Honolulu, Hawaii
                                                     , 1999

                                   RE:  H.B. No. 171
                                        H.D. 2
                                        S.D. 2

Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii


     Your Committee on Judiciary, to which was referred H.B. No.
171, H.D. 2, S.D. 1, entitled: 


begs leave to report as follows:

     The purpose of this measure is to enact the Uniform Health-
Care Decisions Act.

     Your Committee finds that since the Supreme Court's decision
in Cruzan v. Commissioner, Missouri Department of Health, 497
U.S. 261 (1990), significant changes have occurred in state
legislation on health care decision making.  Nearly all states
have statutes authorizing the use of powers of attorney for
health care.  In addition, a majority of states have statutes
allowing family members, and in some cases close friends, to make
health care decisions for adult individuals or emancipated minors
who lack capacity.

     However, your Committee recognizes that there is a greater
need for uniformity among advance directives for health care and
believes that this Uniform Health Care Decisions Act will
simplify and facilitate the making of advance health care
directives.  Your Committee notes that recommended forms are
being included in this measure, and to enhance public access to
these forms, they should be posted on the internet websites of
appropriate state agencies.

                                   STAND. COM. REP. NO. 1600
                                   Page 2

     Your Committee intends that this measure replace chapter
327D, Hawaii Revised Statutes, relating to medical treatment
decisions which was first enacted in 1986 and has not been
revised since 1992.  In the intervening years, medical science
has advanced tremendously and medical ethics has developed
correspondingly.  This measure brings medical treatment decisions
into today's world of advances in medicine, patient rights, and
attitudes toward dying.  Your Committee notes that this measure
is not intended to disrupt the existing surrogate law and
practices in acute care and long-term care settings.

     Testimony in support of this measure was submitted by the
Executive Office on Aging, the Governor's Surrogate Decision
Making Committee, Policy Advisory Board for Elder Affairs, Hawaii
Catholic Conference, Healthcare Association of Hawaii, Hawaii
Medical Association, Hawaii Nurses Association, a law school
professor, and a private citizen.  Testimony in opposition to
this measure was submitted by the Third Order of Mary in Kapaa,
Christian Voice of Hawaii, Hawaii Right to Life, the Archbishop
Fulton Sheen Foundation, Pro-Family Hawaii, the Good Shepard
Lutheran Church, and nine private citizens.  The Hawaii Right to
Life (Kamuela Chapter) also submitted comments on this measure.

     Upon further consideration, your Committee has amended this
measure by:

     (1)  Including within the definition of "health care" that
          withholding or withdrawing artificial nutrition or
          hydration is in accord with the health care providers
          prevailing clinical standard of conduct;

     (2)  Deleting all references to "non-designated surrogate"
          and establishing classes of surrogates as either those
          who are designated in writing or orally by the patient,
          or those who are not designated but can act as
          surrogates based upon their relationship to the

     (3)  Clarifying that only surrogates designated in writing
          or orally by the patient are extended the full-range of
          surrogate decisions, and limiting the range of
          decisions that can be made by surrogates who are not
          designated by the patient to prevent them from
          withdrawing or withholding artificial nutrition and

     (4)  Providing a ranking hierarchy of priority for
          surrogates and defining the process through which
          disputes between surrogates are to be resolved; and

                                   STAND. COM. REP. NO. 1600
                                   Page 3

     (5)  Making technical, non-substantive changes for the
          purposes of clarity and style.

     As affirmed by the record of votes of the members of your
Committee on Judiciary that is attached to this report, your
Committee is in accord with the intent and purpose of H.B. No.
171, H.D. 2, S.D. 1, as amended herein, and recommends that it
pass Third Reading in the form attached hereto as H.B. No. 171,
H.D. 2, S.D. 2.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Judiciary,

                                   AVERY B. CHUMBLEY, Co-Chair

                                   MATTHEW M. MATSUNAGA, Co-Chair