AN ACT Relating to resuscitation of persons after cardiac or respiratory arrest; amending RCW 70.122.010, 70.122.020, 70.122.050, 70.122.070, and 70.122.080; and adding new sections to chapter 70.122 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

Sec. 1. Section 2, chapter 112, Laws of 1979 and RCW 70.122.010 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to the rendering of their own medical care, including the decision to have life-sustaining procedures withheld or withdrawn in instances of a terminal condition and the decision not to be resuscitated in the event of cardiac or respiratory arrest, or both.

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 for persons with a terminal condition or resuscitation of a person after a cardiac or respiratory arrest, or both 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 or of refraining from resuscitating a person where the ((~~patient~~)) person has voluntarily and in sound mind evidenced a desire that such procedures be withheld or withdrawn.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 in the event of a terminal condition or to instruct such person's physician, health personnel, or residential facility personnel to refrain from resuscitating the person following a cardiac or respiratory arrest, or both.

Sec. 2. Section 3, chapter 112, Laws of 1979 and RCW 70.122.020 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 or a nursing home as defined in RCW ((~~70.38.020(8)~~)) 18.51.010.

(4) "Life-sustaining procedure" means any medical or surgical procedure or intervention 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.

(9) "Residential facility" includes boarding homes as defined in RCW 18.20.020 and independent senior housing, independent living units in continuing care retirement communities, and other similar living situations.

NEW SECTION. Sec. 3. A new section is added to chapter 70.122 RCW to read as follows:

(1) Any adult person may execute a directive directing that if the person experiences a cardiac or respiratory arrest, or both, he or she not be resuscitated.

(2) 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 or residential facility in which the declarer is a patient or resident, 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.

(3) The directive, or a copy, shall be made part of the declarer's medical records.

(4) The directive shall be essentially in the following form, but in addition may include other specific directions:

DIRECTIVE

Directive made this ____ day of __________ (month, year).

I __________, being of sound mind, willfully, and voluntarily make known my desire that I not be resuscitated in the event of cardiac or respiratory arrest, or both. 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.

I understand the full import of this directive and I am emotionally and mentally competent to make this directive.

!sc ,34Signed!w_

City, County, and State of Residence

!ixThe declarer has been personally known to me and I believe him or her to be of sound mind.

!sc ,34Witness!w_

Sec. 4. Section 6, chapter 112, Laws of 1979 and RCW 70.122.050 are each amended to read as follows:

(1) No physician or health facility which, acting in good faith in accordance with the requirements of this chapter, causes the withholding or withdrawal of life-sustaining procedures from a qualified patient, shall be subject to civil liability therefrom. No licensed health personnel, acting under the direction of a physician, who participates in good faith in the withholding or withdrawal of life-sustaining procedures in accordance with the provisions of this chapter shall be subject to any civil liability. No physician, or licensed health personnel acting under the direction of a physician, who participates in good faith in the withholding or withdrawal of life-sustaining procedures in accordance with the provisions of this chapter shall be guilty of any criminal act or of unprofessional conduct.

(2) No physician, health facility, or residential facility that withholds resuscitation from a person who has executed a directive under section 3 of this act in good faith in accordance with the requirements of this chapter is subject to civil liability therefrom. No person, acting in good faith in compliance with the provisions of this chapter, is subject to civil liability, nor is he or she guilty of a criminal act or unprofessional conduct.

Sec. 5. Section 8, chapter 112, Laws of 1979 and RCW 70.122.070 are each amended to read as follows:

(1) The withholding or withdrawal of life-sustaining procedures from a qualified patient, or withholding of resuscitation from a person pursuant to the ((~~patient's~~)) person's directive in accordance with the provisions of this chapter shall not, for any purpose, constitute a suicide.

(2) The making of a directive pursuant to RCW 70.122.030 or section 3 of this act 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 from an insured qualified patient or the withholding of resuscitation from a person who has executed a directive under section 3 of this act, 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. 6. Section 10, chapter 112, Laws of 1979 and RCW 70.122.080 are each amended to read as follows:

The act of withholding or withdrawing life-sustaining procedures when done pursuant to a directive described in RCW 70.122.030 ((~~and which~~)), or the withholding of resuscitation pursuant to a directive described by section 3 of this act, that 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 that placed the declarer in a terminal condition and the death of the declarer.

NEW SECTION. Sec. 7. A new section is added to chapter 70.122 RCW to read as follows:

(1) Prior to adding a declaration under section 3 of this act to a declarer's medical records, a physician, health facility, or residential facility shall make a reasonable effort to determine that the directive complies with section 3 of this act and, if the declarer is mentally competent, that the directive is currently in accord with the desires of the qualified patient.

(2) A directive under section 3 of this act shall be conclusively presumed, unless revoked, to be the directions of the declarer regarding the withholding of resuscitation. No physician, and no licensed health personnel or residential facility 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 a residential facility refuses to effectuate the directive, the residential facility shall make a good faith effort to transfer the declarer to another residential facility that will effectuate the directive of the declarer.