Sponsor Statement for SB 291

Senate Bill 291 is a major revision to Alaska Statute title 18, Chapter 12; "Rights of the Terminally Ill". It is intended to offer Alaskans some assurance that their wishes will be carried out with regard to medical treatment and life sustaining procedures.

Last year, the Legislature added provisions to the Living Will form suggested in Alaska law to add the option of organ and tissure donation. In the course of hearing that bill it became clear that our law as currently written offers little assurance that an incapacitated person's wishes will be carried out.

AS 18.12.010 states that a living will is operative "only if the declarant's condition is determined to be terminal". That is a call many doctors seem reluctant to make. The result is that heroic measures are often taken against the will of the patient.

A 1995 study published in the Journal of the American Medical Association found that doctors often misunderstand or ignore a patient's request with the result that large numbers of people still die alone, in pain and tethered to mechanical ventilators in intensive-care units.

The law is explicit. Every competant adult has the right to make fundamental decisions regarding his or her medical treatment. This includes the right to accept or refuse treatment and to prepare an advance directive.

SB 291 states 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.

It defines "medically determined" as requiring a determination from two physicians, one of who must be the attending physician, who have personally examined the person.

Serious medical condition is defined as

1. a terminal condition;
2. a permanently unconscious condition;
3. 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
4. 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.

We used Oregon law as the model for SB 291. It allows an individual to decide for themselves what they want done or not done in each of these situtations. Oregon law was cited in that JAMA study as respecting the wishes of the patient.

Section eight of the bill sets out the conditions under which life sustaining proceedures can be withheld or withdrawn when an individual does not have an advance directive.

Section seven makes it clear that nothing in this chapter is intended to condone, authorize or approve mercy killing or assisted suicide.

SB 291 will take Alaska into the 21st century with a law that allows individuals to make decisions regarding health care with more assurance that those wishes will be carried out in the event they are unable to speak for themselves.