Opinion ID: 1432062
Heading Depth: 2
Heading Rank: 1

Heading: Colyer-Type Situations

Text: In Colyer, we held that RCW 11.92.040(3) enables a guardian to use his best judgment and exercise, when appropriate, an incompetent's personal right to refuse life sustaining treatment. Colyer, at 131. We concluded that although appointment of a guardian is a judicial process, once the guardian is appointed, the courts need not be involved in the substantive decision to refuse or withdraw life sustaining treatment. Colyer, at 129-30. Language used in Colyer, however, can be construed to require appointment of a guardian before any treatment decision can be made concerning an incompetent patient. This, however, is not the intended result. [3] Guardianship proceedings are often used in cases where patients are incapable of making decisions concerning medical treatment. We do not feel that guardianship proceedings are a necessary predicate to effective decision-making in this type of situation. If the incompetent patient's immediate family, after consultation with the treating physician and the prognosis committee, all agree with the conclusion that the patient's best interests would be advanced by withdrawal of life sustaining treatment, the family may assert the personal right of the incompetent to refuse life sustaining treatment without seeking prior appointment of a guardian. Accord, John F. Kennedy Mem. Hosp., Inc. v. Bludworth, 452 So.2d 921 (Fla. 1984); Barber v. Superior Court, 147 Cal. App.3d 1006, 195 Cal. Rptr. 484 (1983); see also President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment (1983). In Colyer we stated that guardianship hearings would not be overly burdensome, but upon reflection, the approach that best accommodates these most fundamental societal decisions is to allow the surrogate decision maker, the family, to make the decision free of the cumbersomeness and costs of legal guardianship proceedings. If all parties, the immediate family, the treating physicians and the prognosis committee, agree as to the course of treatment, a guardian is not necessary. John F. Kennedy Mem. Hosp., Inc. v. Bludworth, supra . The principal function the guardianship process serves is to protect against abuse by preventing too precipitous a decision or the appointment of one with less than proper motives. Colyer, at 130. Arguably then, elimination of the guardianship process would eliminate these safeguards and open the door for abuse. We are convinced that the remaining procedural safeguards surrounding this decision will adequately protect against abuse. First, this decision can be reached only after there is a medical diagnosis by the attending physicians that (1) the incompetent patient is in a persistent vegetative state with no reasonable chance of recovery and (2) the patient's life is being maintained by life support systems. Throughout this initial diagnosis process the treating physicians are under an ethical, moral and legal duty to treat the patient so as to advance his recovery and alleviate his suffering. Second, this initial diagnosis must be unanimously approved by the prognosis committee.