Legislature(1995 - 1996)
03/21/1996 08:00 AM House STA
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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 The next order of business to come before the House State Affairs Committee was HB 371. CHAIR JAMES called on Representative Kay Brown, sponsor of HB 371. Number 0868 REPRESENTATIVE KAY BROWN expressed her appreciation of the House State Affairs Committee for looking at this issue today. The issue was both profound and emotional. She explained when she introduced HB 371 the situation was somewhat different than today. At that time, she was seeking to legalize the opportunity for a terminally ill competent adult to receive the assistance of a doctor to end his or her life in a dignified manner. However, since the introduction of HB 371, the Ninth Circuit Court of Appeals had recognized the right to die with dignity as a constitutional liberty for those that were terminally ill and competent. She referred the committee members to the summary of findings by Terri Lauterback, Legislative Counsel. The summary outlined the provisions of the decision in the Compassion in Dying, et al. v. State of Washington case which were similar to the provisions in HB 371. Furthermore, she recognized that there were many different points of view on this issue. She emphasized that the passage of HB 371 did not require anybody to do anything that did not fit within their own moral code. However, it did allow those that had a different moral code to act in accordance with their own conscience. The legislature should move forward, debate, and establish appropriate and proper safeguards to exercise this right. The court decision made it difficult, if not impossible, to prosecute a physician for participating in an act of this nature. Moreover, the words struck down in the state of Washington were similar to the words in the Alaska law. The public interest was best served by setting the conditions so that all parties were protected. The safeguards in the law recognizing the state of the legal situation were as followed: "The patient must be terminally ill in the opinion of a physician. "The patient must knowingly request life-ending medication in writing. "A second, consulting physician must then confirm both the diagnosis and the patient's mental competence. "The request must be witnessed by individuals who have nothing to gain from the patient's death and are not connected with the patient's health care providers. "The request must be made at least twice and no fewer than 10 days must pass between a first and second request. "The administration of the life-ending medication is solely in the hands of the patient; the patient may change his or her mind at any time. "Physicians and pharmacists have the absolute and unquestioned right to decline involvement. Physicians unwilling to participate are not required to refer patients to willing physician (but may not withdraw from the case before the patient obtains the services of an alternate physician). Under current state law, pharmacists are not required to fill any prescription. "Hospitals also have the right to decline involvement. Institutions unwilling to participate must take all reasonable steps to transfer the patient to his/her home or to an institution which is willing to participate." REPRESENTATIVE BROWN further referenced a recent poll that showed strong support for HB 371 in Anchorage. The results were: for example, two-thirds were very likely or somewhat likely to support it; 14 percent were very likely or somewhat likely to support it once they learned about the specific provisions and safeguards; and there was overwhelming support that people should have control over their own medical care and their own end-of-life decision. She urged the committee members to consider the benefits of moving the bill forward to establish a framework rather than leaving the matter in the hands of the courts and attorneys. She would be happy to answer any questions. CHAIR JAMES called on the first witness via teleconference in Anchorage, Sylvia Short. Number 1186 SYLVIA SHORT, Member, Alaskans For Death With Dignity, explained the decision of the Ninth Circuit Court of Appeals struck down the statutes in the state of Washington that parallel the statutes in Alaska. Alaska was bound by the decision of the Ninth Circuit Court of Appeals as a member of the circuit. As a result of the decision, there were not any guidelines or safeguards to support the participating physicians. The only way to save the state from the needless cost of court cases and from the possibility of misinterpreting the court decision was to pass HB 371. CHAIR JAMES called on the next witness via teleconference in Anchorage, Al Sundquist. Number 1377 AL SUNDQUIST thanked the committee members for his opportunity to testify today. He expressed his support of HB 371. He discussed the arbitrary structure of the assisted suicide laws. He cited the development of the Uniform Penal Code and read, "model code reports considered the argument that the criminality of assisted suicide should turn upon the presence of the selfish (indisc.), but concluded that the life, of course, was to maintain the prohibition and rely on litigation in the sentence." He said it was time for the acceptance of a compassionate motive for suicide. Furthermore, he quoted the Archbishop Francis T. Hurley as stating, "I have sat at the bedside of the dying, and I have heard the cries of those in extreme pain. I found myself praying to God for their speedy death. On occasion I have held them in my arms as they died." Assisting their speedy death was a humane and compassionate solution, according to Mr. Sundquist. "Let me answer to my God in my own way. You in the committee have the power to save me from the fearful death solution. Please pass HB 371." CHAIR JAMES called on the next witness via teleconference in Anchorage, Lynn Stimler. Number 1499 LYNN STIMLER, Executive Director, American Civil Liberties Union - Alaska Affiliate (ACLU), said it was clear that the decision of the Ninth Circuit Court of Appeals that a terminally ill competent person had the right to determine the time and manner of his death. This was a very important chance for the legislature to establish boundaries of this new constitutional right. The ACLU believed that HB 371 would pass constitutional muster under the Ninth Circuit Court of Appeals' analysis. She called HB 371 a responsible attempt to set limits and establish procedures for Alaskans suffering from terminal illnesses. If the legislature were to do nothing, it would make it more difficult for terminally ill patients to assert their constitutional right. CHAIR JAMES called on the next witness via teleconference in Anchorage, Janet Oates. Number 1642 JANET OATES, Director of Marketing and Government/Community Relations, Providence Health System - Alaska, discovered the following observation, "my observation is that in the U.S. people often cry `there ought to be a law,' as if that would settle the matter." Perhaps, the observation reflected the aversion to struggle with difficult moral issues. The Providence Health System in Alaska opposed HB 371. The system opposed it based on the respect for the sacredness of life, and for the compassionate care of the dying and vulnerable person. The system felt the growing public support was a result of the fear of losing dignity and control during the dying process, the fear of un-released pain, the fear of being a burden to the family, and the fear of abandonment by family and friends. The health care system in general had failed miserably for the support of a dying person. The Providence Health System was aggressively promoting better pain management and education for the support of the dying. Furthermore, the system was concerned because it felt this was a reflection of society's approach of a "quick fix." She cited the country of Holland where the system was over utilized. She urged the committee members to give this matter some time. Pain management was improving everyday to help the dying. In conclusion she quoted, "laws are powerful ways for society to tell their stories." Laws did not only reflect the values of society, but also shaped the values. CHAIR JAMES called on the next witness via teleconference in Anchorage, Arthur Curtis. Number 1890 ARTHUR CURTIS said as a Minister he pondered the questions of suffering and life and death often. The evidence indicated pain could not be controlled to make life liveable and endurable in the thrones of an incurable illness. Furthermore, science was probably unlikely to make those last days endurable for some illnesses. Moreover, HB 371 established guidelines to ensure that nobody was forced into making a decision against his will. It did not condone murder or suicide. It was simply an aide to hasten an inevitable death. The bill could be competently passed by the legislature to ensure that decisions were made according to a person's own moral and religious belief. CHAIR JAMES called on the next witness via teleconference in Anchorage, Kent Autor. Number 2028 KENT AUTOR expressed his support of HB 371. He supported the bill based on the irony that he could be more merciful to his dog than he could be to himself. The bill enabled his freedom of choice for himself. It also enabled his doctor to provide the assistance to exercise his right. The bill also removed government restrictions on individual liberties. He did not see it as a moral issue or an issue of rights, he saw it as an issue of freedom granted by the constitution. Finally, the law set forth sensible and effective restrictions to preclude abuse. Moreover, he stated he had a great deal of experience with death. It surprised him that humans came into this world the same way, but there were an infinite number of ways to leave it, some better than others. He asserted the majority of citizens supported the concept of HB 371. His experience in the pet cremation service industry further confirmed the widespread support for medically assisted deaths. He reiterated it was ironic that a person could be more merciful towards his pet than himself. He stated this was not a matter of managing pain, but of managing the prospect of life's misery. He thanked the committee members for their time. CHAIR JAMES called on the next witness via teleconference in Anchorage, Kent Woodman. Number 2256 KENT WOODMAN said he had been an Alaskan resident for over 42 years. He was not here today to discuss his personal illness, but to talk about the duty of the laws. The United States Ninth Circuit Court of Appeals just ruled that it was unconstitutional to prohibit a physician assisted end-of-life. He called it a "whopping" defeat for the opposition. The decision was being studied now by the Attorney General (AG) of Alaska. Furthermore, the AG had already issued instructions not to prosecute positions under the statutes because they were similar enough to Washington's laws. The item of a "slippery slope" was dismissed as a pertinent defense. The most supportive element of the document was that the religious and moral persuasions could not impose their standards on others. The position further stated laws were needed on the books to set the parameters to prevent abuse. The failure to pass HB 371 this session would force the passage of another bill the next session that might not be as well crafted. He called HB 371 an excellent document. TAPE 96-39, SIDE A Number 0049 CHAIR JAMES called on the next witness via teleconference in Delta Junction, Charles Abbott. CHARLES ABBOTT expressed his opposition to HB 371. He believed that the argument of a person setting his values according to what he felt was right was missing the point. He equated HB 371 with the abortion issue that argued the death of a child was dignity for the mother. He also believed that the first death would be "death with dignity," the second would be "death with intimidation," and the third would be "death with abuse." He thanked the committee members for their time. CHAIR JAMES called on the next witness via teleconference in Mat- Su, Jim Ede. Number 0117 JIM EDE expressed his support for HB 371. He supported previous testimony in support of the bill as well. If, there was any doubt whether or not to support the bill, he suggested studying the decision of the Ninth Circuit Court of Appeals for clarification. He believed in following the law of the land. He urged the committee members to pass the bill as quickly as possible. CHAIR JAMES called on the next witness via teleconference in Dillingham, Linda Wahl. Number 0211 LINDA WAHL said she had lived in Dillingham since 1968. She objected to HB 371 due to the term, "terminally ill." She cited her daughter was diagnosed as terminally ill in 1990 and was still around due to care and alternative treatment methods. She explained a physician in 1991 over medicated her and felt justified in doing so. It was not asked for nor was she in any condition to ask for it. She said the decision making powers needed to be questioned for the terminally ill. Her daughter was still considered terminally ill but was a working and productive member of the community. The issues needed to be looked at closer before adopting an easy-out for people. CHAIR JAMES called on the next witness via teleconference in Fairbanks, Bruce Gordon. Number 0365 BRUCE GORDON expressed his support for HB 371. He explained his daughter died recently from a terminal illness. She knew her end was coming soon and was determined to end her life without putting him at risk before current law. She also knew that under current law her doctor would risk prosecution, if he were to prescribe sufficient pain medication to end her suffering. Fortunately, she found a non-violent means and died in her own bed. The freedom that she was searching for was provided for in HB 371. He reiterated his support for the bill and urged the committee members to approve it. CHAIR JAMES called on the next witness via teleconference in Fairbanks, Vicky Lawyer. Number 0509 VICKY LAWYER expressed her support of HB 371. She shared a story about a friend who suffered from a terminal disease. Her friend had a living will, but it was not enough to let him die the way he wanted. He eventually got to the point where he was ready to die, but the laws were in the way. The only option was to remove his feeding tube and starve to death. It took two weeks for nature to take its course. She wondered at what point free will ended because we assert it everyday. She explained the two important words today were "decision" and "choice." This was not a political issue or a religious issues, it was a personal issue. Her friend was not allowed to die the way he wanted to, and that was the sad part of her story. Please vote in favor of HB 371. She thanked the committee members. CHAIR JAMES called on the next witness via off-net in Kotzebue, Al Bowling. Number 0690 AL BOWLING expressed his support of HB 371. He was a strong supporter of the inalienable rights given by the creators of the constitution. He supported the right, when placed in this situation, to chose to end the suffering with prescription medication. He reiterated the laws that were designed to prevent this choice were unconstitutional and illegal. The legislature was a body to protect the rights of its citizens and to provide guidelines. Preventing the passage of HB 371, would be an attempt to deprive Alaskans of their constitutional right. It was the moral obligation of the Alaska State Legislature to pass HB 371. CHAIR JAMES called on the next witness via teleconference in Sitka, Christina Perrigo. Number 0801 CHRISTINA PERRIGO said USA Today reported the number of older persons suffering from a terminal illness who attempted suicide due to depression was around 90 percent. Even Jack Kavorkian said that he considered anyone with a disabling disease who was not depressed as abnormal. Those who argue in favor of physician assisted suicide ignore the treatment for depression. It was the depression, not the disease, that made a person suicidal. She was also concerned about the terminally ill circumventing the dying process. She explained there were five stages in the dying process - denial, anger, bargaining, depressing, and acceptance. Based on her experience suicide was wrong because it short circuited the five stages of the dying process. Furthermore, many terminally ill patients would consider suicide because they were pressured into seeing themselves as burdens on their family or society. The family members who supported the suicide often unwillingly supported the notion that the ill family members' life had lost all meaning. Furthermore, escalating medical costs were a cause for the terminally ill to see themselves as a drain on the economy and society. She said the "right to die" would become a "duty to die." She lastly referred to Scripture in the Bible. CHAIR JAMES called on the next witness via teleconference in Sitka, Lloyd Perrigo. Number 0975 LLOYD PERRIGO asked the committee members to give the bill long consideration. He was concerned for the elders. Those who were elderly now or classified as terminally ill might feel a duty to end their lives because of their strong independence and their desire to not be a burden. They needed our protection and suicide was not a treatment for depression. There were effective means to deal with depression for terminally ill patients. Furthermore, he was concerned for himself, his children, and his grandchildren. He wondered what would happen in 30 years, for example, if the bill was to pass. He felt it would not be safe to live in Alaska. He was afraid the bill would transfer to those that were not terminally ill creating involuntary deaths. He reiterated, to protect the elders and everybody for the future, he urged the committee members to not support the bill. CHAIR JAMES called on the next witness via teleconference in Anchorage, Renee Murray. Number 1109 RENEE MURRAY said she was a 42 year Alaskan resident. She expressed her support of HB 371. It was a personal choice, according to the bill. The decision could not be made by the family or the doctor, it must be made by the individual. She also felt very strongly about HB 371 because she was a senior citizen. She wanted to be able to make a choice in her life. She did not see a reason for others to be involved in the last choice she would ever have to make. She wanted to reserve that last right. She further believed it was a constitutional right as well. CHAIR JAMES called on the first witness in Juneau, Beverly Haywood. Number 1243 BEVERLY HAYWOOD, Co-Chairperson, Juneau Unitarian Fellowship, said the Fellowship unanimously supported HB 371. Furthermore, in 1988 after several years of study the Unitarian Universalist Association of North American passed a resolution in favor of the right to die with dignity. The Association was a mainstream Protestant Church. She read the resolution into the record. "Guided by our belief as Unitarian Universalist that human life has inherent dignity, which may be compromised when life is extended beyond the will or ability of a person to sustain that dignity; and believing that it is every person's inviolable right to determine in advance the course of action to be taken in the event that there is no reasonable expectation of recovery from extreme physical or mental disability; and "WHEREAS, medical knowledge and technology make possible the mechanical prolongation of life; and "WHEREAS, such prolongation may cause unnecessary suffering and/or loss of dignity while providing little or nothing of benefit to the individual; and "WHEREAS, such procedures have an impact upon a health-care system in which services are limited and are inequitably distributed; and "WHEREAS, differences exist among people over religious, moral, and legal implications of administering aid in dying when an individual of sound mind has voluntarily asked for such aid; and "WHEREAS, obstacles exist within our society against providing support for an individual's declared wish to die; and "WHEREAS, many counselors, clergy, and health-care personnel value prolongation of life regardless of the quality of life or will to live; "THEREFORE BE IT RESOLVED: That the Unitarian Universalist Association calls upon its congregations and individual Unitarian Universalists to examine attitudes and practices in our society relative to the ending of life, as well as those in other countries and cultures; and "BE IT FURTHER RESOLVED: That Unitarian Universalists reaffirm their sup[port for the Living Will, as declared in a 1978 resolution of the General Assembly, declare support for the Durable Power of Attorney for Health Care, and seek assurance that both instruments will be honored; and "BE IT FURTHER RESOLVED: That Unitarian Universalists advocate the right to self-determination in dying, and the release from civil or criminal penalties of those who, under proper safeguards, act to honor the right of the terminally ill patients to select the time of their own deaths; and "BE IT FURTHER RESOLVED: That Unitarian Universalists advocate safeguards against abuses by those who would hasten death contrary to an individual's desires; and "BE IT FINALLY RESOLVED: That Unitarian Universalist, acting through their congregations, memorial societies, and appropriate organizations, inform and petition legislators to support legislation that will create legal protection for the right to die with dignity, in accordance with one's own choice." CHAIR JAMES called on the next witness in Juneau, Ritchie Sonner. Number 1428 RITCHIE SONNER, Executive Director, Hospice and Home Care - Juneau, explained hospice was a form of health care that addressed the terminally ill by providing pain management to keep the patient as comfortable as possible in the comfort of their own environment. It also tried to keep the patient lucid and aware. Hospice was a recent development in the field of medicine as well as pain management. Pain management was now a state of the art treatment method compared to even 10 years ago. It was still in its developmental stage. Hospice opposed HB 371 because it felt that the hospice philosophy of pain management and home care was being provided. Unfortunately, the medical community was not as educated as it should be and was not aware of the alternatives available. That was the challenge of hospice. Furthermore, she explained it was not uncommon for someone with a terminal illness to request to end his life. However, once the pain was brought under control, he was able to experience the remaining days, weeks, or months of his life without requesting to end it again, according to numerous accounts of hospice care providers. She reiterated Hospice opposed HB 371. CHAIR JAMES called on the next witness in Juneau, Archbishop Francis T. Hurley. Number 1539 FRANCIS T. HURLEY, Archbishop, Archdiocese of Anchorage, referred the committee members to his handouts including an article written by himself and an opposition article written by Kent Lee Woodman in the Anchorage Daily News. The two articles indicated this was a very, very difficult issue. He came today with a strong background as a Catholic Bishop. The Catholic Church had a long history of countering pain through hospitals, medical schools and universities, for example. It was considered an evil that had to be avoided and stopped if at all possible. The Church did not believe that one had to suffer to get to heaven, contrary to allegations. Furthermore, he explained the Ninth Circuit Court of Appeals' ruling was narrow, and read, "the prescribing of a medication by a physician for the purpose of enabling a patient to end his life." The remaining was the opinion of the Court. He felt confident it was going to be a matter of the United States Supreme Court. The Court made it clear that the state did have an interest and a right to intervene in this issue. It was a question of balance, however. The Court claimed it was its prerogative and not the legislature's. He wondered if the Court was moving into the legislative mode. Moreover, HB 371 left many questions unanswered. He stated, "all law affects culture and the way we think and the way we act." The bill would create a coercive atmosphere among the elderly, he believed. He was further concerned about the impact on the native culture. Furthermore, the law also affected the public attitude towards life. He also questioned the ramifications of HB 371 and cited abortion. The permission for an abortion had led to the idea that the government should pay for an abortion for the poor. He was concerned of moving towards a government assisted suicide. He further raised a legal question and wondered if "incompetent" individuals were entitled to the same exercises as "competent" individuals. That legal question had yet to be confronted. He also believed this was a controversy that would touch more people more profoundly than any other case the courts would see in the foreseeable future. That was a powerful statement. In conclusion, he said laws were a combination of many considerations, not just religion. These included, for example: legal, sociological, psychological, philosophical, medical, cultural, spiritual, and financial to name a few. Moreover, this issue evolved around two highly emotionally charged words, "suicide" and "dignity." He cringed when he heard the word "dignity" associated with the word death. He had seen, watched, and talked to people that were dying. He wondered if all the people involved in taking care of the dying and the dying process itself were not dignified. He thanked the committee members for their time.
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