HOUSE BILL REPORT
ESSB 5401
As Amended by the House
BYSenate Committee on Human Services & Corrections (originally sponsored by Senators Kreidler, Sellar, Wojahn, McDermott, Bottiger, Zimmerman, Lee, Talmadge, Bluechel, Vognild, Fleming, Bender, Bailey, Garrett, Rinehart, Bauer, Moore, Hansen, Saling and Gaspard)
Changing provisions relating to the natural death act.
House Committe on Health Care
Majority Report: Do pass with amendment. (8)
Signed by Representatives Braddock, Chair; Brooks, Bumgarner, Cantwell, Lewis, Lux, Sprenkle and Vekich.
House Staff:John Welsh (786-7133)
AS PASSED HOUSE APRIL 10, 1987
BACKGROUND:
The legislature in 1979 enacted the Natural Death Act (NDA) which authorizes a person to sign a written directive directing the attending physician to withhold or withdraw life-support treatment, which serves only to prolong the moment of death. The attending physician must determine that the patient has an irreversible terminal condition, where death is imminent, which must be certified by an additional physician.
Nearly 90 percent of all Americans die as a result of chronic degenerative conditions rather than sudden death. It is estimated that 80 percent of the deaths in the United States now occur in hospitals and long-term care facilities such as nursing homes. Modern medical life-support technology presently offers the ability to keep some terminally ill patients alive almost indefinitely. The NDA and its written directive does not apply to most such situations because it is limited only to situations involving imminent death.
On two occasions the Washington State Supreme Court has recognized the right of individuals to refuse life sustaining treatment when they were in a terminal condition. That right is derived from the constitutional right to privacy which in medical care decision-making embodies the sanctity of individual freedom of choice, self-determination, personal autonomy and human dignity.
Current statutes make no provision for withholding or withdrawing life-sustaining treatment in the absence of a written directive. The state Power of Attorney Act makes no specific reference to the ability of persons to empower another person, an attorney-in-fact, to make health care decisions for them in cases of incompetency.
SUMMARY:
An adult person may authorize the attending physician, in accordance with a signed and witnessed written directive, to withhold or withdraw any artificial or mechanical medical or surgical care which serves only to postpone the moment of death when the patient reaches a terminal condition. A terminal condition includes one which is medically diagnosed as incurable, or with no reasonable probability of recovery from a comatose or vegetative state. In cases where a written directive has been executed, a copy of the directive is required to be forwarded to the appropriate health facility upon admission. The directive is invalid where the patient is diagnosed as pregnant.
Procedures are established for withholding or withdrawing life-sustaining treatment in the absence of a written directive. Conditions for withdrawing or withholding life-support treatment for those not having signed a written directive are specified as follows: 1) The patient is incapable of expressing his or her desires; 2) The attending physician determines the existence of a terminal condition, and an additional physician certifies the existence of such condition after personally examining the patient; (where no family members are involved, two additional physicians must verify the condition); 3) There is authorization from any one of the following individuals in descending priority: a guardian, person holding a durable power of attorney, spouse, adult children, parents, adult brothers and sisters or nieces and nephews; and 4) There is a good faith determination that the qualified patient, if competent, would choose to forgo life-sustaining treatment. In the absence of such determination, the decision must be made only if it is in the patient's best interests. Where none of the persons described above are available, the attending physician may withhold or withdraw life-sustaining treatment under the same requirements in the chapter.
Health facilities, health personnel and patient surrogates are immune from civil liability, not involving negligence, and criminal liability for effectuating in good faith the provisions of the chapter.
Physicians and health facilities choosing not to comply with a patient's directive are required to transfer the patient to another physician or health facility that will comply with the directive. However, those physicians or facilities not complying with the patient's directive shall not be subject to any discrimination, disciplinary action or harassment from the employer. Physicians and health facilities must inform patients who have signed written directives of any policy or practice which precludes the honoring of the directive.
Physicians and nurses may determine and pronounce death. Written directives signed prior to the effective date of this act are not affected by these amendments. Nothing in the chapter is to be construed to authorize euthanasia.
Individuals are authorized pursuant to a durable power of attorney to empower others to make health care decisions on their behalf, including the withholding or withdrawal of life-sustaining treatment. This latter decision is subject to the existence of a terminal condition, and the same requirements contained in the Natural Death Act (NDA). However, these authorized persons are prohibited from consenting on the patient's behalf to convulsion treatment, psychosurgery, commitment in mental health facility (except through Involuntary Treatment Act) and sterilization. A process for revoking a durable power of attorney is provided for through a written notice.
Fiscal Note: Not Requested
House Committee ‑ Testified For: Senator Kreidler, prime sponsor; Sister Sharon Park, Washington State Catholic Conference; Dr. Belding Scribner, Washington State Senior Citizens' Lobby; Arnold Livingston, Senior Citizens' Lobby; Mike Rendish, American Association of Retired Persons; Hilde Birnbaum, Senior Caucus of Group Health Cooperative; Diane Young, Nursing Home Registered Nurses; Bobbie McAbee, Washington State Nurses Association; Frank Winslow, Alzheimer's Society of Washington; Frances Graves, State Task Force on Life Supports; and Bodil Campbell, Citizen.
House Committee - Testified Against: Helen Donovan, National Pro-Life Nurses Association; Nancy Farnam, Registered Nurse; Mary Jo Kahler, Registered Nurse; Les Newton, M.D., Human Life of Washington; Elenor Schoen, American Association of Retired Persons and Gerrie Duzenack, Citizen.
House Committee - Testimony For: Advances in medical technology have made it possible to prolong human life beyond natural conditions, and senior citizens in terminal conditions who do not wish their life or death to be artificially prolonged should have their desires respected. Staying hooked up on artificial life-support systems causes loss of patient dignity, unnecessary pain and suffering while doing nothing medically necessary or beneficial to the patient.
Artificial nutrition and hydration is no different than any other artificial means to prolong the dying process when there is no hope of recovery. Withdrawing artificial nutrition and hydration involves no pain or suffering of any kind in terminal conditions, and the patient experiences no thirst or hunger. The provision of artificial nutrition and hydration after a certain point actually harms the patient whose body can no longer absorb those fluids.
Two recent state Supreme Court decisions declared that persons have a constitutional right to authorize the withholding or withdrawal of life-sustaining treatment in terminal conditions. These rights may also be exercised by other persons on behalf of the patient, and attending physicians may consult with family members to ascertain the intentions and desires of the patient.
Hospitals and other health facilities, as well as physicians and health personnel, should be relieved of legal liability for effectuating the rights of terminal patients under these circumstances.
House Committee - Testimony Against: Nutrition and hydration are basic to human life and should not be withdrawn from patients. Some patients have actually recovered from so-called terminal conditions despite physician pronouncements. Patients should not be allowed to starve to death. This is euthanasia legislation, and has tremendous potential for abuse. Withdrawal of life-support takes life by omission. Feeding does not prolong life as death results from the failure of the organs; feeding supports the body's natural defenses.