1481‑S AMS SMIL
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92) 006223
By Senators L. Smith, Craswell and Rasmussen
WITHDRAWN - NOT OFFERED 3/5/92
On page 1, at the beginning of the amendment, strike the entire amendment and title amendment and insert the following:
"Sec. 1. 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) "Attending physician" means the physician selected by, or assigned to, the patient who has primary responsibility for the treatment and care of the patient.
(2) "Directive" means a written document voluntarily executed by the declarer in accordance with the requirements of RCW 70.122.030.
(3) "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.
(4) "Life-sustaining procedure" means any medical or surgical procedure or intervention, including artificially provided nutrition or hydration, which utilizes mechanical or other artificial means to sustain, restore, or supplant 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. "Life-sustaining procedure" shall not include the administration of medication or the performance of any medical procedure deemed necessary to alleviate pain.
(5) "Physician" means a person licensed under chapters 18.71 or 18.57 RCW.
(6) "Qualified patient" means a patient diagnosed and certified in writing to be afflicted with a terminal condition by two physicians one of whom shall be the attending physician, who have personally examined the patient.
(7) "Terminal condition" means an incurable condition caused by injury, disease, or illness, which, regardless of the application of life-sustaining procedures, would, within reasonable medical judgment, produce death, and where the application of life-sustaining procedures serve only to postpone the moment of death of the patient.
(8) "Adult person" means a person attaining the age of majority as defined in RCW 26.28.010 and 26.28.015."
"Sec. 2. RCW 70.122.030 and 1979 c 112 s 4 are each amended to read as follows:
(1) Any adult person may execute a directive directing the withholding or withdrawal of life-sustaining procedures in a terminal 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 to the health facility upon the withdrawal of life-sustaining procedures. The directive shall be essentially in the following form, but in addition may include other specific directions:
DIRECTIVE TO PHYSICIANS
Directive made this .... day of .......... (month, year).
I .........., being of sound mind, willfully, and voluntarily make known my desire that my life shall not be artificially prolonged under the circumstances set forth below, and do hereby declare that:
(a) If at any time I should have an incurable injury, disease, or illness certified to be a terminal condition by two physicians, and where the application of life-sustaining procedures 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, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally.
(b) In the absence of my ability to give directions regarding the use of such life-sustaining procedures, 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 such refusal.
(c) 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.
(d) If I am certified to be in a terminal condition and it is determined that my death is imminent then: (Check only one, and initial)
____ I DO want to receive artificially provided nutrition or hydration.
____ I DO NOT want to receive artificially provided nutrition or hydration.
(e) I understand the full import of this directive and I am emotionally and mentally competent to make this directive.
Signed................
City, County, and State of Residence
The declarer has been personally known to me and I believe him or her to be of sound mind.
Witness...............
Witness...............
(2) Prior to effectuating a directive the diagnosis of a terminal condition by two physicians shall be verified in writing, attached to the directive, and made a permanent part of the patient's medical records."
"Sec. 3. RCW 70.122.060 and 1979 c 112 s 7 are each amended to read as follows:
(1) Prior to effectuating a withholding or withdrawal of life-sustaining procedures 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, that the directive and all steps proposed by the attending physician to be undertaken are currently in accord with the desires of the qualified patient.
(2) The attending physician or health facility shall inform a patient or patient's authorized representative of the existence of any policy or practice of not withholding or withdrawing life-sustaining procedures 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 practice of not withholding or withdrawing life-sustaining procedures, 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 to withhold or withdraw life-sustaining procedures if they have complied with the requirements of this subsection, including compliance with the written plan required under this subsection.
(3) The directive shall be conclusively presumed, unless revoked, to be the directions of the patient regarding the withholding or withdrawal of life-sustaining procedures. 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."
"NEW SECTION. Sec. 4. Any determination of imminent death shall be confirmed unanimously in writing by a panel of three physicians before a person is a qualified patient. The panel shall not include any physician making the original determination."
"NEW SECTION. Sec. 5. If a qualified patient is mentally competent and requests in writing that he or she wishes to die at home, or a physician certifies in writing that the patient is mentally competent and has clearly indicated that he or she wishes to die at home, the patient shall be discharged as soon as possible. The physician, health care provider, or facility has an obligation to explain the medical risks of an immediate discharge to the qualified patient. If the physician, health care 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. 6. 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 procedures from a qualified patient in accordance with the requirements of this chapter, shall be immune from civil liability or professional conduct sanctions unless otherwise negligent.
A physician, health facility, or health personnel, who withholds or withdraws life-sustaining procedures from a qualified patient who has indicated in their directive they want to receive such treatment shall not be immune from criminal or civil liability for failing to effectuate the directive of the qualified patient pursuant to this chapter.
No physician, health facility, or health personnel, acting in good faith and who otherwise complies with the requirements of this chapter, who provides life-sustaining procedures to a person who is under their immediate and temporary care shall be criminally or civilly liable for failing to effectuate the directive of the qualified patient pursuant to this chapter."
"NEW SECTION. Sec. 7. Nothing in this chapter shall be construed to limit or expand the right of any person, other than an adult person who has executed a valid directive pursuant to the provisions of this chapter, to direct that life-sustaining procedures be withheld or withdrawn from any person."
"NEW SECTION. Sec. 8. RCW 70.122.050 and 1979 c 112 s 6 are each repealed."
"NEW SECTION. Sec. 9. Sections 4 through 7 of this act are each added to chapter 70.122 RCW."
WITHDRAWN - NOT OFFERED 3/5/92
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senators L. Smith, Craswell and Rasmussen
On page 1, line 1 of the title, after "act;" strike the remainder of the title and insert "amending RCW 70.122.020, 70.122.030, and 70.122.060; adding new sections to chapter 70.122 RCW; and repealing RCW 70.122.050."
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006239
BySenator L. Smith
WITHDRAWN 3/5/92
On page 1, line 11,
strike "((medical)) health" and insert "medical"
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
NOT ADOPTED 3/5/92
On page 1, line 13 of the amendment, strike "or permanent unconscious condition"
NOT ADOPTED 3/5/92
On page 1, beginning on line 19 of the amendment, strike "or permanent unconscious condition"
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
NOT ADOPTED 3/5/92
On page 2, line 10 of the amendment, strike "or permanent unconscious condition"
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
WITHDRAWN 3/5/92
On page 3, beginning on line 15 of the amendment, strike all material through "state." on line 18
WITHDRAWN 3/5/92
On page 3, line 19 of the amendment, strike "(7)" and insert "(6)"
WITHDRAWN 3/5/92
On page 3, line 21 of the amendment, strike "(8)" and insert "(7)"
WITHDRAWN 3/5/92
On page 3, beginning on line 25 of the amendment, after "patient" strike all material through "patient" on line 28
WITHDRAWN 3/5/92
On page 3, line 29 of the amendment, strike "(9)" and insert "(8)"
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
WITHDRAWN 3/5/92
On page 4, line 13 of the amendment, strike "or permanent unconscious condition"
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
WITHDRAWN 3/5/92
On page 5, beginning on line 12 of the amendment, strike "or in a permanent unconscious condition by two physicians,"
WITHDRAWN 3/5/92
On page 5, beginning on line 25 of the amendment, strike all material through "state." on line 29
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
WITHDRAWN 3/5/92
On page 6, beginning on line 10 of the amendment, strike "or in a permanent unconscious condition"
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
WITHDRAWN 3/5/92
On page 7, beginning on line 7 of the amendment, strike "or the diagnosis of a permanent unconscious state by two physicians"
SHB 1481 - S AMD TO HC COMM AMD (S-4349.4/92)
By Senator L. Smith
WITHDRAWN 3/5/92
On page 10, beginning on line 8 of the amendment, strike "or a permanent unconscious condition"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006240
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 2, line 2, delete "having the capacity to make health care decisions"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006241
BySenator L. Smith
WITHDRAWN 3/5/92
On page 2, line 3, after
"voluntary" strike "((and in sound mind)) and insert
"and in sound mind"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006242
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 1, line 11, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 2, line 1, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 2, line 4, after
"such" strike "((procedures)) treatment" and
insert "procedures"
On page 2, line 9, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 3, line 3, after
"Life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 3, line 11, after
"Life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 4, line 4, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 4, line 12, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 5, line 14, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 5, line 18, after
"such" strike "((procedures)) treatment" and
insert "procedures"
On page 5, line 24, after "sustaining" strike "treatment" and insert "procedures"
On page 6, line 2, after "life-sustaining"
strike "((procedures)) treatment" and insert
"procedures"
On page 7, line 6, after
"life-sustaining" "life-sustaining" strike "((procedures))
treatment" and insert "procedures"
On page 8, line 6, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 8, line 29, after
"life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 9, beginning on
line 12, after "life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 9, beginning on
line 21, after "life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 10, beginning on
line 3, after "life-sustaining" strike "((procedures)) treatment"
and insert "procedures"
On page 11, line 4, after "life-sustaining" strike "treatment and insert "procedures"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006243
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 2, line 25, after
"declarer" strike "((in accordance with the requirements))
generally consistent with the guidelines" and insert "in
accordance with the requirements"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006244
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 3, line 1, after "70.126.010" strike "or a boarding home as define in RCW 18.20.020" and insert "adult family homes as defined in RCW 70.128.010(1)"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006245
BySenator L. Smith
WITHDRAWN 3/5/92
On page 3, line 4, after
"surgical" strike "((procedure or intervention which utilizes))
intervention that uses" and insert "procedure or intervention
which utilizes"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006246
BySenator L. Smith
WITHDRAWN 3/5/92
On page 3, line 5, after "means" delete ", including artificially provided nutrition and hydration,"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006247
BySenator L. Smith
WITHDRAWN 3/5/92
On page 3, beginning on
line 7, strike "((supplant)) replace" and insert
"supplant"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006248
BySenator L. Smith
WITHDRAWN 3/5/92
On page 10, line 23, strike sections 10, 11, 12, 13, and 14 in their entirety.
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006258
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 2, line 10, after "condition" strike all materials through and including "care." on line 13, and insert ", except that decisions to remove hydration and nutrition may not be made in the absence of clear and convincing evidence that such removal was the patient's clearly expressed desire."
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006259
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 3, line 8, after
"to" strike ((artificially)) and insert
"artificially"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006260
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 3, beginning on
line 9, strike "((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" and insert "moment of death
and where, in the judgment of the attending physician, death is imminent whether
or not such procedures are utilized"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006263
BySenator L. Smith
WITHDRAWN 3/5/92
On page 3, after line 14, strike all material down to and including "state." on line 18, and renumber the following subsections accordingly
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006264
BySenator L. Smith
WITHDRAWN 3/5/92
On page 3, line 23, after
"by" strike "((two physicians one of whom shall be))"
and insert "two physicians one of whom shall be"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006265
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 5, line 1, strike
"((shall)) may be ((essentially))" and insert
"shall be essentially"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006267
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 6, line 7, after "for me" strike ", whether"
On page 6, line 7, after "power of attorney" strike "or otherwise"
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006268
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 3, line 11, after "dying." insert "Life sustaining procedures shall not be withheld or withdrawn if the intent or the result of withholding or withdrawing such procedures is to cause, or is the cause of the death of a qualified patient."
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006269
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 8, line 3, strike all of section 6, and insert the following:
"NEW SECTION. Sec. 6. Any physician, health care provider acting under the direction of a physician, or health facility ad its personnel who participate in good faith in the withholding or withdrawal of life-sustaining procedures from a qualified patient in accordance with the requirements of this chapter shall be immune from civil liability or professional conduct sanctions unless otherwise negligent.
A physician, health facility, or health personnel, who withholds or withdraws life-sustaining procedures from a qualified patient who has indicated in his or her directive that he or she wants to receive such treatment shall not be immune from criminal or civil liability for failing to effectuate the directive of the qualified patient pursuant to this chapter.
No physician, health facility, or health personnel, acting in good faith and who otherwise complies with the requirements of this chapter, who provides life-sustaining procedures to a person who is under his or her immediate and temporary care shall be criminally or civilly liable for failing to effectuate the directive of the qualified patient pursuant to this chapter."
SHB 1481 - S AMD TO S COMM AMD (S‑4349.4/92) 006270
BySenator L. Smith
NOT ADOPTED 3/5/92
On page 3, line 24, after
"physician," strike "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" on line 28, and insert
"and one of whom shall be a board-certified neurologist, both of whom
shall have personally examined the patient. The second physician need not be a
board-certified neurologist if the attending physician is a board-certified
neurologist."