concept in this bill, aside from compassion, is individual autonomy. It gives terminally ill Alaskans, but only those who want it, a means of seeking an end to suffering in a humane manner. This bill gives the physicians, but only those who want it, the ability to respond favorably to requests for aid in dying. HB 371 does not ask anyone to abandon their personal belief that assistance in dying is immoral or wrong. It expressly recognizes the absolute right of any Alaskan opposed to assistance in dying, to flatly refuse to be involved in the procedures outlined in the bill. MR. BERKOWITZ said a quick review of the provisions of the bill makes it clear that everything in it is designed to ensure careful, thoughtful and voluntary decision making. There are several strict requirements: 1) that the attending physician determine that the condition is terminal; that the patient is mentally competent and (indisc.) is voluntary; 2) that a consulting physician confirm the above and there be a written request witnessed by two disinterested individuals who do not stand to gain from the patient's death; 3) multiple requests at least 10 days apart; 4) the attending physician counsel the patient regarding available alternatives; and 5) that the medication be self-administered. If those procedures are followed then and only then, the physician is exempt from the existing law which makes assisting in suicide a class A felony; manslaughter. It is important to remember that the bill does not modify existing law regarding assisted suicide except in this one specific respect. Supporting this bill does not mean you are supporting suicide. In conclusion, Mr. Berkowitz said the time has come to limit the role of the state in a matter which with proper safeguards, can and should be solely decided between the physician and the patient. Number 420 ARTHUR CURTIS, Minister, testified from Anchorage that he has lived in Anchorage for the past 6 1/2 years. He had two points he wished to make to the committee: First, sometimes people object to a bill like this because they say it is a "slippery slope"; that allowing a physician to assist somebody to die will bring other sorts of assisted suicides or it will lower the quality of life in our society by emphasizing death. It seems clear to him from his own review of the legislation and from Mr. Berkowitz's testimony that there are all sorts of safeguards that do not put us on a "slippery slope." It is very clear this is not suicide; this is assistance in dying for a person who knows he or she is already dying. It is not to be compared with other sorts of death. His second point was that our attitudes have changed on the question of suffering. In the (indisc.-paper shuffling) tradition, suffering was often thought to have redeeming value, but it is obvious from the testimony presented today the degrading suffering at the end of life has no redeeming value, neither for the person suffering it who is about to die nor for the relatives and friends who care for this person. He felt it is very clear that we have come to realize this sort of suffering is different and this particular legislation would allow us to prevent that sort of degrading suffering. Number 509 DR. RODMAN WILSON, Acting Executive Director, Alaska State Medical Association (ASMA), testified via teleconference from Anchorage. His testimony was presented on behalf of the Alaska State Medical Association; however, the association does not yet have a position on HB 371 and may discuss it further at their annual meeting the following Saturday. Although the ASMA is sympathetic with the situations that people have experienced, they do have some problems with the bill. The first problem is that "terminal" is not defined. They have a problem with furnishing medication which apparently will be given orally. He referred to a letter written to Representative Brown from a doctor in Kodiak regarding this problem. He said it is sometimes hard to kill a person orally if the person is vomiting, if they are not absorbing the medication, or for whatever reason it just might not work. He commented that intravenous can be effective and quick. The other consideration is that ASMA is not sure there are very many doctors in Alaska who will choose to participate in a death of a person this way. There may be a handful who will, but it may be very difficult to find a doctor to go along with this, thereby making it difficult to refer a patient on to another doctor. Dr. Wilson concluded he suspects that general culture is ahead of professional cultural on this topic, but he's not quite sure that Alaska doctors are ready to go along with this. He reiterated ASMA does not have a position yet and he cannot say whether they will support, oppose or be neutral on this legislation. Number 670 KENT LEE WOODMAN, Hemlock Society, said "Senator Jacob Javits, Vice President Henry A. Wallace, composer Dimitri Shostakovich, heavyweight boxing champion Ezzard Charles, actor David Niven, Charlie Mingus, Stephen Hawking, Lou Gehrig, Representative Brian Porter's father and me, Kent Lee Woodman. I like to think that I was added to that list of dead or dying suffers of ALS sufferers to add some class to it." Amyotrophic Lateral Sclerosis has been diagnosable for about 125 years. So far it has always been fatal; there is no treatment. In this disease, the nerve endings lose their ability to transmit electrical signs to the muscles. A person becomes weaker and weaker until they are confined to a wheelchair, then to bed, then connected to tubes and a ventilator. Then, if you haven't been hit by a People Mover bus, you die from respiratory failure. There are short term versions of the disease where a person lasts from 18 to 30 months, and a longer version. Mr. Woodman is just beginning his ninth year. He said that's all he would say about his own personal problems, but he wanted the committee to be informed because it says a lot about his clarity of thought on the instant matter. MR. WOODMAN said he would not go over the bill in detail, but wanted to talk about perspective and to discuss some of the opposition that may be heard as this bill goes through the process. There are nine states with bills; 26 states doing something in the area of forming bills. Oregon's legislation passed last year, but it has been challenged by the losers and it is headed for the Supreme Court. The up side is that Representative Brown and Alaskans for Death with Dignity had the advantage of all of those bills, all the arguments, all the challenges, and all the nay- sayers, and have crafted a very carefully prepared document. Alaska could be the first state in the Union to get such a measure in place and actually working. Mr. Woodman pointed out that in no state in the United States is it against the law to commit suicide. A person is free in the 50 states, the District of Columbia and all the Territories to perform a "38 caliber tonsillectomy", examine the insides of their wrist with a razor, tune up their car with the garage door closed, etc., and it's not even a misdemeanor. A person can try and fail miserably and then the public funded folks come out and clean up , pump the person out or fix them up and they are frequently in much worse shape than before. Strangely enough, if you help someone commit this non-offense, you face a felony rap. This constitutes the only legal action a person can take which develops a felony conviction for helping. MR. WOODMAN continued that individuals who support this bill abhor suicide. It may sound strange, but he said it goes against his personal ethics and it's potentially a waste of a person's ability and potential contribution to society. Suicide is the taking of a life when there are other options. Suicide is copping out when you are depressed, such as the loss of a job, a lover or lots of money. Some counseling can start the reversal of one's fortunes until they find the guts to reach down and grab their bootstraps and pick themselves up and start participating in the program again. Mr. Woodman emphasized this bill is not about suicide. This bill is not about ending life - it's about ending death. Those few Alaskans who will avail themselves of the benefits of this bill will already be dead by the time they make the option. They are terminal, they are suffering, they know they can no longer contribute, and they face their own hell of physical pain and the awful internal pain of humiliation and frustration at not being able to even handle their own toilet activities, let alone make a contribution to society. MR. WOODMAN commented that he had read a touching account by the widow of an AIDS patient who watched her husband go through a horrible last seven months of his death. He wasted away to 70 pounds, lost bodily functional control, and was in terrible pain. He wanted to leave and see what happens next, but he was forced to go through this debilitating punishment. His wife watched all that she had known and loved wither away. She watched his strength disappear and was left with haunting memories instead of the few good ones that mourners are supposed to have for comfort. Her comment was that all the do-gooders who insisted that this public humiliation, pain, debilitation and agony must continue never came to the hospital to visit. None of them offered any support or helped pay the doctors or hospital bills; they were all safe and snug in their homes absolutely certain they knew what was best for all the rest of us. MR. WOODMAN recalled that his mother, Betsy Woodman, was a vibrant, creative, energetic woman. When his father and he were at the hospital and the chaplain came in and said she didn't make it through emergency surgery after an automobile accident five years ago, the doctor asked if we wanted to go in and say good-bye. I determined not to go in. My mother was already gone and I wanted the freshest memory of just the day before when she was planning a trip, counseling him on a personal problem, researching an article and fixing a great meal. He did not want to replace those memories and his vision of his mother with a battered vessel that used to house her. He has never regretted that decision. Lots of people do not have that option. A physician who spoke to their group last fall pointed out that when parents were kids, they expected to live to perhaps 55 or 60. Folks 75 years ago usually died a lot faster from accidents, injuries and quick-acting diseases. Improvements in medical research, technology, baby formula and pharmacology have allowed us to look forward to life at 70+, but there is a change coming over the country. Just like the "graying of America" we see more and more folks dying from chronic diseases and frequently taking months and years to do it. In fact, today and more and more in the future, there will be more people lying in beds with tubes poked in them while they wither away from a whole raft of diseases which offer drawn out, painful deaths. In short, new problems require new solutions -- no different than the urgency in overhauling our Social Security System due to the rapidly changing demographics. MR. WOODMAN continued there are those people who insist that suffering until the last ounce of life is snuffed out through extreme pain is what "God intended." Some people even feel that this end of life suffering is the price of admission to their Val Halla. He said he supports their view and their right to have it; he will help to defend their right to discuss it, prosthelitize it and practice it. It is indeed unfortunate for those people who are heading for an alternative Val Halla where the admission price is different. He does not share their position. He resents any effort to have the government force their religious, ethical or moral position and practices on him. He has his own and they are no less noble. He seeks a level playing field. As the law is now written, everyone must follow their code and if public opinion polls can be believed, they are in the minority. He seeks to amend the law to allow him to exercise his own moral, religious and ethical options about his own dying process. Different from the opposition, however, what he seeks is a change that would allow us all to exercise our own principals, while the opposition would wish to retain laws that favor only theirs. MR. WOODMAN said he would like to explode a pair of opposition myths which the community will hear: One is the "slippery slope" which was just discussed. He remarked you can hear the frenzied wringing of hands and people saying "oh sure, we pass this one now and tomorrow Dr. Kevorkian will set up shop in Spenard." That's as illogical as it is preposterous, but it is a common thread of the opposition whose true motive is their religious beliefs. That same line of argument could be "oh sure, pass a law today to offer assistance to homeless people, and tomorrow everyone will be on welfare." That's preposterous. Each new piece of proposed legislation will have its own total public hearing and debate. If someone comes along in a year or two and proposes a change to the new legislation, he or she will have to go through all the motions, provide all the arguments, set aside the debate. There isn't any relationship. He urged the committee to listen to such arguments closely and see if there are any redeeming qualities to them or if they are pure, illogical emotionalism. MR. WOODMAN stated the second myth is the one of religious, ethical or moral authority. When a member of the religious right makes what appears to be a factual statement, remember that he or she is only stating his or her opinion. Religious leaders are sharing with you their slant on their code of ethics and their religious teachings. What preposterous egos they must have. Out of 200+ religions in the world, what makes them think theirs is the center of the universe. MR. WOODMAN concluded the bottom line is: Why should government attempt to referee such a match Government has no place in the battle at all and public legislation has no place in it either. If anyone says that he has a vested interest in this legislation, it wouldn't help him at all. By the time he needs it, he won't be able to swallow. Number 1120 JANET OATES, Representative, Sisters of Providence Health System, referenced Mr. Woodman's testimony and said she thought it was interesting that he is concerned about his rights and government interference in his life; they share that same concern. Providence Health System sees this legislation as being very involved with their activities. Needless to say, Providence Health System is opposed to this bill. She wanted to reinforce some of the comments that were made earlier and add a few. Providence Health System does recognize the right and responsibility of each person to make decisions regarding their medical treatment. However, they feel that the growing public support for assisted suicide is the result of several underlying fears about dying. Most of those fears have already been mentioned: fear of losing dignity and control in a dying process, fear of unrelieved pain, fear of being a burden to one's family and friends, and abandonment by family and friends. In response to those fears, Providence Health System has seen that they can be addressed by providing an environment in which dying people are treated with respect, able to have a loved one present, have care givers who are attentive to the patient's wishes and needs, given appropriate and enough medication and other therapeutic interventions to reduce or eliminate pain. She thought they would be the first to acknowledge that the health care system has done a lousy job in dealing with the issue of pain and symptom relief. The Sisters of Providence Health System does business in Washington, Oregon and California so they are very familiar with the initiatives that have been introduced. It became a challenge to them, not by just saying this is wrong, but how can we make this better. Medicine has a tendency to see death as a failure and then to over-treat it or to abandon the dying. As a health system, they've been looking at ways to promote the provision of effective pain and symptom relief. Just this past week, another physician joined their medical staff who specializes in pain management. Providence Health System is expanding their pain management program because they have seen this to be a real need. A number of religious health care organizations have developed a list of goals to address the issue. She noted that the universities in both Washington and Oregon medical schools are teaching physicians more about pain management by making it a part of the required studies. She thought that was an area that Providence Health System needed to look at before they take physicians on staff. She invited committee members' participation in educational direction in Alaska. MS. OATES said they think advanced directives are an under-utilized opportunity to prepare for end-of-life decisions. She mentioned the federal mandate that every patient who is admitted has to be notified of their rights to make advanced directives. They provide both material and pastoral care social workers who are able to explain those options. They encourage people to make those decisions well in advance before they can no longer make them for them for themselves. Those decisions and preferences of patients are honored in accord with existing legal and ethical standards, whether it's to provide, withhold or discontinue medical treatment including tube feedings. Specifically, Providence Health System opposes the bill for a number of reasons. She shared some thoughts with committee members: "Assisted suicide, and they see this as assisted suicide, is a flight from compassion, not an expression of it. It should be suspect not because it's too hard, but because it is too easy." She expressed concern that this may be a quick fix as well as passing the buck. She has heard many times that it is shifting this fearful responsibility to physicians rather than taking individual action or action for family members. They view it also as an erosion of the physician/patient relationship which is what happens when health care becomes simply a business. Patients are losing trust in institutions and physicians because of the fear they are no longer there to provide or advocate for appropriate treatment and relief of their pain, but rather worry about the bottom line - income. Legislation of this nature takes away compassionate support for people when they are most vulnerable. Providence Health System fears this will reinforce few that dying people are a burden to society. Ms. Oates asked committee members to imagine a frail, elderly woman already feeling that she is an emotional and financial drain on her family, wondering to herself "do they want me to ask for it now?" MS. OATES read the following statement: "As personal and private as the act of dying is, each of our deaths is shaped in very real ways by social and institutional forces. The symbolic significance attached to death is derived from religious and cultural realities that precede and survive individuals. Thus, the social arrangements that attend death are formative and defining. The way a person dies is not only of importance to him or her, but is of importance to the society at large, now and in the future. To sanction physician assisted death by giving it legal approval would introduce a radical social change." She questioned whether we are ready for that radical social change. MS. OATES said Providence Health System has some specific concerns about the language of the legislation. They are concerned that institutions and physicians who are unwilling to participate in this process are essentially obligated to find alternative providers. She echoed Dr. Wilson's comment that it may not be very easy to find those providers. TAPE 96-8, SIDE A Number 046 CHARLES ROHRBACHER testified he is an artist, social democrat, not part of the religious right, and he's a catholic. He has an aunt who is currently dying of cancer and his family has wrestled with this question of supporting her during this last year. She has experienced a lot of pain and the family has worked closely with her physicians and Hospice Home Care to support, help and comfort her as she's gotten sicker and closer to dying. Mr. Rohrbacher testified in opposition to HB 371. There are two aspects of the bill that he wished to address. First, it seemed to him that if this bill passed, it would create a bias in favor of death. When speaking of eco-systems in terms of species having a difficult time surviving, he feels we live in a social eco-system and need to be thinking about the broader impact of this type of legislation. He thought this bias in favor of death would continue to pervade our society. The right to die may well be transformed by social, economic and family pressures into an obligation to die. Given the present failure of our society to ensure an even minimal right to decent health care for every person, and a political culture in our time that increasingly is willing to sacrifice the needs of the poorest and the most defenseless of our fellow citizens to the dubious necessities of a balanced budget, it would be naive to believe that the terminally ill, elderly and the disabled would not feel increasing and eventually overwhelming pressure to cease being a burden on others. In addition, he believes it would allow those individuals who are not sick, aged or disabled to shirk their necessary duty to lovingly assist, comfort and care for the sick. This legislation, if passed, would dramatically undermine the already attenuated bonds of solidarity between economic and social classes, between the young and the old, and between children and parents. Furthermore, he believes that this legislation, despite its good intentions, simply reinforces an already far too pervasive valuation of human life, based on an arbitrary determination of that person's social or economic utility. MR. ROHRBACHER said secondly, he believes this legislation by its very nature, subverts the doctor/patient relationship, transforming the physician who at present is ethically bound to do only good for their patients into their potential executioners. It is already outrageous that physicians in some states participate in the execution of condemned prisoners. This bill would make this practice so far confined to the executioner chamber, widespread throughout our society. He commented what is most disturbing about this proposed legislation is what it says about who we are as a society. We seem to be prepared to help the sick and the elderly die with dignity, yet we are less and less willing as a society to help these same persons live with dignity. As with the death penalty, abortion and our headlong race to cut the budget at the expense of our poorest and most defenseless citizens, we seem ready and even eager to embrace easy life-denying solutions rather than to make the hard choices and sacrifices that are necessary so that all persons may live and die with dignity and respect. Number 398 BARBARA TURNER testified that her concern regarding the proposed legislation was on page 10, Section 14. Her disability is cerebral palsy and had lived in a nursing home for awhile. She would not want the option of being put to death because morally it would be wrong. She would not want that choice. She wants to live as long as she can with as much dignity and independence as possible. She would not want someone getting rid of her if they decided to do so. She feels this legislation is just one step away from allowing a person to just get rid of the problem. Number 516 DONNA BURNETT testified she is definitely opposed to this legislation because she takes care of her sister, Barbara Turner, who is terminally ill. She foresees other things happening if this bill becomes law that could lead to other practices. We all have a right to make the choices that we make but she asked, isn't it God that gives us the first choice. He is the one who chooses how we are, how we are going to live and how we are going to die. She commented she has had a lot of deaths in her family and is certainly aware of the suffering, but it is her belief that we should be giving these people life and a way of happiness, not only spiritually, but physically as well. They have a right to be treated with dignity, a right to live and should be treated as people who need our support. This legislation gives the terminally ill who choose to die a way out because they think there's no hope. There is hope in Jesus Christ and in us if we allow it. Number 658 FATHER MICHAEL NASH, Catholic Bishops of Alaska, testified on behalf of himself, the Catholic Diocese of Juneau, Archbishop Francis Hurley of Anchorage and Bishop Michael Kaniecki of Fairbanks. Father Nash stated that some people would say that because we speak from a moral perspective, the Catholic Church has little right to be here, but he pointed out the Catholic Church has been very involved in health care in the state of Alaska for the past 100 years. Most of the first hospitals here were Catholic Hospitals, and even now they have the major medical facilities in Anchorage and Ketchikan. He expressed his compassion and a deep level of care for people who suffer from terminal illness and for their families. As a Catholic priest, he has been with the families of many people and with the individuals who have gone through this very difficult process of dying. But even so, he felt compelled to say that he believed this bill to be both morally wrong and bad public policy. He explained that he comes from a moral tradition that has guided Western Civilization for the last 1500 years, and which developed such concepts as the common good. There are some people who say "you just want to impose your morals on us," but he thinks that not to include that tradition in a public debate is a very grave mistake, because it does represent a lot of thinking over a long period of time. FATHER NASH said the first thing that concerns him about this legislation is the fact that it attempts to make the right to die a human right; in fact, speaks of it in the same kind of language as the right to life, liberty and pursuit of happiness. If we enshrine the right to die as a right under the Constitution, then we have to extend that right to every person in the society. If we say we are going to allow the terminally ill to die, do we also say to the 21-year-old who is depressed today and will be depressed for the next 20 days, that with 10 days notice we can prescribe the medication that will end their life. Or do we say no, because we only extend this right to certain classes of people, to the terminally ill. Father Nash echoed the comments made by Charles Rohrbacher regarding the need to be faithful to each other and not always take the easy way out. FATHER NASH stated he has a concern about HB 371 involving the medical profession in this process of assisted suicide. One of the complaints today of terminally ill patients is that doctors and medical staff tend to pull away from the patients and leave them isolated when they know they are dying. If that medical staff is going to be responsible for actually administering or providing the means to death of assisting in their suicide, essentially being an agent of their death, how much more will the medical staff withdraw. Father Nash commented that we've heard horror stories today of suffering. Recently, a physician friend of Father Nash's told him categorically that pain can be controlled and that advances are being made every day. He noted that testimony had previously been given that pain can't be controlled, but he tends to believe his physician friend. He expressed concern, however, for the terminally ill person who wants to live with this pain control, if this bill comes in to effect. His fear is if we offer people the opportunity to die, we won't make a strong effort to provide good pain control. In other words, if this is a simple way out, then we simply may not provide the level of pain control for the person that wants to live could have. We won't expend our resources in that direction; we'll expend them elsewhere. He noted that resources is another problem. He fears that the right to die could very quickly become the duty to die for those individuals who are economically disadvantaged. As health care resources become more and more scarce, he is concerned that the people who won't be given the resources are the most vulnerable among us. Those are going to include many of the elderly, terminally ill, and many of the severely mentally ill. This option may be given to them as an easy way out. They will be encouraged to take that final exit. He commented he knows that is not the intention of the sponsors of this bill. This bill is sponsored by individuals who come with compassion for one category of persons. Father Nash is speaking for the other category of people; the other people who will be affected by this bill just as sure as can be. FATHER NASH said his final concern was the "slippery slope". In World War II, the Dutch physicians were the only physicians in Nazi-occupied Europe, who categorically refused to do euthanasia. All the rest of the physicians bent to the pressure from the Nazis to practice euthanasia especially with the mentally ill. Ten or fifteen years ago, when assisted suicide in Holland became a matter of practice and was legitimized by the courts, there were very special safeguards put in place. In just about 12 years, those safeguards have eroded to the point where recently when a woman was put to death by a physician, it was done without her or her husband's consent, and done only at the request of her children. The physician who broke most of the safeguards wasn't taken to court and convicted of this crime, but was punished by a sentence of 3-months in jail, which was all suspended. In other words, the courts simply acceded to this extension from the assisted suicide program. He remarked that it only took 12 years to get to that point. He believes the slippery slope argument is a valid argument and that we will watch people die involuntarily, either through court action or through simple inattention. Number 1118 ROGER SNYDER said he sincerely believed the motivation for this legislation is compassion for the hard cases. He noted however, that we lack a broad experience with assisted suicide in this country. Proponents of this bill can only speculate about its value or its consequences to individuals or to society. He believes the implications of this bill are being missed, and that's why he is opposing it. If this legislation is passed, very soon the courts, not legislatures, will decide that we can't discriminate; that the right to die must be applied to all, not just the terminally ill but to everyone including minors without parental consent. For newborns or patients unable to communicate, others will decide for them and how will legislation control the selfish motives involved in that. Mr. Snyder said the biggest problem with this bill is opening the door to the consequences no one wants. He noted that abortion was first legalized as a compassionate response to hard cases. When that happened, who would have predicted 23 years ago, abortion on demand for any reason, at any time during the pregnancy, or for minors without parental consent. While he was not before the committee to testify on abortion, he thought there was a lesson to be learned about the evolution of law in this country. He truly believes that euthanasia will follow that ever-widening path. Speaking to committee members he said, "You, for all your good intentions and compassion will not be able to control the consequences - the expansion, once you establish the legal precedence." Individuals who scoff at the slippery slope will not change the reality and the truth of it. He pointed out the bill has been very carefully phrased to prevent abuses, but isn't the legislature making new laws to deal with creative abuses of existing laws. This bill opens a pandora's box, for all its compassion and desire to help suffering, of abuses involving death; voluntary and then involuntary. He spoke of the Netherlands where voluntary euthanasia has been practiced for about 10 years. They have experienced exactly the downward cycle that individuals have been expressing. One report found that half of the physician assisted suicides in the Netherlands come without the consent of the patients. Many of the elderly and severely ill people there will not go to doctors or hospitals anymore. Mr. Snyder said that is not the kind of health care reform that any of us are looking for. Support for legislation of this nature very often comes from people who are fearful of prolonged suffering and who believe that the only alternatives are great suffering or a drug-induced stupor of some kind. He emphasized that is not true, although he believes that in a very inhumane and undignified way, those fears are being used to manipulate people to support legislation like this. Surely there are better ways to deal with suffering at the end of life than legalizing killing. Let's not send a message that we solve our problems by killing problem people. Proponents speak of privacy, the right to die, the right to do with their own life what they will. Those are important rights to a point, but he believes that the point before you is the point that we endorse death as good social policy. You cannot make good public policy out of the hard cases, no matter how hard or emotionally wracking they are. Euthanasia laws will become a murder weapon in the hands of people who want to use them for such. It will become so, if we allow emotions to overrule good judgment about the real social costs, about the real way things evolve in our society. The truth is that the right to die ultimately is the right to kill and you, as legislators, have a say in preventing anyone from being given that right. Number 1500 MIKE MONAGLE testified on behalf of the Juneau chapter of the Knights of Columbus, which is a Catholic men's organization. The local membership is about 120 members and the international membership is over 1.2 million men. First he addressed the title of the bill, "The rights of the terminally ill." Certainly no one is going to say they are against someone's rights, especially not the terminally ill. However, what would the focus be if the title was changed to "The right to kill the helpless." For individuals who think that's a rhetorical question, he cited some statistics released by the Dutch government in 1991 from the Remmelink study, after Professor J. Remmelink who was the Attorney General for the High Counsel of the Netherlands. The results of that study are as follows: The total number of people euthanized in 1990 was 11,840 who died by lethal overdoses or injections. Of the 11,840 people euthanized, 1,040 of those deaths were classified as involuntary, which means that doctors killed patients without their written consent. Fourteen percent of the 1,040 were judged to be incompetent; 72 percent had not discussed terminating their lives; and in 8 percent of these cases, doctors admitted that viable options were available. In 45 percent of the 11,840 people euthanized in 1990, the patient's family had no knowledge that their loved ones were terminated by a doctor. Not considered in that study, but through available information, was that 8,100 patients died as a result of lethal doses of pain medication; thus allowing physicians to avoid the paperwork, the scrutiny and the reporting requirement set out by the courts. In 61 percent of these cases there was no express patient consent. One of the most flagrant examples of this abuse of the helpless was the case of a woman who, in her youth, had lost two of her children. When she was 50 years old she lost her husband. She attempted to commit suicide, went to the care of a psychiatrist to whom she expressed her desire to commit suicide. The psychiatrist gave her a lethal dose of barbiturates and she committed suicide. The Dutch government brought charges against the doctor, but he was found not guilty. In its decision, the court ruled that doctors could involuntarily euthanize a patient if they could adequately argue that this is what the patient would have wanted. He pointed out the Dutch study is not the only in-depth study that has been done. The federal government of Canada has also considered whether to pass a physician assisted suicide statute and they chose not to. A study was conducted by the Legal Research Institute of the University of Manitoba and it sustained much of the Dutch findings. A study done by the British Medical Association on the Dutch euthanasia issue concluded that where death is an acceptable medical solution, there is little incentive to develop programs which provide modern, available, and effective pain control for their patients. The Dutch population is roughly the size of California, yet today there are only two hospice centers in the entire country. He pointed out some of the effects after 15 years of euthanasia in the Netherlands: In 1992, the Dutch Pediatric Association issued formal guidelines for killing severely handicapped newborns stated that for both children and their parents, an early death is better than life; in 1993 the Dutch court affirmed that euthanasia was a valid practice for psychiatric reasons; some doctors in the country provide self-help clinics for teen-agers who express an interest in ending their lives; Dutch organizations supporting the disabled, now recommend that disabled persons carry "Do Not Euthanize" cards when entering hospitals for medical treatment; euthanasia training is now provided in nursing homes and medical schools; and physicians are helping people commit suicide who suffer from diabetes, rheumatism, multiple sclerosis and even severe bronchitis. MR. MONAGLE concluded that he had previously heard that a lot of thought went into this legislation and there are many safeguards. He asked committee members how they could guarantee that not one person will be killed involuntarily against their will if this bill passes? How can they guarantee the same abuses that happened in Holland will not happen here in Alaska? He urged committee members not to pass HB 371. CO-CHAIR TOOHEY announced this bill will be held again on Tuesday, February 13.
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