Law affects end-of-life care

COEUR d'ALENE - A new law goes into effect July 1 giving Idaho health care workers the right to refuse to provide end-of-life care they find morally objectionable.

Some fear the legislation places the conscience of a caregiver ahead of a dying person's rights.

"We very strongly opposed this legislation this year," said David Irwin, spokesman for AARP of Idaho. "This is a bad idea. It's bad policy. It's not respective of the rights of Idahoans."

The organization, representing older Idaho residents, is most concerned, Irwin said, about the legislation's effect on living wills and advanced directives, legally-binding documents that allow persons with terminal or irreversible conditions to dictate whether caregivers should continue artificial life-sustaining treatments.

"If you draft a document that says you only want to be on life support for two weeks or three months, that's not something you do lightly," Irwin said. "That's why our members were so outraged by this. They want those rights to be respected, and this legislation allows those rights to not be respected."

Idaho's Medical Consent and Natural Death Act was passed in 2005 just days after the death of Terri Schiavo, a Florida woman whose feeding tube was removed after a lengthy, high-profile right-to-die legal battle. The act grants individuals the right to dictate which medical procedures should or should not be used to prolong their lives and allows them to name those who can make those decisions for them in the event they cannot.

The "Freedom of Conscience for Health Care Professionals" bill primarily addressed health care workers and pharmacists dealing with issues of abortion and conception, but included a provision for end-of-life care.

Irwin said that is the only part of the legislation AARP members oppose.

"Our members contacted their legislators by the thousands, and they moved forward with it anyway," Irwin said. "For our members to have their issue fall upon deaf ears was extremely problematic."

Heading into election season, Irwin said Idaho AARP has surveyed its 180,000 members (90 percent of whom vote regularly) to see which issues matter most to them.

Repealing the health care conscience bill is near the top of the list.

The only issue more important to Idaho AARP members is resolving Idaho's state budget problems.

"They want lawmakers to go back and fix it," Irwin said. "We're going to hold candidates accountable on the campaign trail. We're going to make sure they do what they public wants."

After the House and Senate passed the health care conscience bill during the last legislative session, it was given to Gov. Butch Otter to be signed into law. Otter declined to endorse it, but neither did he return it to the Legislature.

Idaho's Constitution dictates that unless a bill is returned to the Legislature, it becomes law after five days, regardless of whether the governor signs it.

In a letter to Senate President Brad Little, Otter voiced his reservations about the bill he forwarded to the Secretary of State without his signature.

"Forcing health care professionals to provide services they find morally objectionable is unacceptable; however, negatively impacting patients' rights - especially when it comes to end-of-life decisions - is equally problematic," Otter wrote. "I encourage the Legislature to revisit these issues and the definition of heath care service to ensure patients receive the care they may need with dignity and respect, and without imposing on the morals of a provider."

Carmen Brochu, Kootenai Medical Center's Vice President of Patient Care, does not see the new legislation changing things at the hospital, where they already regularly face ethical dilemmas and end-of-life issues.

The hospital has an ethics committee that assesses issues and guides the staff as they deal with ethical concerns.

In her 26 years at KMC, Brochu said there have only been a handful of times when an employee's religious or moral beliefs were at odds with providing patient care, whether it be an organ retrieval, therapeutic abortion or end-of-life care issue.

"Under all of those circumstances, the staff were allowed to step away from being the caregiver and to explore their ethical dilemmas," Brochu said.