Chapter 70.122 RCW
NATURAL DEATH ACT
|70.122.030||Directive to withhold or withdraw life-sustaining treatment.|
|70.122.040||Revocation of directive.|
|70.122.051||Liability of health care provider or facility.|
|70.122.060||Procedures by physician – Health care facility or personnel may refuse to participate.|
|70.122.070||Effects of carrying out directive – Insurance.|
|70.122.080||Effects of carrying out directive on cause of death.|
|70.122.090||Criminal conduct – Penalties.|
|70.122.100||Mercy killing or physician-assisted suicide not authorized.|
|70.122.110||Discharge so that patient may die at home.|
|70.122.120||Directive’s validity assumed.|
|70.122.900||Short title – 1979 c 112.|
|70.122.905||Severability – 1979 c 112.|
|70.122.915||Application – 1992 c 98.|
|70.122.920||Severability – 1992 c 98.|
Futile treatment and emergency medical personnel: RCW 43.70.480.
The legislature finds that adult persons have the fundamental right to control the decisions relating to the rendering of their own health care, including the decision to have life-sustaining treatment withheld or withdrawn in instances of a terminal condition or permanent unconscious condition.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 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 believes that physicians and nurses should not withhold or unreasonably diminish pain medication for patients in a terminal condition where the primary intent of providing such medication is to alleviate pain and maintain or increase the patient’s comfort.
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 treatment where the patient having the capacity to make health care decisions has voluntarily evidenced a desire that such treatment be withheld or withdrawn.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 treatment in the event of a terminal condition or permanent unconscious condition. The legislature also recognizes that a person’s right to control his or her health care may be exercised by an authorized representative who validly holds the person’s durable power of attorney for health care.[1992 c 98 § 1; 1979 c 112 § 2.]
Unless the context clearly requires otherwise, the definitions contained in this section shall apply throughout this chapter.
(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.
(3) “Directive” means a written document voluntarily executed by the declarer generally consistent with the guidelines of RCW 70.122.030.
(4) “Health facility” means a hospital as defined in RCW 70.41.020(2) or a nursing home as defined in RCW 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.
(5) “Life-sustaining treatment” means any medical or surgical intervention that uses mechanical or other artificial means, including artificially provided nutrition and hydration, to sustain, restore, or replace a vital function, which, when applied to a qualified patient, would serve only to prolong the process of dying. “Life-sustaining treatment” shall not include the administration of medication or the performance of any medical 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.
(8) “Qualified patient” means an adult person who is a patient diagnosed in writing to have a terminal condition by the patient’s attending physician, who 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.
(9) “Terminal condition” means an incurable and irreversible condition caused by injury, disease, or illness, that, within reasonable medical judgment, will cause death within a reasonable period of time in accordance with accepted medical standards, and where the application of life-sustaining treatment serves only to prolong the process of dying.[1992 c 98 § 2; 1979 c 112 § 3.]
Directive to withhold or withdraw life-sustaining treatment.
(1) Any adult person may execute a directive directing the withholding or withdrawal of life-sustaining 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. 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 when the withholding or withdrawal of life-support treatment is contemplated. The directive may be in the following form, but in addition may include other specific directions:
Health Care Directive
Directive made this . . . . day of . . . . . . (month, year).
I . . . . . ., having the capacity to make health care decisions, willfully, and voluntarily make known my desire that my dying shall not be artificially prolonged under the circumstances set forth below, and do hereby declare that:
(a) If at any time I should be diagnosed in writing to be in a terminal condition by the attending physician, or in a permanent unconscious condition by two physicians, and where the application of life-sustaining treatment would serve only to artificially prolong the process of my dying, I direct that such 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 death 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 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 of such refusal. If another person is appointed to make these decisions for me, whether through a durable power of attorney or otherwise, I request that the person be guided by this directive and any other clear expressions of my desires.
(c) If I am diagnosed to be in a terminal condition or in a permanent unconscious condition (check one):
I DO want to have artificially provided nutrition and hydration.
I DO NOT want to have artificially provided nutrition and hydration.
(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.
(e) I understand the full import of this directive and I am emotionally and mentally 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 and that any changes shall be consistent with Washington state law or federal constitutional law to be legally valid.
(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 capable of making health care decisions.
Witness . . . . . . . . . . . .
Witness . . . . . . . . . . . .
(2) Prior to withholding or withdrawing life-sustaining treatment, the diagnosis of a terminal condition by the attending physician or the diagnosis of a permanent unconscious state by two physicians shall be entered in writing 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.[1992 c 98 § 3; 1979 c 112 § 4.]
Revocation of directive.
(1) A directive may be revoked at any time by the declarer, without regard to declarer’s mental state or competency, by any of the following methods:
(a) By being canceled, defaced, obliterated, burned, torn, or otherwise destroyed by the declarer or by some person in declarer’s presence and by declarer’s direction.
(b) By a written revocation of the declarer expressing declarer’s intent to revoke, signed, and dated by the declarer. Such revocation shall become effective only upon communication to the attending physician by the declarer or by a person acting on behalf of the declarer. The attending physician shall record in the patient’s medical record the time and date when said physician received notification of the written revocation.
(c) By a verbal expression by the declarer of declarer’s intent to revoke the directive. Such revocation shall become effective only upon communication to the attending physician by the declarer or by a person acting on behalf of the declarer. The attending physician shall record in the patient’s medical record the time, date, and place of the revocation and the time, date, and place, if different, of when said physician received notification of the revocation.
(2) There shall be no criminal or civil liability on the part of any person for failure to act upon a revocation made pursuant to this section unless that person has actual or constructive knowledge of the revocation.
(3) If the declarer becomes comatose or is rendered incapable of communicating with the attending physician, the directive shall remain in effect for the duration of the comatose condition or until such time as the declarer’s condition renders declarer able to communicate with the attending physician.[1979 c 112 § 5.]
Liability of health care provider or facility.
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.[1992 c 98 § 5.]
Procedures by physician – Health care facility or personnel may refuse to participate.
(1) Prior to the withholding or withdrawal of life-sustaining 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 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 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. If the patient, after being informed of such policy or directive, 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 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 treatment. No physician, health facility, or health personnel acting in good faith 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.
(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.[1992 c 98 § 6; 1979 c 112 § 7.]
Effects of carrying out directive – Insurance.
(1) The withholding or withdrawal of life-sustaining 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 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.[1992 c 98 § 7; 1979 c 112 § 8.]
Effects of carrying out directive on cause of death.
The act of withholding or withdrawing life-sustaining treatment, when done pursuant to a directive described in RCW 70.122.030 and which results in 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 anyone that placed the declarer in a terminal condition or a permanent unconscious condition and the death of the declarer.[1992 c 98 § 8; 1979 c 112 § 10.]
Criminal conduct – Penalties.
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 treatment contrary to the wishes of the declarer, and thereby, because of any such act, directly causes life-sustaining 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.[1992 c 98 § 9; 1979 c 112 § 9.]
Mercy killing or physician-assisted suicide not authorized.
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.[1992 c 98 § 10; 1979 c 112 § 11.]
Discharge so that patient may die at home.
If a qualified patient capable of making health care decisions indicates that he or she wishes to die at home, the patient shall be discharged as soon as reasonably possible. The health care provider or facility has an obligation to explain the medical risks of an immediate discharge to the qualified patient. If the 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.[1992 c 98 § 4.]
Directive’s validity assumed.
Any person or health facility may assume that a directive complies with this chapter and is valid.[1992 c 98 § 12.]
Short title – 1979 c 112.
This act shall be known and may be cited as the “Natural Death Act”.[1979 c 112 § 1.]
Severability – 1979 c 112.
If any provision of this act or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of the act which can be given effect without the invalid provisions or application, and to this end the provisions of this act are severable.[1979 c 112 § 13.]
This chapter shall not be construed as providing the exclusive means by which individuals 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 chapter 98, Laws of 1992.[1992 c 98 § 11.]
Application – 1992 c 98.
A directive executed anytime before June 11, 1992, which generally complies with chapter 98, Laws of 1992 is effective under chapter 98, Laws of 1992.[1992 c 98 § 13.]
Severability – 1992 c 98.
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.[1992 c 98 § 17.]