End-of-Life Issues Trouble Lawmakers
Bill to ease control for those near death
By Meg Hackman,  The Concord Monitor

January 13, 2006

Next week, lawmakers will consider how New Hampshire should regulate end-of-life medical decisions, continuing a debate that has grown increasing complex as advancements make it easier to prolong life.

The House is expected to vote Wednesday on a bill that retools regulations for living wills and medical powers of attorney, and adds guidelines for do-not-resuscitate orders, not currently addressed under New Hampshire law. Supporters say the legislation simplifies complex legal documents, making it easier for people to control the care they receive at the end of their lives.

"I think it's a very humane approach to what we all will eventually face," said Rep. Hilda Sokol, a Hanover Democrat who's sponsoring the bill. "If you're born, you know you'll eventually die."

The legislation has been two years in the making. Doctors, religious leaders, lawyers and legislators mulled the bill's nuances and discovered that the debate about when and how life ends is as emotional as the debate about when life begins.

While they were working, the nation became embroiled over similar issues as it watched the battle over the fate of Terri Schiavo, a brain-damaged Florida woman who relied on a feeding tube for fluid and nutrition. Doctors were eventually allowed to remove the tube, as Schiavo's husband wished, and she died last spring. But lawmakers across the nation continue to grapple with how to regulate end-of-life care.

Opponents of New Hampshire's bill have raised both technical and philosophical objections: The state, they say, should do everything possible to protect life, and they worry that legislation like this could lead to physician-assisted suicide or medical rationing. Other think the bill's language permits death in too many circumstances and fear the legislation makes it too easy for elderly or disabled people to surrender their rights.

The Rev. Edward J. Arsenault, an administrator at the Catholic Dioceses of New Hampshire, says the legislation complicates an already difficult issue. The bill, he said, has too many inconsistencies. He's especially concerned with the way it defines "permanently unconscious" and "near death."

"The church believes that every human life must be respected from the moment of conception until natural death," he said. "No person may choose to end his or her own life, or to end the life of another. While death is a natural process at the end of every life, not every person who is permanently unconscious is near death."

New Hampshire's advance directive laws haven't been changed since 1991. The House judiciary committee endorsed the legislation 15-5. Rep. Maureen Mooney, a Merrimack Republican, says the committee used modern medical definitions of terms such as "near death" and "permanently unconscious."

"This bill is solely focused around the patient's own determination of their future health care,"she said. "You can attach pages and pages of instructions. . . . The current law is confusing."

In the committee's minority report, Rep. Nancy Elliott, a Merrimack Republican, writes that the bill "does a disservice to our citizens."

"The advanced directives . . . in this bill are slanted towards death, giving very little option to citizens wishing to choose life," she wrote.

The concepts addressed by the legislation are not new. New Hampshire has had laws about advanced directives for well over a decade. Residents can use two documents to indicate what kind of care they'd like at the end of their lives. One, called a living will, outlines the procedures a person wants when they're near death or permanently unconscious. The other, called a durable power of attorney for health care, designates someone to make medical decisions when the patient cannot.

Mooney says the proposed legislation makes the forms easier to understand by eliminating double negatives and incorporating modern medical terminology. Advanced registered nurse practitioners would also have more authority under the proposal. They could help a doctor determine that a person is near death or permanently unconscious, and sign a do-not-resuscitate order with a patient's permission.

"In some rural areas, people only have access to nurse practitioners," Mooney said.

The new law would also make the forms easier to notarize. Right now, the law requires two witnesses and a notary or justice of the peace to sign the documents. The bill would make the forms official with just two witnesses.

Current law does not cover do-not-resuscitate orders, which bar medical personnel from using CPR or other resuscitation techniques if a patient has a heart attack or stops breathing. Instead, most hospitals and nursing homes have internal do-not-resuscitate forms that patients can choose to fill out.

Supporters of the legislation say this can lead to confusion among emergency medical personnel. The bill would create a standardized form that would be good no matter where a person receives treatment.

"DNRs are written all the time in New Hampshire," said Shawn LaFrance, a member of the Healthcare Decision Coalition. "But there's no legal framework for that to take place. . . . Problems arise because people move to different health care settings."

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