Update on Update on End of Life Issues in KansasEnd of Life Issues in Kansas

Legislative Panel Legislative Panel

Pain Management/ End-of-Life WorkshopPain Management/ End-of-Life WorkshopAugust 3, 2009August 3, 2009

Capitol Plaza Hotel, Topeka, KansasCapitol Plaza Hotel, Topeka, KansasManer Conference CenterManer Conference Center

Pioneer RoomPioneer Room

SUMMARY (HB2109)SUMMARY (HB2109)2009 Kansas Health Care Decisions 2009 Kansas Health Care Decisions

(HCD) Act: (HCD) Act: ProcessProcess

• In December 2005, the Judicial Council In December 2005, the Judicial Council convened End of Life Decisions Advisory convened End of Life Decisions Advisory CommitteeCommittee

• Task review all EOL legislation in KS Task review all EOL legislation in KS statute. statute.

• Laws related to HC durable powers of Laws related to HC durable powers of attorney and advance directives (living attorney and advance directives (living wills) targeted wills) targeted

SUMMARY (HB2109)SUMMARY (HB2109)2009 Kansas Health Care Decisions 2009 Kansas Health Care Decisions

(HCD) Act: (HCD) Act: ProcessProcess

• In late 2008, work concluded with a In late 2008, work concluded with a recommendation from the Judicial Council.recommendation from the Judicial Council.

• Bill introduced in House Judiciary Bill introduced in House Judiciary Committee by Chairman Kinzer (R-Olathe) Committee by Chairman Kinzer (R-Olathe) – 2 hearings– 2 hearings

• No action during sessionNo action during session

2009 Kansas HCD Act: 2009 Kansas HCD Act: HistoryHistory

• Diverse work group (15) more than 2 yearsDiverse work group (15) more than 2 years

– Views from medical, hospice, hospital, long term care Views from medical, hospice, hospital, long term care fields, and legal, right to life and disability rights groupsfields, and legal, right to life and disability rights groups

• The Committee heard from judges, state The Committee heard from judges, state and professional associations and national and professional associations and national life protection advocacy groups.life protection advocacy groups.

2009 Kansas HCD Act: 2009 Kansas HCD Act: HistoryHistory

• Committee did not achieve complete Committee did not achieve complete agreement on all mattersagreement on all matters– Judicial Council unanimously adopted the Committee’s Judicial Council unanimously adopted the Committee’s

recommendationrecommendation

2009 KS HCD 2009 KS HCD Act:Act: Summary 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

2009 KS HCD 2009 KS HCD Act:Act: Summary 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

Special Issue - Repeal of DNR DirectiveSpecial 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.

Special Issue - Repeal of DNR DirectiveSpecial 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

Issue - Repeal of the DNR DirectiveIssue - 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 In those instances, individuals other than the

declarant or a person instructed by the declarant or a person instructed by the declarant have signed the document declarant have signed the document

– Law does Law does notnot contemplate that type of contemplate that type of documentationdocumentation

– Physician orders must substitutePhysician orders must substitute

Issue - Repeal of the DNR DirectiveIssue - Repeal of the DNR Directive

• Repeal of law would allow – Adoption of new models to address patient Adoption of new models to address patient

preference preference – Improvements in documenting broader array Improvements in documenting broader array

of appropriate treatment interventionsof appropriate treatment interventions– Surrogate and agents concur with physician Surrogate and agents concur with physician

orders on those options as conditions change orders on those options as conditions change (dynamic document)(dynamic document)

– Physician orders to guide conduct by medical Physician orders to guide conduct by medical personnel for frail patients in a various personnel for frail patients in a various settings.settings.