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Bill would change rules for 'do not resuscitate' directives

Richard Mauer

JUNEAU -- Sen. Fred Dyson said his reason for rewriting some sections of the state's patient-rights law was to clear up "ambiguities" in the way doctors handle resuscitation -- the last-gasp effort at reviving a person whose heart has stopped.

But at a Senate hearing on his bill Monday, several doctors, a nurse, a hospital administrator and a social worker all complained that his proposed law would change medical practice in Alaska and require doctors to administer CPR regardless of the condition of the patient.

Dyson's Senate Bill 172 amends state law that gives patients -- or their surrogate, if they're incapable -- the authority to decline medical procedures, either at the time they're needed or in an advance directive. The current law gives Alaskans the right to wither or die on their own terms by allowing them to reject CPR, forced nutrition and hydration, surgery, medication and other treatments.

Dyson, a conservative Eagle River Republican and one of the Legislature's staunchest right-to-life advocates, said he doesn't want to take away a patient's right of refusal, and his bill leaves it intact.

But, said Dyson, what happens when patients change their minds after leaving "do not resuscitate" directives? Or how about a doctor, or, more likely, a team of doctors who agree that prolonging a terminal patient's life through CPR would only enhance misery and be unethical -- even if the patient's spouse demanded they do it?

Dyson cited the example of a recent widow who contacted his office, Margret Mullins. Her husband, Merv, an engineer, was diagnosed in 2010 with terminal brain cancer. Medical staff at Providence Alaska Medical Center "refused to remove the 'do not resuscitate' order from her husband," Dyson testified at the Senate Judiciary Committee, which was hearing his bill.

A few minutes later, Mullins herself testified on a telephone line from the Legislature's office in Anchorage. She said doctors at Providence "urged us to sign a DNR order." They explained that performing CPR could leave him with broken ribs and prolong his agony, she said.

"Mervin and I thanked them for their experience but relied on our faith in God, and Mervin repeatedly confirmed that DNRs are against our faith. We believe every effort should be made to sustain life and if that failed, God was indeed taking a believer home," she said. "We also explained that poor quality of life was not a consideration for us because only God knew what could be done through a suffering person's life."

Mullins never said that her husband was refused resuscitation, only that she and he were outraged by what happened. He died Feb. 29, she said.

Witnesses who testified after Mullins said Dyson's bill would fundamentally change current law. Where the law now allows a patient to refuse treatment, Dyson's would require a physician to provide treatment, or at least CPR, they said.

"The current unamended Alaska health care decision act protects a person's rights, their autonomy, to consent or decline any medical procedure or treatment," said Dr. Stephen Rust, a specialist in geriatric medicine and palliative care in Anchorage with a practice at Providence. Current medical practice in Alaska is also "biased" toward life, he added -- if a patient's will is not known, almost all doctors will try to resuscitate.

"That being said, CPR is applied to people who, for all practical purposes, have died from something. It's an extreme measure, it's a violent act," he said. "Contrary to popular belief, it's not a panacea."

Dr. George Rhyneer Sr., a cardiologist from Eagle River who has performed thousands of CPRs, said he was sympathetic to Dyson's motives but said resuscitation is generally effective only in "sudden, unexpected death," not in terminal cases where death is already near.

"When to offer CPR or when to withdraw it is a decision which needs to be made by all concerned," Rhyneer said. "This is particularly important because CPR isn't always successful and often it results in more disability, pain and suffering than was originally present."

Rhyneer said he was especially concerned about the change in the law that would require him to perform CPR.

"I don't drag people off the street to become my patients and patients can't demand that I be their doctor," he said "I believe we're all agreed that I can't force treatments. Likewise, medical ethics and general morality dictate that I shouldn't have to provide treatments which I deem unsafe, ineffective, harmful or useless."

Judiciary chairman Hollis French, D-Anchorage, closed the hearing without a vote and without scheduling another session for the bill. He said afterward that he had grave questions about the measure, though he wouldn't rule out the possibility of bringing it back.

Dyson said his "respect for life" was behind his interest in changing the law. He said would still try to salvage the measure.

Reach Richard Mauer at rmauer@adn.com or 907-500-7388.

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By RICHARD MAUER
Anchorage Daily News
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