Legislative Report 5/9/2013 - End of Life Choices

I have heard from constituents for and against S.77, Choices at the End of Life.  It has been one bill that I have been very conflicted about, and I have put a lot of thought into it.  I listened to testimony from both perspectives during the Senate hearing a couple of months ago.  I have read the emails, the editorials and the handouts on both sides of the issue.  Before coming to a final decision on whether to support it or not, I wanted to wait until the House Human Services Committee completed its work.  That time arrived last week.

In thinking about this concept, I believe that the patient is the highest priority to be considered.  I know that palliative care and hospice are good alternatives as one approaches an end to life under potentially painful, drawn-out circumstances.  I believe that each person has a right to approach death in a manner that they feel best suits their belief system and circumstances.  I believe that patients must be able to make such decisions free of overt or subtle coercion.  I believe that participation in administration of the treatment proposed by S.77 must not be required of physicians or institutions that have philosophical objections or policies prohibiting such treatment. 

It is with these criteria that I evaluated S.77 and made my decision to support its passage.  The House Human Services Committee carefully constructed the bill to take into consideration these same criteria.  S.77 places heavy emphasis and requirements for the protection of the rights of the patient, much more so than Oregon's law and more than what were originally proposed in the Senate.  It requires that the patient have a terminal illness with a prognosis of life expectancy of less than 6 months as diagnosed by a physician and be informed that the prognosis is just an estimate.  It requires a second opinion on the prognosis from another physician who must also determine that the patient is capable of acting voluntarily. It provides strict requirements to ensure that the patient is making the request multiple times of their own free will, and it requires waiting periods between the two oral and one written request by the patient to participate before the drugs can be dispensed to the patient.  Rather than exclude the patient's family from the process, the patient must be encouraged to notify a next of kin or someone with whom the patient has a significant relationship after they make their initial decision.  And, importantly, it requires the physician to inform the patient of all feasible alternatives for end of life care, including palliative care and hospice.  Furthermore, it allows the patient to rescind their request at any time should they change their mind.

Under the status quo a patient with a terminal illness who has concerns about pain, cost of care, burdens on their family members, etc., can decide to end their lives without this bill by any number of methods.  They may not have taken the opportunity to find out what alternatives to taking their life are available, or to talk to family members out of fear of upsetting them or being talked out of what they are doing, and they may not be fully aware of what could go wrong with their plans and the consequences.  But if they are determined to do so, they may go ahead with their plans.

S.77 lays out a process that would provide an opportunity to make the same plans, but with the advantage of a second opinion, counseling on hospice and palliative care alternatives, requirements for multiple requests requiring multiple reconsiderations of their decision, and the considered involvement of loved ones who might also have the opportunity to let the patient know that they are still loved and valued. If they decide to go ahead anyway, they will have the assurance that it will be effective based on medical knowledge. 

S.77 does not encourage suicide.  On the contrary, it involves the state in the patient's decision only to insure that the decision they are making is well informed and well thought out.  To this extent it is, in my opinion, an improvement over the status quo.  And that is why I voted for its passage.

Note: While I supported the version of S.77, I was disappointed that the House-Senate conference committee changed the bill  by inserting a section that repeals the House version in 2016 and replaces it with the Senate language that deleted most of the safeguards I described above.  For this reason I did not support the conference committee report and declined to vote on the final measure.

The Word in the House 5/2/2013 - Siting of Electric Generation Facilities

The Legislature is in the final weeks of the session, and the number of bills coming to the floor for a vote each week number in the dozens.  Many are technical and non-controversial in nature and are passed after an explanation of their provisions by a member of the committee that had primary responsibility for the bill.  Some bills, previously passed by the House that came back with changes made by the Senate, have been voted on again, either to concur with the changes and to send them on to the Governor, or to disagree with the changes and to commit them to a conference committee.  Conference committees consist of three members of the House and three members of the Senate.  If a compromise is agreed to in conference, the bill comes back to the floor of each body and is voted up or down with no other amendments allowed.

Last week one of the Senate bills that were voted on by the House was S.30, which deals with the siting of electric generation plants.  S.30 started as a call for a three year moratorium on wind generation projects along Vermont ridgelines.  By the time it was voted out of the Senate, it had been reduced to requiring a study of environmental, health and economic effects of wind projects to be conducted by the Department of Public Service with the assistance of the Agency of Natural Resources, the Department of Health, the Department of Taxes, the Agency of Commerce and Economic Development, the Public Service Board, and several other entities.  It was not clear whether this was to be a study of studies or would consist of original research.  Furthermore, only $75,000 was allocated for the study and it had to be completed by November 15, 2013. 

The bill was assigned to the House Natural Resources and Energy Committee on which I serve.  We took two weeks of testimony, hearing 50 witnesses including property owners near the Lowell and Sheffield wind farms, health experts, and representatives from the affected state agencies and departments, from environmental organizations, and from regional and local planning commissions. Several witnesses reviewed with us studies dealing with many of the topics included in the bill.  We also heard from the Governor’s Energy Generation Siting Policy Commission, which had been established to study exactly the issues raised by the Senate and which was about to issue its report.  The common threads we heard throughout included:

·         Keep the conversation going.  All the concerns need to be considered and addressed.

·         Use the recommendations of the Governor’s Siting Commission.  Many experts have done a lot of work to examine the problems and propose solutions.

·         Maintain a balanced approach.  Make sure the legislative process is not weighted toward a pro- or anti-wind bias.

After reviewing the testimony, our committee decided unanimously to alter S.30, limiting it to a review of the Siting Commission’s recommendations with the goal of developing appropriate legislation on the siting of any electrical generation facilities taking into consideration Act 250 and the PSB’s Section 248 process, regional and local plans, setbacks from residences, and other concerns. This work will be done by the Natural Resource Committees of the House and Senate meeting together up to six times between now and December.  The bill passed the House on a vote of 140-3 and now goes back to the Senate which is expected to concur.  I look forward to being part of this effort later this year.

The past week and a half also saw legislation passed that requires public employees’ unions to assess a “fair share” fee on non-union members for the benefits they receive through the bargaining process and for grievance representation which unions are required to do.  A supplemental education finance bill, H.538, was also passed which is expected to save about $5.5M of education spending if implemented.  The various provisions of H.538 have different levels of support from different constituencies.  While everyone seemed to find something they didn’t like in the bill, overall it received overwhelming support and passed on a vote of 110-24.

I have heard from many of you on a variety of topics and continue to welcome your input.  You can email me at myantachka.dfa@gmail.com or call me at 425-3960.

Legislative Report 4/25/2013 - Decriminalizing Marijuana

It’s a weed and goes by that name.  Its scientific name is Cannabis but is more commonly known as marijuana. Last year 2 states, Oregon and Colorado, legalized marijuana.  Vermont and several other states have legalized its use for medicinal purposes.  However, federal law still prohibits its use for any purpose.  Marijuana policy is always controversial with advocates for and against legalization, and trying to find a reasonable approach to controlling a substance that is prevalent despite its prohibition is a challenge. 

Last week the Vermont House passed H.200 decriminalizing possession of less than one ounce of marijuana.  However, possession of marijuana in any amount without a doctor’s written statement of need for a recognized illness is still illegal in Vermont.  The bill is now under consideration by the Vermont Senate.  It is important to understand exactly what H.200 does as well as the rationale for its purpose.

Teenagers will often push the limits of their freedom and sometimes make bad decisions. Parents often don’t know that their teen is smoking, drinking or using marijuana until their child gets in trouble. The important thing is to find a way to intervene and get them back on the right path. A teenager who gets caught in Vermont with marijuana can face consequences which can have lasting negative effects on their future. 

Under present law anyone caught in possession of marijuana regardless of the amount is subject to criminal prosecution.  The charges are felony possession of a controlled substance.  A person convicted of this violation is subject to prison time as well as a fine, although a judge may assign the offender to a court diversion program if it is a first offense.  Penalties increase for subsequent instances of possession and as the amount possessed increases.  Additional consequences include ineligibility for federal college loans and college tuition tax credits.  Ironically, because of these serious consequences and the stricter requirements for prosecution, arresting officers who catch a teenager smoking marijuana will sometimes just confiscate the substance, warn the individual, and let them go.  This treatment is unlikely to change the attitude of the teen.

H.200 retains the current penalties for amounts greater than one ounce.  Furthermore, a person over 21 years of age caught smoking marijuana on a school bus transporting minors or within 100 feet of a school building is subject to charges of felony possession.

Possession of less than one ounce of marijuana becomes a civil violation under H.200, similar to a motor vehicle violation.  This means that it is subject to a fine, but it does not carry a criminal charge.  In addition to a $300 fine, the individual will have their driver’s license suspended for a period of time and be required to participate in the court diversion program.  Since there will be no excuse for not charging a teenager with possession if criminal charges are not involved,  more consistent enforcement of the civil penalty will increase the chances for intervention.  The necessity of coming up with $300 and attending court diversion is more likely to bring this bad decision to the parents’ attention and provide a much needed opportunity for a life-changing conversation.
You can reach me by phone (425-3960) or by email (myantachka.dfa@gmail.com)