H-0055.6 _______________________________________________
HOUSE BILL 1481
_______________________________________________
State of Washington 52nd Legislature 1991 Regular Session
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 January 30, 1991. Referred to Committee on Health Care.
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 new sections to chapter 70.122 RCW; creating new sections; 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:
The
legislature finds that adult persons have the fundamental right to control the
decisions relating to the rendering of their own ((medical)) health
care, including the decision to have life-sustaining ((procedures)) treatment
withheld or withdrawn in instances of a terminal condition or permanent
unconscious condition.
The legislature further finds that modern medical technology has made possible the artificial prolongation of human life beyond natural limits.
The
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 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 has voluntarily ((and in sound mind)) evidenced a desire that
such ((procedures)) treatment be withheld or withdrawn.
In
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 ((procedures))
treatment in the event of a terminal condition or permanent
unconscious condition.
The legislature further recognizes that in the absence of controversy, the court is normally not the proper forum in which to make decisions regarding life-sustaining treatment.
To avoid treatment that is not desired by a person in a terminal condition or permanent unconscious condition, the legislature declares this chapter to be in the interest of the public health and welfare.
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.
(((2)))
(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.
(((3)))
(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.
(((4)))
(5) "Life-sustaining ((procedure)) treatment"
means any medical or surgical ((procedure or intervention which utilizes))
intervention that uses mechanical or other artificial means,
including but not limited to artificial 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.
(((5)))
(7) "Physician" means a person licensed under chapters 18.71
or 18.57 RCW.
(((6)))
(8) "Qualified patient" means 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 by two physicians, one of whom is the patient's attending
physician, and both of whom have personally examined the patient.
(((7)))
(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.
(((8)
"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:
(1)
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. However, a witness to a
directive may be an employee of a long-term care facility, as defined in RCW
43.190.020, in which the declarer is a resident if the second witness is a
state long-term care ombudsman, pursuant to chapter 43.190 RCW. 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:
((DIRECTIVE
TO PHYSICIANS))
Health Care Directive
Directive made this ____ day of __________ (month, year).
I
__________, ((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:
(a) If
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 death, 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 dying 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 vegetative state.
(b) In
the absence of my ability to give directions regarding the use of such
life-sustaining ((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.
(c) If I am diagnosed to be in a terminal condition or a permanent unconscious condition, I wish to have artificial nutrition and hydration withheld or withdrawn.
(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.
(((d)))
(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 as long as it is consistent with Washington state law or federal constitutional law.
(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.
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)) capable of making health care decisions.
Witness..........................
Witness..........................
(2)
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.
(4) After the effective date of this act, all directives should include a reference to a qualified patient's desires with regard to the withholding or withdrawal of artificial nutrition and hydration.
NEW SECTION. Sec. 4. If a qualified patient capable of making health care decisions indicates by words or actions that he or she wishes to die at home in dignity, the patient shall be discharged as soon as reasonably possible. There shall be no civil or criminal liability for claims arising from such discharge.
NEW SECTION. Sec. 5. A new section is added to chapter 70.122 RCW to read as follows:
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:
(1)
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
qualified patient.
(2)
The directive shall be conclusively presumed, unless revoked, to be the
directions of the patient regarding the withholding or withdrawal of
life-sustaining ((procedures)) treatment. No physician, ((and
no licensed)) health facility, or health personnel acting in good
faith ((under the direction of a physician,)) 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)) A person or health facility who chooses not to
comply with the directive shall immediately take all reasonable steps to
transfer care of the qualified patient to another physician or health facility
who will effectuate the directive. A person whose conscience, or a health facility
with a policy that, does not allow participation in the withholding or
withdrawal of life-sustaining treatment, and who takes all reasonable steps to
transfer care of the qualified patient, shall be unconditionally protected from
civil and criminal liability unless otherwise negligent.
(3) 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.
Sec. 7. RCW 70.122.070 and 1979 c 112 s 8 are each amended to read as follows:
(1)
The withholding or withdrawal of life-sustaining ((procedures)) treatment
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.
(2)
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:
The
act of withholding or withdrawing life-sustaining ((procedures)) treatment,
when done pursuant to a directive described in RCW 70.122.030 and which causes
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 declarer.
Sec. 9. RCW 70.122.090 and 1979 c 112 s 9 are each amended to read as follows:
Any
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 ((procedures)) treatment 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. A new section is added to chapter 70.122 RCW to read as follows:
This chapter shall not be construed as requiring a physician or a registered nurse to provide futile treatment, nor shall it be construed as requiring a licensed practical nurse acting under the direction of a registered nurse, a physician's trained mobile technician or paramedic certified pursuant to RCW 18.71.205, or an emergency medical technician certified pursuant to RCW 18.73.081, acting under the direction of a physician, to provide futile treatment.
NEW SECTION. Sec. 12. A new section is added to chapter 70.122 RCW to read as follows:
This chapter shall not be construed as providing the exclusive means by which individuals or their authorized representatives identified in RCW 7.70.065, including holders of durable powers of attorney pursuant to RCW 11.94.010 or otherwise, 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. 13. A new section is added to chapter 70.122 RCW to read as follows:
Any person or health facility may assume that a directive complies with this chapter and is valid.
NEW SECTION. Sec. 14. A new section is added to chapter 70.122 RCW to read as follows:
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. 15. RCW 70.122.050 and 1979 c 112 s 6 are each repealed.
NEW SECTION. Sec. 16. 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.
NEW SECTION. Sec. 17. This act constitutes an alternative to Initiative 119. The secretary of state shall place this act on the ballot in conjunction with Initiative 119 at the next ensuing regular general election.