CERTIFICATION OF ENROLLMENT
SUBSTITUTE HOUSE BILL 1481
1992 Regular Session
Passed by the House March 8, 1992
Yeas 74 Nays 16
Speaker of the
House of Representatives
Passed by the Senate March 5, 1992
Yeas 28 Nays 21
I, Alan Thompson, Chief Clerk of the House of Representatives of the State of Washington, do hereby certify that the attached is SUBSTITUTE HOUSE BILL 1481 as passed by the House of Representatives and the Senate on the dates hereon set forth.
President of the Senate
Approved Place Style On Codes above, and Style Off Codes below.
Governor of the State of Washington
Secretary of State
State of Washington
SUBSTITUTE HOUSE BILL 1481
AS AMENDED BY THE SENATE
Passed Legislature - 1992 Regular Session
State of Washington 52nd Legislature 1992 Regular Session
By Committee on Health Care (originally sponsored by Representatives May; Hine; Ballard; R. Johnson; Betrozoff; Spanel; Broback; Rasmussen; Wood; Brumsickle; Neher; Leonard; Ferguson; Day; Lisk; Cooper; Brough; Prentice; Forner; Basich; Paris; Holland; G. Fisher; Horn; Sprenkle; Dellwo; Moyer; Grant; Braddock; Bowman; Heavey; Kremen; Cantwell; Winsley; Zellinsky; Silver; Franklin; Pruitt; Inslee; Edmondson; Sheldon; McLean; Riley; Wynne; Rayburn; Wilson; and Orr)
Read first time 01/27/92.
AN ACT Relating to the natural death act; amending RCW 70.122.010, 70.122.020, 70.122.030, 70.122.060, 70.122.070, 70.122.080, 70.122.090, and 70.122.100; adding a new section to chapter 43.70 RCW; adding new sections to chapter 70.122 RCW; and repealing RCW 70.122.050.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 70.122.010 and 1979 c 112 s 2 are each amended to read as follows:
legislature finds that adult persons have the fundamental right to control the
decisions relating to the rendering of their own ((
care, including the decision to have life-sustaining (( procedures)) treatment
withheld or withdrawn in instances of a terminal condition or permanent
The legislature further finds that modern medical technology has made possible the artificial prolongation of human life beyond natural limits.
legislature further finds that, in the interest of protecting individual
autonomy, such prolongation of ((
life)) the process of dying for
persons with a terminal condition or permanent unconscious condition may
cause loss of patient dignity, and unnecessary pain and suffering, while
providing nothing medically necessary or beneficial to the patient. The
legislature further believes that physicians and nurses should not withhold or
unreasonably diminish pain medication for patients in a terminal condition
where the primary intent of providing such medication is to alleviate pain and
maintain or increase the patient's comfort.
legislature further finds that there exists considerable uncertainty in the
medical and legal professions as to the legality of terminating the use or
application of life-sustaining ((
procedures)) treatment where the
patient having the capacity to make health care decisions has
voluntarily (( and in sound mind)) evidenced a desire that such (( procedures))
treatment be withheld or withdrawn.
recognition of the dignity and privacy which patients have a right to expect,
the legislature hereby declares that the laws of the state of Washington shall
recognize the right of an adult person to make a written directive instructing
such person's physician to withhold or withdraw life-sustaining ((
treatment in the event of a terminal condition or permanent
unconscious condition. The legislature also recognizes that a person's
right to control his or her health care may be exercised by an authorized
representative who validly holds the person's durable power of attorney for
Sec. 2. RCW 70.122.020 and 1979 c 112 s 3 are each amended to read as follows:
Unless the context clearly requires otherwise, the definitions contained in this section shall apply throughout this chapter.
(1) "Adult person" means a person who has attained the age of majority as defined in RCW 26.28.010 and 26.28.015, and who has the capacity to make health care decisions.
(2) "Attending physician" means the physician selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient.
(3) "Directive" means a written document voluntarily executed
by the declarer (( in accordance with the requirements)) generally
consistent with the guidelines of RCW 70.122.030.
(4) "Health facility" means a hospital as defined in RCW (( 70.38.020(7)))
70.41.020(2) or a nursing home as defined in RCW (( 70.38.020(8)))
18.51.010, a home health agency or hospice agency as defined in RCW
70.126.010, or a boarding home as defined in RCW 18.20.020.
(5) "Life-sustaining (( procedure)) treatment"
means any medical or surgical (( procedure or intervention which utilizes))
intervention that uses mechanical or other artificial means,
including artificially provided nutrition and hydration, to sustain,
restore, or (( supplant)) replace a vital function, which, when
applied to a qualified patient, would serve only to (( artificially))
prolong the (( moment of death and where, in the judgment of the attending
physician, death is imminent whether or not such procedures are utilized)) process
of dying. "Life-sustaining (( procedure)) treatment"
shall not include the administration of medication or the performance of any
medical (( procedure)) or surgical intervention deemed necessary solely
to alleviate pain.
(6) "Permanent unconscious condition" means an incurable and irreversible condition in which the patient is medically assessed within reasonable medical judgment as having no reasonable probability of recovery from an irreversible coma or a persistent vegetative state.
(7) "Physician" means a person licensed under chapters 18.71
or 18.57 RCW.
(8) "Qualified patient" means an adult person who is a
patient diagnosed (( and certified)) in writing to (( be afflicted with))
have a terminal condition by (( two physicians one of whom shall be))
the patient's attending physician, who (( have)) has
personally examined the patient, or a patient who is diagnosed in writing to
be in a permanent unconscious condition in accordance with accepted medical
standards by two physicians, one of whom is the patient's attending physician,
and both of whom have personally examined the patient.
(9) "Terminal condition" means an incurable and
irreversible condition caused by injury, disease, or illness, (( which,
regardless of the application of life-sustaining procedures, would)) that,
within reasonable medical judgment, (( produce)) will cause death within
a reasonable period of time in accordance with accepted medical standards,
and where the application of life-sustaining (( procedures)) treatment
serves only to (( postpone the moment of death of the patient)) prolong
the process of dying.
"Adult person" means a person attaining the age of majority as
defined in RCW 26.28.010 and 26.28.015.))
Sec. 3. RCW 70.122.030 and 1979 c 112 s 4 are each amended to read as follows:
Any adult person may execute a directive directing the withholding or
withdrawal of life-sustaining ((
procedures)) treatment in a
terminal condition or permanent unconscious condition. The directive
shall be signed by the declarer in the presence of two witnesses not related to
the declarer by blood or marriage and who would not be entitled to any portion
of the estate of the declarer upon declarer's decease under any will of the declarer
or codicil thereto then existing or, at the time of the directive, by operation
of law then existing. In addition, a witness to a directive shall not be the
attending physician, an employee of the attending physician or a health
facility in which the declarer is a patient, or any person who has a claim
against any portion of the estate of the declarer upon declarer's decease at
the time of the execution of the directive. The directive, or a copy thereof,
shall be made part of the patient's medical records retained by the attending
physician, a copy of which shall be forwarded by the custodian of the
records to the health facility (( upon the withdrawal of life-sustaining
procedures)) when the withholding or withdrawal of life-support
treatment is contemplated. The directive (( shall)) may be (( essentially))
in the following form, but in addition may include other specific directions:
Health Care Directive
Directive made this ____ day of __________ (month, year).
being of sound mind)) having the capacity to make health care
decisions, willfully, and voluntarily make known my desire that my
(( life)) dying shall not be artificially prolonged under the
circumstances set forth below, and do hereby declare that:
at any time I should ((
have an incurable injury, disease, or illness
certified)) be diagnosed in writing to be in a terminal
condition by (( two physicians)) the attending physician, or in
a permanent unconscious condition by two physicians, and where the
application of life-sustaining (( procedures)) treatment would
serve only to artificially prolong the (( moment of my death and where my
physician determines that my death is imminent whether or not life-sustaining
procedures are utilized)) process of my dying, I direct that such (( procedures))
treatment be withheld or withdrawn, and that I be permitted to die
naturally. I understand by using this form that a terminal condition means
an incurable and irreversible condition caused by injury, disease, or illness,
that would within reasonable medical judgment cause death within a reasonable
period of time in accordance with accepted medical standards, and where the
application of life-sustaining treatment would serve only to prolong the
process of dying. I further understand in using this form that a permanent
unconscious condition means an incurable and irreversible condition in which I
am medically assessed within reasonable medical judgment as having no
reasonable probability of recovery from an irreversible coma or a persistent
the absence of my ability to give directions regarding the use of such
procedures)) treatment, it is my intention that
this directive shall be honored by my family and physician(s) as the final
expression of my legal right to refuse medical or surgical treatment and I
accept the consequences (( from)) of such refusal. If another
person is appointed to make these decisions for me, whether through a durable
power of attorney or otherwise, I request that the person be guided by this
directive and any other clear expressions of my desires.
(c) If I am diagnosed to be in a terminal condition or in a permanent unconscious condition (check one):
I DO want to have artificially provided nutrition and hydration.
I DO NOT want to have artificially provided nutrition and hydration.
(d) If I have been diagnosed as pregnant and that diagnosis is known to my physician, this directive shall have no force or effect during the course of my pregnancy.
(e) I understand the full import of this directive and I am emotionally
and mentally (( competent)) capable to make the health care
decisions contained in this directive.
(f) I understand that before I sign this directive, I can add to or delete from or otherwise change the wording of this directive and that I may add to or delete from this directive at any time and that any changes shall be consistent with Washington state law or federal constitutional law to be legally valid.
(g) It is my wish that every part of this directive be fully implemented. If for any reason any part is held invalid it is my wish that the remainder of my directive be implemented.
City, County, and State of Residence
declarer has been personally known to me and I believe him or her to be ((
sound mind)) capable of making health care decisions.
Prior to ((
effectuating a directive)) withholding or withdrawing
life-sustaining treatment, the diagnosis of a terminal condition by (( two
physicians)) the attending physician or the diagnosis of a permanent
unconscious state by two physicians shall be (( verified)) entered
in writing(( , attached to the directive,)) and made a permanent part of
the patient's medical records.
(3) A directive executed in another political jurisdiction is valid to the extent permitted by Washington state law and federal constitutional law.
NEW SECTION. Sec. 4. If a qualified patient capable of making health care decisions indicates that he or she wishes to die at home, the patient shall be discharged as soon as reasonably possible. The health care provider or facility has an obligation to explain the medical risks of an immediate discharge to the qualified patient. If the provider or facility complies with the obligation to explain the medical risks of an immediate discharge to a qualified patient, there shall be no civil or criminal liability for claims arising from such discharge.
NEW SECTION. Sec. 5. Any physician, health care provider acting under the direction of a physician, or health facility and its personnel who participate in good faith in the withholding or withdrawal of life-sustaining treatment from a qualified patient in accordance with the requirements of this chapter, shall be immune from legal liability, including civil, criminal, or professional conduct sanctions, unless otherwise negligent.
Sec. 6. RCW 70.122.060 and 1979 c 112 s 7 are each amended to read as follows:
Prior to ((
effectuating a)) the withholding or withdrawal of
life-sustaining (( procedures)) treatment from a qualified patient
pursuant to the directive, the attending physician shall make a reasonable
effort to determine that the directive complies with RCW 70.122.030 and, if the
patient is (( mentally competent)) capable of making health care
decisions, that the directive and all steps proposed by the attending
physician to be undertaken are currently in accord with the desires of the
(2) The attending physician or health facility shall inform a patient or patient's authorized representative of the existence of any policy or practice that would preclude the honoring of the patient's directive at the time the physician or facility becomes aware of the existence of such a directive. If the patient, after being informed of such policy or directive, chooses to retain the physician or facility, the physician or facility with the patient or the patient's representative shall prepare a written plan to be filed with the patient's directive that sets forth the physician's or facilities' intended actions should the patient's medical status change so that the directive would become operative. The physician or facility under this subsection has no obligation to honor the patient's directive if they have complied with the requirements of this subsection, including compliance with the written plan required under this subsection.
The directive shall be conclusively presumed, unless revoked, to be the
directions of the patient regarding the withholding or withdrawal of
procedures)) treatment. No physician, (( and
no licensed)) health facility, or health personnel acting in good
faith (( under the direction of a physician,)) with the directive or
in accordance with the written plan in subsection (2) of this section shall
be criminally or civilly liable for failing to effectuate the directive of the
qualified patient pursuant to this subsection. (( If the physician refuses
to effectuate the directive, such physician shall make a good faith effort to
transfer the qualified patient to another physician who will effectuate the
directive of the qualified patient.))
(4) No nurse, physician, or other health care practitioner may be required by law or contract in any circumstances to participate in the withholding or withdrawal of life-sustaining treatment if such person objects to so doing. No person may be discriminated against in employment or professional privileges because of the person's participation or refusal to participate in the withholding or withdrawal of life-sustaining treatment.
Sec. 7. RCW 70.122.070 and 1979 c 112 s 8 are each amended to read as follows:
The withholding or withdrawal of life-sustaining ((
from a qualified patient pursuant to the patient's directive in accordance with
the provisions of this chapter shall not, for any purpose, constitute a suicide
or a homicide.
The making of a directive pursuant to RCW 70.122.030 shall not restrict,
inhibit, or impair in any manner the sale, procurement, or issuance of any
policy of life insurance, nor shall it be deemed to modify the terms of an
existing policy of life insurance. No policy of life insurance shall be
legally impaired or invalidated in any manner by the withholding or withdrawal
of life-sustaining ((
procedures)) treatment from an insured
qualified patient, notwithstanding any term of the policy to the contrary.
(3) No physician, health facility, or other health provider, and no health care service plan, insurer issuing disability insurance, self-insured employee welfare benefit plan, or nonprofit hospital service plan, shall require any person to execute a directive as a condition for being insured for, or receiving, health care services.
Sec. 8. RCW 70.122.080 and 1979 c 112 s 10 are each amended to read as follows:
act of withholding or withdrawing life-sustaining ((
when done pursuant to a directive described in RCW 70.122.030 and which (( causes))
results in the death of the declarer, shall not be construed to be an
intervening force or to affect the chain of proximate cause between the conduct
of (( any person)) anyone that placed the declarer in a terminal
condition or a permanent unconscious condition and the death of the
Sec. 9. RCW 70.122.090 and 1979 c 112 s 9 are each amended to read as follows:
person who willfully conceals, cancels, defaces, obliterates, or damages
the directive of another without such declarer's consent shall be guilty of a
gross misdemeanor. Any person who falsifies or forges the directive of
another, or willfully conceals or withholds personal knowledge of a
revocation as provided in RCW 70.122.040 with the intent to cause a withholding
or withdrawal of life-sustaining ((
contrary to the wishes of the declarer, and thereby, because of any such act,
directly causes life-sustaining (( procedures)) treatment to be
withheld or withdrawn and death to thereby be hastened, shall be subject to
prosecution for murder in the first degree as defined in RCW 9A.32.030.
Sec. 10. RCW 70.122.100 and 1979 c 112 s 11 are each amended to read as follows:
Nothing in this chapter shall be construed to condone, authorize, or approve mercy killing or physician-assisted suicide, or to permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying.
NEW SECTION. Sec. 11. This chapter shall not be construed as providing the exclusive means by which individuals may make decisions regarding their health treatment, including but not limited to, the withholding or withdrawal of life-sustaining treatment, nor limiting the means provided by case law more expansive than this act.
NEW SECTION. Sec. 12. Any person or health facility may assume that a directive complies with this chapter and is valid.
NEW SECTION. Sec. 13. A directive executed anytime before the effective date of this act which generally complies with this act is effective under this act.
NEW SECTION. Sec. 14. A new section is added to chapter 43.70 RCW to read as follows:
The department of health shall adopt guidelines and protocols for how emergency medical personnel shall respond when summoned to the site of an injury or illness for the treatment of a person who has signed a written directive or durable power of attorney requesting that he or she not receive futile emergency medical treatment.
NEW SECTION. Sec. 15. RCW 70.122.050 and 1979 c 112 s 6 are each repealed.
NEW SECTION. Sec. 16. Sections 4, 5, and 11 through 13 of this act are each added to chapter 70.122 RCW.
NEW SECTION. Sec. 17. If any provision of this act or its application to any person or circumstance is held invalid, the remainder of the act or the application of the provision to other persons or circumstances is not affected.