Legislature(1997 - 1998)
03/11/1998 09:10 AM Senate HES
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
SB 291 - LIV. WILLS/ANATOMICAL GIFTS/PATIENT CARE
RALPH BENNETT, legislative aide to Senator Robin Taylor, sponsor of
SB 291, read the sponsor statement. SB 291 revises Title 18,
Chapter 12, which pertains to rights of the terminally ill. The
current statute offers little assurance that an incapacitated
person's wishes will be carried out because it states that living
wills are operative only if the declarant's condition is determined
to be terminal.
SB 291 clarifies that an advance directive or living will is given
operative effect only if it has been medically determined that the
declarant is in a serious medical condition. The bill defines
"medically determined" as a determination from two physicians who
personally examined the patient, one of whom is the attending
physician. The bill defines "serious medical condition" as: a) a
terminal condition; b) a permanently unconscious condition; c) a
condition in which the administration of life-sustaining procedures
would not benefit the patient's medical condition and would cause
permanent and severe pain; and d) a progressive illness that will
be fatal and is in an advanced stage; the person is consistently
and permanently unable to communicate by any means, to swallow food
and water safely, to care for the person's self, and to recognize
the person's family and other people, and it is very unlikely that
the person's condition will substantially improve.
SB 291 was modeled after Oregon law. That law was cited in a
Journal of the American Medical Association study as respecting the
wishes of the patient. Section 7 of SB 291 clarifies that nothing
in this chapter is intended to condone, authorize, or approve mercy
killing or assisted suicide. Section 8 sets out conditions under
which life-sustaining procedures can be withheld when an individual
does not have a living will.
CHAIRMAN WILKEN noted Mark Johnson of the Department of Health and
Social Services (DHSS) and Joe Ambrose of Senator Taylor's staff
were available to answer questions.
Number 125
BRIDGET CARNEY, Corporate Director of Ethics for PeaceHealth, a
Catholic health care system in Alaska, Washington, and Oregon,
testified in favor of SB 291 via teleconference. Under Oregon's
Self Determination Act, Peacehealth is able to offer to all
patients, entering its hospital facilities, the opportunity to
complete an advanced directive. When a patient expresses interest,
a social worker is available upon request to help complete the
documents. This approach has been very successful as far as
patient understanding of his/her options in terms of withholding
and withdrawing treatment and it forces patients and physicians to
communicate about the advance directive options in a thorough
manner. It also gives the person with durable power of attorney
the ability to withhold and withdraw treatment as needed if the
patient is unconscious. Staff clearly explain the difference
between an advanced directive and assisted suicide, given that
Oregon has such legislation. MS. CARNEY said an advance directive
does not substitute for conversation, because one might be kept
elsewhere in a clinic file without the knowledge of the attending
physician, so the document is not useful. She reiterated she
strongly supports this approach and the way it has been adapted in
SB 291.
Number 174
VIRGINIA PERI made the following comments on her own behalf.
Current Alaska law pertaining to living wills is overly broad,
speaks only to terminal illness, and needs clarification. She has
had five operations in six years but her wishes as a patient, as
stated in her Alaska living will, were not honored in Alaska
hospitals because she was not terminally ill. She chose to prepare
a second living will in Oregon that speaks to serious medical
illness which was accepted in Washington State by the University of
Washington Medical Center Hospital while she was treated there. In
addition, current Alaska law contains no definitions for life-
sustaining procedures and nutrition and hydration, and treats all
equally. Many persons enter a hospital without a living will and
are not aware of their rights as a patient. SB 291 clarifies the
law to give greater understanding to those people using a living
will.
DEBORAH RANDALL, an attorney with the law firm of Davis and Davis,
stated she worked with Virginia Peri on this legislation. She and
Ms. Peri believe tremendous advancements in the area of advanced
directives and health care powers of attorney have occurred over
the last few years. Linda Emmanuel, working with the American
Medical Association, recently published a 12 page advanced
directive that outlines several medical conditions and the medical
treatment options a person can choose to have or have not applied.
Alaska's statute addresses one condition: a terminal condition,
defined as "a progressive incurable or irreversible condition that,
without the administration of life-sustaining procedures, will, in
the opinion of two physicians, result in death within a relatively
short time." She stated under that definition leaves a lot of room
for misinterpretation and could result in withholding CPR on a 40
year old who had a heart attack because a heart attack can be
considered an irreversible condition. The Oregon statute is much
more thorough and has passed the test of time. It allows a patient
to tailor his/her wishes to many different situations; i.e., it
allows the patient to decide whether he/she wants every life saving
measure taken for a terminal condition unless he/she is in a
persistent vegetative coma. She suggested combining Alaska's
living will statute with the health care power of attorney
provision which currently consists of two lines in the general
power of attorney law. In addition, she asked that provision be
amended to allow an agent to withhold life-sustaining procedures.
Ms. Randall stated her support of SB 291 and said it will create a
win-win situation for all Alaskans.
Number 249
RICHARD WILLIAMS, senior representative of the Older Alaskans
Commission, testified via teleconference from Anchorage. MR.
WILLIAMS said death does not frighten him, dying does. Recent
advancements in the field of medicine allow doctors to draw out the
process of dying as long as they wish. SB 291 gives individuals
the opportunity to determine how they want to die in certain
circumstances.
FRAN MCNEILL, Family Care Coordinator for Life Alaska, stated
support for SB 291 for the following reasons. SB 291 honors the
patient and family by allowing the patient the right of self-
determination and preserving the patient's autonomy. It enables the
family and patient to look at some of the most pressing and
difficult issues surrounding the possibility of death prior to a
crisis. It also supports the community and gives people the
opportunity to choose whether to donate tissue and organs. SB 291
clarifies some of the complex issues we face resulting from
advancements made in the field of health care.
TOM BULLER, Ph.D., a member of the Department of Philosophy at the
University of Alaska, Anchorage, concurred with remarks made by
previous witnesses, and added the following comments. SB 291 has
an ethical/moral basis and provides evidence of our respect for
self-autonomy, self-determination, and individual well being.
Advance directive legislation allows an individual to determine the
conditions under which he/she wishes treatment to be discontinued.
The bill fosters physician/patient communication and allows for
discussion about expectations of the quality of one's life. He
agreed with Ms. Carney that SB 291 in no way endorses assisted
suicide. It deals with the right to refuse treatment. The Supreme
Court stated in two rulings last year that the right to bodily
integrity is very different from the issue of assisted suicide.
Number 328
MELBA COOKE, a case manager with the ALASKANS AIDS ASSISTANCE
ASSOCIATION, stated support for SB 291. At present, her clients
must write out everything they wish in regard to life-sustaining
procedures; SB 291 speaks to everything her clients would
appreciate. She agreed with previous speakers' comments and
encouraged committee members to pass this legislation.
SENATOR ELLIS pointed out the Legislature passed legislation
relating to advanced directives for mental health care by former
Senator Reiger two years ago. The Legislature is not plowing new
ground in terms of the advanced directive aspect of SB 291, but is
reviewing the current living will statute which is unworkable and
inadequate. He congratulated the sponsor for putting the bill
forward, and said he is glad to be a co-sponsor. Senator Ellis
maintained that advanced directives are allowed in the realm of
mental health care, therefore the same reasoning should be applied
to other areas of health care.
SENATOR GREEN questioned whether the new advance directives are
complex and will have to be completed in consultation with an
attorney.
MS. CARNEY answered no, the paperwork does not require a patient to
meet with an attorney. The Sacred Heart Hospital has prepared an
educational booklet that contains definitions of terms and other
detailed information for patients, and the hospital's social
workers review the documents with patients.
Number 371
MR. AMBROSE indicated the new advance directive is actually less
complicated than the medical directive packet compiled by the AMA.
The AMA packet gets into areas that most people do not even want to
think about. The problem with the current law is that it is so
broad, specific instructions are frequently not carried out. The
Chase Review reports that a living will should state completely and
explicitly those areas of health care about which the individual
wants to make decisions. He reminded committee members under state
law, any attorney in Alaska must assist a person with a living will
on a pro bono basis. He noted committee packets contain a copy of
the documents offered to clients.
MS. CARNEY indicated PeaceHealth is investigating how to put
advanced directives on to a computer system so that patients'
wishes are readily available because sometimes records are not
accessible in emergency situations.
Number 394
SENATOR GREEN asked whether SB 291 mandates that educational
materials be provided to the patient.
MR. AMBROSE replied it does not.
SENATOR ELLIS moved CSSB 291(JUD) out of committee with individual
recommendations. There being no objection, the motion carried.
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