Imagine you have a terminal condition that will most likely take your life within a few months, yet still have full capacity to make all health care and other decisions in your life. You are admitted to a health care facility for a routine overnight treatment and a physician places a Do Not Resuscitate (DNR) order on you without your knowledge and against your consent. A DNR order means no attempt at resuscitation will be made to revive you should you suffer sudden cardiac and/or respiratory arrest. You disagree with the order, and ask the doctor to make an attempt at cardiopulmonary resuscitation (CPR) should you need it, the doctor refuses.
Would this concern you? This was the experience of an Anchorage couple with Providence Alaska Medical Center reported to my office this past October.
The Health Care Decisions Act, codified in Alaska Statute, 13.52.100(c) states: An individual who is a qualified patient, including an individual for whom a physician has issued a do not resuscitate order, has the right to make a decision regarding the use of cardiopulmonary resuscitation and other life-sustaining procedures as long as the individual is able to make the decision.
In a recent meeting with the Providence Executive Leadership Team, I was told that the doctor always has the last word on a DNR order, regardless of patient consent. Providence maintained this was true even if the patient had full capacity to make all their own health care decisions and understood the risks and benefits of an attempt at CPR. The law states otherwise. I was more than a little surprised at Providence position on this issue because they declare in their mission and core values statement that all people are created in the image of God and that life is a gift from God.
The recent ADN article concerning the authority of a patient to consent to a DNR order being placed on them was disingenuous, with an overt attempt to marginalize this bill by linking the matter to abortion. It was inaccurate and missed the point of the discussion in the state Legislature entirely.
Senate Bill 172 is largely a clarification of existing law. Virtually all of the testimony in the Senate Judiciary Committee against the bill was actually and mistakenly aimed against existing law.
Legislative Legal Services, provider of non-partisan legal opinions and research to the Legislature, issued an Oct 28, 2011 opinion based on their review of the Health Care Decisions Act in current Alaska law. Legal states it seems clear that a patient with capacity has the right to make a DNR order ineffective, and concludes the better interpretation of AS 13.52 is that a doctor’s right to issue a DNR order is limited by the decision of the patient or the patient’s authorized representative, (yet) there are some ambiguities in the chapter that could result in other interpretations.
I sponsored SB 172, with strong bi-partisan support, seeking to clarify the ambiguities in state law identified by Legislative Legal Services and a 2005 Duke Law Review article entitled “The Alaska Health Care Decisions Act, Analyzed.”
The Legislature may indeed decide to modify existing law and adopt the policy position that “life that is painful or ‘meaningless’ should be allowed or encouraged to die quickly” and that medical professionals should have the final word on those decisions. While I certainly would not support such a determination, that is not the issue on the table. Rather, the question is whether current law gives a patient, with capacity, the right to make a do not resuscitate order ineffective. I maintain it does, and SB 172 seeks to clarify the meaning of existing language in the law.
I believe we should strive for consensus of all the parties involved in end of life decisions. If there is an impasse, who should we permit to have final say on an end-of-life health decision? The patient whose life is at stake, or the doctor? I say the patient.
• Dyson is a state senator who represents Eagle River.