Update on End of Life Issues in Kansas Legislative Panel

1. Update on End of Life Issues in Kansas Legislative Panel Pain Management/ End-of-Life Workshop August 3, 2009 Capitol Plaza Hotel, Topeka, Kansas Maner Conference Center Pioneer Room

2. SUMMARY (HB2109)2009 Kansas Health Care Decisions (HCD) Act: Process • In December 2005, the Judicial Council convened End of Life Decisions Advisory Committee • Task review all EOL legislation in KS statute. • Laws related to HC durable powers of attorney and advance directives (living wills) targeted

3. SUMMARY (HB2109)2009 Kansas Health Care Decisions (HCD) Act: Process • In late 2008, work concluded with a recommendation from the Judicial Council. • Bill introduced in House Judiciary Committee by Chairman Kinzer (R-Olathe) – 2 hearings • No action during session

4. 2009 Kansas HCD Act: History • Diverse work group (15) more than 2 years • Views from medical, hospice, hospital, long term care fields, and legal, right to life and disability rights groups • The Committee heard from judges, state and professional associations and national life protection advocacy groups.

5. 2009 Kansas HCD Act: History • Committee did not achieve complete agreement on all matters • Judicial Council unanimously adopted the Committee’s recommendation

6. 2009 KS HCD Act: Summary • Judicial Council recommendation based on model Uniform Code used by legislatures nationwide • Includes number of Kansas specific compromise amendments. • Establishes single law • combines separate legislation now governing living wills and durable power of attorney laws • provides for surrogate hierarchy

7. 2009 KS HCD Act: Summary • Issue of medically administered nutrition and hydration required significant compromise to Uniform Code • additional documentation proposed to clarify declarant’s intent • Single law repeals existing legislation on living wills, appointment of agents and pre-hospital DNR directives. • Amended in hearing to authorize agents to decide on organ donation, autopsy, disposition of body

8. Special Issue - Repeal of DNR Directive • 1994 law intended to ensure those outside acute care settings not wanting resuscitation would not be subjected to those attempts. • Law limited to those who could declare such wish and sign document or instruct another to sign • Law not intended to interfere with methods or documents for physician DNR orders.

9. Special Issue - Repeal of DNR Directive • One primary purpose of law • Provide immunity for EMS in respecting wishes • Protecting providers from civil action or claims of unprofessional conduct • Original law presented statutory form

10. Issue - Repeal of the DNR Directive • Over time, form used to limit care for frail patients who cannot benefit from resuscitation attempts. • In those instances, individuals other than the declarant or a person instructed by the declarant have signed the document • Law does not contemplate that type of documentation • Physician orders must substitute

11. Issue - Repeal of the DNR Directive • Repeal of law would allow • Adoption of new models to address patient preference • Improvements in documenting broader array of appropriate treatment interventions • Surrogate and agents concur with physician orders on those options as conditions change (dynamic document) • Physician orders to guide conduct by medical personnel for frail patients in a various settings.