Legislature(1995 - 1996)
02/06/1996 03:05 PM House HES
| Audio | Topic |
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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES
STANDING COMMITTEE
February 6, 1996
3:05 p.m.
MEMBERS PRESENT
Representative Cynthia Toohey, Co-Chair
Representative Con Bunde, Co-Chair
Representative Gary Davis
Representative Norman Rokeberg
Representative Caren Robinson
MEMBERS ABSENT
Representative Tom Brice
Representative Al Vezey
COMMITTEE CALENDAR
* HOUSE BILL NO. 371
"An Act relating to the rights of terminally ill persons."
- HEARD AND HELD
(*First public hearing)
PREVIOUS ACTION
BILL: HB 371
SHORT TITLE: RIGHTS OF TERMINALLY ILL PERSONS
SPONSOR(S): REPRESENTATIVE(S) BROWN,TOOHEY,Finkelstein,Davies
JRN-DATE JRN-PG ACTION
12/29/95 2363 (H) PREFILE RELEASED
01/08/96 2363 (H) READ THE FIRST TIME - REFERRAL(S)
01/08/96 2363 (H) HES, STATE AFFAIRS, JUDICIARY
02/06/96 (H) HES AT 03:00 PM CAPITOL 106
WITNESS REGISTER
REPRESENTATIVE KAY BROWN
Alaska State Legislature
Capitol Building, Room 517
Juneau, Alaska 99801-1182
Telephone: (907) 465-4998
POSITION STATEMENT: Prime sponsor of HB 371
DICK BOGARD
HC 1, Box 228
Sterling, Alaska 99672
Telephone: (907) 262-4985
POSITION STATEMENT: Testified on HB 371
LOTTE BOGARD
HC 1, Box 228
Sterling, Alaska 99672
Telephone: (907) 262-4985
POSITION STATEMENT: Testified on HB 371
SHIRLEY DEMIENTIEFF
229 2nd Avenue
Fairbanks, Alaska 99701
Telephone: (907) 456-3318
POSITION STATEMENT: Testified on HB 371
ARTHUR HIPPLER, Executive Director
Alaska Right to Life
3400 Spenard Road
Anchorage, Alaska 99503
Telephone: (907) 376-9234
POSITION STATEMENT: Testified in opposition to HB 371
MARY SOLTIS
405 Verstovia Street
Sitka, Alaska 99835
Telephone: (907) 747-5624
POSITION STATEMENT: Testified on HB 371
ROBERTA FOSTER
P.O. Box 214
Naknek, Alaska 99633
Telephone: (907) 246-3439
POSITION STATEMENT: Testified in Oppositioin to HB 371
MARIE DOYLE
3101 Kachemak Drive
Homer, Alaska 99603
Telephone: (907) 235-2101
POSITION STATEMENT: Testified in support of HB 371
JENNY DICKINSON
2120 East 72nd
Anchorage, Alaska 99507
Telephone: (907) 349-7074
POSITION STATEMENT: Testified in support of HB 371
JOSEPH RAYFIELD
4149 Westwood Drive
Anchorage, Alaska 99509
Telephone: (907) 243-6549
POSITION STATEMENT: Testified in support of HB 371
AILEEN RAYFIELD
4149 Westwood Drive
Anchorage, Alaska 99509
Telephone: (907) 243-6549
POSITION STATEMENT: Testified in support of HB 371
FRANCENA SALVAGE
18722 Guillemot Circle
Anchorage, Alaska 99516
Telephone: (907) 345-4444
POSITION STATEMENT: Testified in support of HB 371
SYLVIA SHORT
705 West 47th
Anchorage, Alaska 99508
Telephone: (907) 562-4992
POSITION STATEMENT: Testified in support of HB 371
ROBERTA STEVENS
2322 Lord Baranoff
Anchorage, Alaska 99517
Telephone: (907) 566-3046
POSITION STATEMENT: Testified in support of HB 371
LYNN STIMLER, Executive Director
Alaska Civil Liberties Union
P.O. Box 201844
Anchorage, Alaska 99520
Telephone: (907) 276-2258
POSITION STATEMENT: Testified in support of HB 371
JERRY GANAPOLE
2536 Arlington Drive
Anchorage, Alaska 99517
Telephone: (907) 277-7887
POSITION STATEMENT: Testified in support of HB 371
AL SUNQUIST
3384 Mt. Vernon Court
Anchorage, Alaska 99503
Telephone: (907) 562-7522
POSITION STATEMENT: Testified in support of HB 371
HERB BERKOWITZ
3216 Madison Way
Anchorage, Alaska 99508
Telephone: (907) 274-4724
POSITION STATEMENT: Testified in support of HB 371
ARTHUR CURTIS, Minister
1605 Sitka Street, No. 203
Anchorage, Alaska 99501
Telephone: (907) 272-7360
POSITION STATEMENT: Testified on HB 371
DR. RODMAN WILSON, Acting Executive Director
Alaska State Medical Association
4107 Laurel
Anchorage, Alaska 99501
Telephone: (907) 562-2662
POSITION STATEMENT: Testified on HB 371
KENT LEE WOODMAN
Hemlock Society
12920 Hillside Drive
Anchorage, Alaska 99516
Telephone: (907) 345-1356
POSITION STATEMENT: Testified in support of HB 371
JANET OATES, Representative
Sister of Providence Health System
9100 Centennial Drive
Anchorage, Alaska 99504
Telephone: (907) 333-8100
POSITION STATEMENT: Testified on HB 371
CHARLES ROHRBACHER
109 Troy Avenue
Juneau, Alaska 99801
Telephone: (907) 586-9774
POSITION STATEMENT: Testified in opposition to HB 371
BARBARA TURNER
3625 Amalga Street, Number 13D
Juneau, Alaska 99801
Telephone: Not available
POSITION STATEMENT: Testified in opposition to HB 371
DONNA BURNETT
3625 Amalga, Number 13D
Juneau, Alaska 99801
Telephone: Not available
POSITION STATEMENT: Testified in opposition to HB 371
FATHER MICHAEL P. NASH
Catholic Bishops of Alaska
419 6th Street, Number 200
Juneau, Alaska 99801
Telephone: (907) 586-1669
POSITION STATEMENT: Testified in opposition to HB 371
ROGER SYNDER
2770 David Street
Juneau, Alaska 99801
Telephone: 586-6559
POSITION STATEMENT: Testified in opposition to HB 371
MIKE MONAGLE
Knights of Columbus
8610 Hayes Way
Juneau, Alaska 99801
Telephone: (907) 789-1788
POSITION STATEMENT: Testified in opposition to HB 371
ACTION NARRATIVE
TAPE 96-7, SIDE A
Number 001
The House Health, Education and Social Services Standing Committee
was called to order by CO-CHAIR TOOHEY at 3:05 p.m.. Members
present at the call to order were Representatives Toohey, Davis,
Rokeberg and Robinson. Members absent were Representatives Bunde,
Brice and Vezey. A quorum was present to conduct business. Co-
Chair Toohey announced the calendar is HB 371, The Rights of the
Terminally Ill. The meeting was teleconferenced to Kenai, Mat-Su,
Sitka and Anchorage.
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.
ADJOURNMENT
CO-CHAIR TOOHEY adjourned the meeting of the House HESS Committee
at 5:02 p.m.
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