Prayer by Pastor Brad Strait, South Presbyterian Church, Littleton.

The Speaker called the House to order at 9:00 a.m.

The roll was called with the following result:

Present--63.

Absent and excused--Representatives Grossman, Reeser--2.

Present after roll call--Representatives Grossman, Reeser.

The Speaker declared a quorum present.

On motion of Representative Arrington, the reading of the journal of January 12, 1998, was declared dispensed with and approved as corrected by the Chief Clerk.

EDUCATION

After consideration on the merits, the Committee recommends the following:

HB98-1031, 1084 be referred to the Committee of the Whole with favorable recommendation.

HEALTH, ENVIRONMENT, WELFARE, AND INSTITUTIONS

After consideration on the merits, the Committee recommends the following:

HB98-1023 be referred to the Committee on Appropriations with favorable recommendation.

HB98-1098 be postponed indefinitely.

HB98-1114 be amended as follows, and as so amended, be referred to the Committee on Appropriations with favorable recommendation:

Amend printed bill, page 2, after line 14, insert the following:

"(I.3)  THE PERSON HAS ATTAINED THE AGE OF SIXTY YEARS OR MORE AND MEETS THE RESOURCE ELIGIBILITY REQUIREMENTS OF THE FEDERAL SUPPLEMENTAL SECURITY INCOME PROGRAM AND IS DETERMINED TO BE UNEMPLOYABLE, AS DEFINED BY RULES OF THE STATE BOARD ADOPTED PURSUANT TO PARAGRAPH (g) OF THIS SUBSECTION (2); OR".

Page 5, after line 14, insert the following:

"(g)  THE STATE BOARD SHALL ADOPT RULES SETTING STANDARDS FOR DETERMINING THE EMPLOYABILITY OR UNEMPLOYABILITY OF PERSONS APPLYING FOR THE OLD AGE PENSION WHO HAVE NOT ATTAINED THE AGE REQUIRED BY PARAGRAPH (f) OF THIS SUBSECTION (2). SUCH RULES SHALL INCLUDE AN EMPLOYMENT ASSESSMENT INSTRUMENT THAT ASSESSES THE APPLICANT'S EMPLOYMENT SKILLS AND INTERESTS, WORK HISTORY, EDUCATION AND TRAINING HISTORY, PHYSICAL STAMINA, THE APPLICANT'S SPECIAL NEED FOR SUPPORTIVE SERVICES, AND ANY BARRIERS TO THE APPLICANT'S EMPLOYMENT, SUCH AS LACK OF JOB OPPORTUNITIES IN THE COMMUNITY IN WHICH THE APPLICANT RESIDES OR LACK OF ACCESS TO TRANSPORTATION OR TRAINING.".

Page 4, line 19, strike "____" and substitute "HOUSE";

line 20, strike "_____," and substitute "1001,".

Page 6, line 23, strike "____ Concurrent Resolution Number ___." and substitute "House Concurrent Resolution Number 1001.";

line 25, strike "____ Concurrent Resolution Number ____." and substitute "House Concurrent Resolution Number 1001.".

HCR98-1001 be amended as follows, and as so amended, be referred to the Committee on Appropriations with favorable recommendation:

Amend printed resolution, page 3, line 18, strike "DISABLED," and substitute "DISABLED OR UNEMPLOYABLE,";

line 20, strike "DISABILITY." and substitute "DISABILITY AND UNEMPLOYABILITY.";

line 22, after "DISABLED", insert "OR ARE EMPLOYABLE UNDER THE CRITERIA ESTABLISHED BY THE GENERAL ASSEMBLY".

Page 4, line 2, after "DISABLED", insert "OR WHO ARE EMPLOYABLE".

Page 5, line 10, strike "DISABLED," and substitute "DISABLED OR UNEMPLOYABLE,".

Page 1, line 108, strike "DISABLED," and substitute "DISABLED OR UNEMPLOYABLE,".

LOCAL GOVERNMENT

After consideration on the merits, the Committee recommends the following:

HB98-1022 be amended as follows, and as so amended, be referred to the Committee of the Whole with favorable recommendation:

Amend printed bill, page 2, strike lines 8 through 11 and substitute the following:

"SEPTEMBER 1, 1974, AS APPLICABLE TO GOVERNMENTAL PLANS, OR, TO THE EXTENT NOT INCONSISTENT, THE FEDERAL "INTERNAL" .

Page 4, strike line 8 and substitute the following:

"INITIAL DETERMINATION OF THE AMOUNT OF BENEFITS THAT ARE PAYABLE.";

strike lines 25 and 26.

Page 5, strike line 1;

line 2, strike "(j)" and substitute "(i)";

strike lines 11 through 14.

Page 6, strike lines 9 and 10 and substitute the following:

"RECALCULATED AFTER THE INITIAL DETERMINATION OF THE AMOUNT OF BENEFITS THAT ARE PAYABLE.";

line 22, strike "QUALIFIED MILITARY SERVICE" and substitute "SERVICE IN THE UNIFORMED SERVICES OF THE UNITED STATES".

Page 8, strike lines 7 through 10 and substitute the following:

"(i)  The board may not engage in a transaction prohibited by section 503 (b) of the internal revenue code.".

HB98-1035, 1056 be referred to the Committee of the Whole with favorable recommendation.

PRINTING REPORT

The Chief Clerk reports the following bill has been correctly printed: HB98-1151.

First Reading

The following bills were read by title and referred to the committees indicated:

HB98-1186 by Representatives S. Williams, Bacon, Dyer, Entz, Mace, S. Johnson, and Keller; also Senator Chlouber--Con-cerning teaching of American Indian culture in public schools.

Committee on Education.

HB98-1187 by Representative Morrison--Concerning operation of motor vehicles by persons under eighteen years of age, and, in connection therewith, establishing certain driving restrictions for persons with minor driver's licenses and creating a committee to evaluate the system of testing and preparing drivers.

Committee on Transportation and Energy.

HB98-1188 by Representatives Snyder and Saliman--Concerning the "Fair Campaign Practices Act".

Committee on State, Veterans, and Military Affairs.

HB98-1189 by Representatives Entz and Reeser; also Senator Bishop--Concerning the funding of Colorado water conservation board projects, and making appropriations in connection therewith.

Committee on Agriculture, Livestock and Natural Resources.

Committee on Appropriations.

HB98-1190 by Representative Gotlieb; also Senator Ament--Concerning state funding for emergency capital construction projects for public school districts.

Committee on Finance.

HB98-1191 by Representative Owen; also Senator Rizzuto--Concerning the establishment of defined contribution plans for specified public employees.

Committee on State, Veterans, and Military Affairs.

HB98-1192 by Representative Paschall; also Senator Mutzebaugh--Concerning strategies for the protection of air quality in carbon monoxide nonattainment areas under the state implementation plan, and, in connection therewith, directing the air quality control commission to require the use of oxygenated fuels only as a contingent strategy for such areas that have been redesignated as attainment areas.

Committee on State, Veterans, and Military Affairs.

HB98-1193 by Representative Sinclair--Concerning a requirement that certain motor vehicles use specified lanes when operating on highways.

Committee on Transportation and Energy.

HB98-1194 by Representative Kaufman--Concerning creation of a judicial resources commission.

Committee on Judiciary.

HB98-1195 by Representative Clarke; also Senator Tanner--Concerning additional restrictions on applications for high impact solid waste management facilities.

Committee on Local Government.

HB98-1196 by Representative Arrington--Concerning elimination of the common-law cause of action for bad-faith breach of an insurance contract under the "Workers' Compensation Act of Colorado", and, in connection therewith, establishing administrative remedies for failure to pay benefits when due.

Committee on Business Affairs and Labor.

HB98-1197 by Representative Leyba; also Senator Perlmutter--Con-cerning the youthful offender system, and, in connection therewith, providing for sentences to such system for certain juveniles who are convicted of class 2 felonies.

Committee on Judiciary.

HB98-1198 by Representative June--Concerning establishment of exceptions to the restrictions on the use of automated vehicle identification systems to detect motor vehicle violations.

Committee on Transportation and Energy.

HB98-1199 by Representative Schauer; also Senator Schroeder--Concerning adherence to the exemptions from overtime recognized by the federal "Fair Labor Standards Act of 1938" in determining requirements for overtime in Colorado.

Committee on Business Affairs and Labor.

HB98-1200 by Representative Taylor; also Senator Wattenberg--Concerning the creation of local marketing districts.

Committee on Local Government.

HB98-1201 by Representatives Kaufman, Bacon, S. Johnson, and Tool; also Senators Matsunaka and Reeves--Concerning addition of a county judge in Larimer county.

Committee on Judiciary.

HB98-1202 by Representative May--Concerning revenues allocated to the capital construction fund for state highway construction projects, and making an appropriation in connection therewith.

Committee on Transportation and Energy.

Committee on Appropriations.

HB98-1203 by Representative Smith--Concerning deceptive trade practices relating to the sale of manufactured homes.

Committee on Agriculture, Livestock and Natural Resources.

HB98-1204 by Representatives Entz, George, and Salaz; also Senators Dennis, Bishop, Chlouber, Congrove, Rizzuto, and Wattenberg--Concerning the administration of state nursing homes, and, in connection therewith, repealing and reenacting statutes relating to the management, control, supervision, and authority to establish state nursing homes and state veterans nursing homes.

Committee on State, Veterans, and Military Affairs.

HB98-1205 by Representatives Kreutz, Entz, Epps, Grossman, June, and Pankey; also Senator Arnold--Concerning the establishment of a duty of ordinary care for health care coverage carriers providing coverage through managed care plans with respect to decisions relating to health care services.

Committee on Health, Environment, Welfare and Institutions.

HB98-1206 by Representative Grampsas; also Senator Hopper--Concerning the use of a portion of the state's share of limited gaming revenues to assist counties in which cities where limited gaming is permitted are located for the costs of detoxification centers.

Committee on Local Government.

HB98-1207 by Representatives Lawrence, Allen, Gotlieb, June, Kaufman, Swenson, Tool, and S. Williams; also Senator Mutzebaugh--Concerning the transportation of prisoners through the state.

Committee on Judiciary.

The following resolution was read by title and referred to the committee indicated:

HCR98-1003 by Representatives Pfiffner; also Senator Coffman--Submitting to the registered electors of the state of Colorado an amendment to section 3 (1) constitution of the state of Colorado, property tax reform, and, in connection therewith, modifying the valuation for assessment percentages for certain classifications of property and establishing a homestead exemption for a portion of the actual value of owner-occupied residential property used as a primary residence.

Committee on Finance.

The following resolution was read by title and referred to the committee indicated:

HJR98-1005 by Representative Morrison--Concerning a guideline on euthanasia to be adopted by the Colorado Board of Medical Examiners.

Committee on Health, Environment, Welfare and Institutions.

WHEREAS, Numerous people suffer from intractable and untreatable pain and terminal illness; and

WHEREAS, Many of these people are of sound mind and wish to direct the withholding of life­sustaining nutrition and hydration that artificially preserves their lives; and

WHEREAS, Others suffering from pain and terminal illness, or their relatives who witness their loved ones' pain and suffering, desire to take a more active approach to end the person's suffering; and

WHEREAS, Physicians treating patients with intractable pain and terminal illness are faced with the ethical dilemma of preserving human life and obeying the law while respecting the wishes of their patients; and

WHEREAS, The debate concerning the appropriate societal policy on euthanasia and physician­assisted suicide continues to be a significant and emotional issue throughout the nation; and

WHEREAS, The United States Supreme Court has recently ruled that certain state legislation prohibiting assisted suicide does not violate the Due Process or Equal Protection Clauses of the United States Constitution while at the same time the 1994 Oregon law authorizing physician­assisted suicide was reaffirmed by the Oregon voters on November 4, 1997; and

WHEREAS, The Colorado Medical Society has elected to address the controversial issue of assisted suicide and has adopted the following sensitive and comprehensive policy on euthanasia to guide physicians:

I. Euthanasia means a good death. Only the competent patient or the authentic proxy of the incompetent patient may decide what for each patient constitutes a good death.

II. Passive euthanasia means that medical interventions are withheld or withdrawn, allowing a disease process to continue its natural course leading to death. Competent patients have a moral right to seek a good death by refusing treatment if that is their wish. Furthermore, physicians have a moral obligation to honor the wishes of their competent patients or the authentic proxy of their incompetent patients, with respect to withholding and withdrawing undesired medical interventions.

III. Active euthanasia means that an intervention by someone other than the patient is intended directly and immediately to bring about the death of a suffering patient at the patient's request. However, providing treatment or medication with the intention of easing the pain of a dying patient is acceptable treatment and not active euthanasia, even though such treatment or medication may foreseeably hasten the moment of death.

IV. Suicide means that one intentionally terminated one's life. Refusing a treatment which may delay the moment of death is not suicide. However, intentionally taking a lethal dose of medication even when fatally ill would be suicide. A physician who intentionally provides a lethal dose of medication for the purpose of aiding a patient to commit suicide is assisting suicide. This differs from providing an adequate dose of medication for the purpose of pain relief, even though it may foreseeably hasten death.

V. Physicians share with all society a duty to obey the law which currently prohibits both active euthanasia and assisting suicide. Because controversy surrounds these issues, physicians ought to continue to evaluate their responsibility to society regarding these practices.

VI. It is critical that the medical profession redouble its efforts to ensure that dying patients are provided optimal treatment for their pain and other discomfort. The use of more aggressive comfort care measures, including greater reliance on hospice care, can alleviate the physical and emotional suffering that dying patients experience. Evaluation and treatment by a health professional with expertise in the psychiatric aspects of terminal illness can often alleviate the suffering that leads a patient to desire assisted suicide.

VII. Physicians must resist the natural tendency to withdraw physically and emotionally from their terminally ill patients. When the treatment goals for a patient in the end stages of a terminal illness shift from curative efforts to comfort care, the level of physician involvement in the patient's care should in no way decrease.

VIII. Requests for physician­assisted suicide should be a signal to the physician that the patient's needs are unmet and further evaluation to identify the elements contributing to the patient's suffering is necessary. Multidisciplinary intervention, including specialty consultation, pastoral care, family counseling and other modalities, should be sought as clinically indicated.

IX. Further efforts to educate physicians about advanced pain management techniques, both at the undergraduate and graduate levels are necessary to overcome any shortcomings in this area. Physicians should recognize that courts and regulatory bodies readily distinguish between use of narcotic drugs to relieve pain in dying patients and use in other situations.

X. The principle of patient autonomy requires that physicians must respect the decision to forego life­sustaining treatment of a patient who possesses decision­making capacity. Life­sustaining treatment is any medical treatment that serves to prolong life without reversing the underlying medical condition. Life­sustaining treatment includes, but is not limited to, mechanical ventilation, renal dialysis, chemotherapy, antibiotics and artificial nutrition and hydration.

XI. There is no ethical distinction between withdrawing and withholding life­sustaining treatment.

XII. Physicians have an obligation to relieve pain and suffering and to promote the dignity and autonomy of dying patients in their care. This includes providing effective palliative treatment even though it may foreseeably hasten death. More research must be pursued examining the degree to which palliative care reduces the requests for euthanasia or assisted suicide.

XIII. Physician­assisted suicide is fundamentally inconsistent with the physician's professional role.

Physicians must not perform euthanasia or participate in assisted suicide. A more careful examination of the issue is necessary. Support, comfort, respect for patient autonomy, good communication, and adequate pain control may decrease dramatically the public demand for euthanasia and assisted suicide. In certain carefully defined circumstances, it would be humane to recognize that death is certain and suffering is great. However, the societal risks of involving physicians in medical interventions to cause patients' deaths is too great to condone active euthanasia or physician­assisted suicide.

Now, Therefore, Be It Resolved by the House of Representatives of the Sixty­first General Assembly of the State of Colorado, the Senate concurring herein:

That the policy on euthanasia adopted by the Colorado Medical Society be adopted by the Colorado Board of Medical Examiners and used as a guideline for all medical physicians licensed by the state of Colorado.

Be It Further Resolved, That a copy of this resolution be sent to each member of the Colorado Board of Medical Examiners and to each medical physician licensed by the state of Colorado pursuant to article 36 of title 12, Colorado Revised Statutes.

_______________

On motion of Representative Anderson, the House adjourned until 9:00 a.m., January 14, 1998.

Approved:

CHARLES E. BERRY,

Speaker

Attest:

JUDITH RODRIGUE,

Chief Clerk