ANALYSIS OF HOUSE BILL 2853

               Creating the end-of-life care act.

Health Care Committee                          2 February 1998

Washington State House of Representatives

SPONSORS:  Representatives Dyer and Cody.

BACKGROUND:  There is no provision in state law specifically authorizing a patient with a terminal illness to make a voluntary request for palliative sedation.  Palliative sedation is a request for medication to relieve pain or suffering, even though it may cause unconsciousness and may have a double effect of hastening death.

There is no statutory provision in law providing for requests by patients to withhold cardiopulmonary resuscitation.  However, rules adopted by the Department of Health (DOH) pursuant to law, provide procedures for obtaining informed consent for such orders in event of cardiac or respiratory arrest.

SUMMARY:  There is a legislative declaration that palliative sedation is a widely accepted ethical medical practice and is not unlawful in this state when consented to by an informed patient.  The patient has a right to make voluntary informed choices of care including palliative sedation.  The state has an obligation to regulated end-of-life care to prevent abuses.

A patient with decision-making capacity may request orally or in writing an order not to attempt resuscitation.  The DOH is directed to adopt rules and protocols for the implementation of cardiopulmonary resuscitation directives or orders for emergency medical personnel, including forms, bracelets, necklaces and cards.

A patient or authorized representative under a durable power of attorney may request orally or in writing medication to relieve pain or suffering.  A physician may prescribe, administer or dispense a controlled substance in any dose deemed medically necessary to manage or relieve pain in accordance with departmental guidelines.

A terminal patient may also voluntarily execute a revocable recorded request for palliative sedation to relieve pain or suffering if repeated twice 24 hours apart, and witnessed by two qualified adults.  The recorded request becomes a part of the patient=s medical records, and the physician shall examine the patient for the capacity to consent and the existence of the terminal condition.  The physician shall explain the diagnosis, review feasible alternatives to palliative sedation, and describe risks and probable result of palliative sedation.  A patient may freely revoke the request.  A physician or other health professional is not required to participate in end-of-life decisions, but, if refusing, shall assist the patient in transferring to another physician or facility.

A physician or other health care professional, including a health facility, who in good faith adheres to a do-not-resuscitate order, or participates in the palliative sedation of a patient in compliance with law is not subject to criminal, civil or administrative liability.

An insurer may not discriminate in the issuance of insurance based on a patient=s decision for refusing resuscitation or requesting palliative sedation, and an insurance policy of life, health or disability is not impaired or invalidated.  It is a misdemeanor for insurers to require the decision.

There are criminal sanctions provided for persons unduly influencing another to execute directives for do-not-resuscitate or palliative sedation, or for thwarting bona fide orders requested by a patient, or for falsifying orders.

Directives for do-not-resuscitate or palliative sedation from other states shall be valid in this state if substantially complying with the law.  

Forms are provided for directives for do-not-resuscitate orders or voluntary requests for palliative sedation to be signed and appropriately witnessed.  Persons may also authorize withholding of cardiopulmonary resuscitation or palliative sedation through a written directive under the Natural Death Act.