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 CommitteeIn December 2005, the Judicial Council convened End of Life Decisions Advisory Committee Task review all EOL legislation in KS statute.Task review all EOL legislation in KS statute. Laws related to HC durable powers of attorney and advance directives (living wills) targetedLaws 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.In late 2008, work concluded with a recommendation from the Judicial Council. Bill introduced in House Judiciary Committee by Chairman Kinzer (R-Olathe) – 2 hearingsBill introduced in House Judiciary Committee by Chairman Kinzer (R-Olathe) – 2 hearings No action during sessionNo action during session

4. 2009 Kansas HCD Act: History Diverse work group (15) more than 2 yearsDiverse 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.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 mattersCommittee 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.