Opinion ID: 2600299
Heading Depth: 1
Heading Rank: 4

Heading: Wrongful Birth/Wrongful Life Claims

Text: ¶ 24 The plaintiffs next contend that summary judgment on their negligence claims was improper because a genuine issue of material fact exists as to whether Dr. Vaughn breached the applicable standard of care by failing to discontinue resuscitation when it became highly probable that Liam would be severely disabled if he survived. They assert that their claims properly rest on the right of parents to prevent the birth of a child with deficits and the child's corresponding right not to be born to suffer a severely disabled existence, as recognized in Harbeson v. Parke-Davis, Inc., 98 Wash.2d 460, 656 P.2d 483 (1983). ¶ 25 We turn first to the parents' claims. In Harbeson, this court recognized that parents may assert a cause of action for wrongful birth under the theories of informed consent and negligence, based on a health care provider's failure to impart information or to perform medical procedures with due care, when the proximate result is the birth of a child with deficits. In that case, the mother was prescribed Dilantin to treat her epilepsy. She and her husband informed physicians that they planned to have children and asked whether the Dilantin would pose any risks of birth defects. The physicians negligently failed to inform them of known risks. The Harbesons subsequently had two children born with birth defects. They would have chosen not to conceive if the physicians had informed them of the potential birth defects associated with the use of Dilantin during pregnancy. ¶ 26 In deciding whether to permit the parents to bring a wrongful birth action, the Harbeson court stated that [t]he critical concept is duty. The core of our decision is whether we should impose upon health care providers a duty correlative to parents' right to prevent the birth of defective children. Id. at 471, 656 P.2d 483 (emphasis added). This court concluded that the imposition of such a duty was appropriate in light of advances in medical technologies which make it possible to predict the occurrence of genetic defects and to diagnose abnormalities in the unborn fetus. Id. at 471-72, 656 P.2d 483. The duty requires health care providers to impart material information as to the likelihood of birth defects and to perform sterilization and abortion procedures with due care. ¶ 27 In Benoy v. Simons, 66 Wash.App. 56, 831 P.2d 167 (1992), the Court of Appeals correctly recognized that Harbeson does not apply when the alleged negligence occurs after a child is born. In that case, a premature infant suffered severe respiratory distress syndrome and a brain hemorrhage after being born by emergency caesarean section. He was placed on a ventilator and treated in an intensive care nursery, but about five weeks later the ventilator was removed and the infant died. His mother argued that the wrongful birth action recognized in Harbeson should be extended to permit suit based on the health care provider's failure to obtain her consent before placing the infant on the ventilator. Benoy, 66 Wash.App. at 62, 831 P.2d 167. The Court of Appeals disagreed, stating that [t]he analogy is unsound because Harbeson, [98 Wash.2d] at 473, [656 P.2d 483] is based on recognition that parents have a right to prevent the birth of a defective child and health care providers have a duty to the parents correlative to that right. Benoy, 66 Wash.App. at 62, 831 P.2d 167. The Court of Appeals observed that the duty recognized in Harbeson is owed by a health care provider to a parent as patient, to provide nonnegligent genetic counseling and prenatal care so that parents may avoid the birth of a child with deficits. The Court of Appeals concluded that Harbeson was inapplicable because the parent was not the patient. ¶ 28 We agree with the Benoy court's reasoning. The right to prevent the birth of a child is based on the parents' constitutional right to reproductive autonomy. See Harbeson, 98 Wash.2d at 472, 656 P.2d 483 (noting that [t]he difficult moral choice of aborting a fetus rests with the parents) (citing Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973)); Griswold v. Connecticut, 381 U.S. 479, 85 S.Ct. 1678, 14 L.Ed.2d 510 (1965) (constitutional right of privacy encompasses right of married couples to use contraception). Before birth, a fetus has no cognizable constitutional interests to balance against the mother's liberty interest. At the point of viability, however, the State's interest in the preservation of potential life intervenes. Planned Parenthood v. Casey, 505 U.S. 833, 112 S.Ct. 2791, 120 L.Ed.2d 674 (1992). Once an infant is born, of course, the parents' right to reproductive autonomy is fully displaced by the infant's constitutionally protected right to life. Because Liam was already born when the alleged negligence occurred, the duty we recognized in Harbeson does not apply in this case. ¶ 29 The Supreme Courts of Wisconsin and Texas also have addressed the issue of whether parents may hold a physician liable under the theories of informed consent and/or negligence based on the failure to refrain from emergency resuscitation of a newborn infant. Both courts have rejected such claims, reasoning that parents do not have a right to withhold life-saving treatment from a newborn, even when it is highly likely that the newborn will be severely disabled, if revived. Miller, 118 S.W.3d 758; Montalvo v. Borkovec, 256 Wis.2d 472, 647 N.W.2d 413, 420 (2002). ¶ 30 Montalvo involved the premature birth of an infant at 23-weeks' gestation by emergency caesarean section. Id. The infant survived as a result of resuscitation measures provided following birth but suffered severe disabilities. The parents alleged that health care providers were negligent for denying them the opportunity to refuse consent to life-saving treatment for the newborn. Under Wisconsin law, a surrogate decision-maker may refuse consent to life-saving treatment only when an individual is in a persistent vegetative state. Id. at 418. Similarly, federal statutory law binding on the state prohibits health care providers from withholding emergency care to a newborn infant. [3] Accordingly, the court rejected the claim, concluding that parents do not have a right, under state or federal law, to withhold or withdraw immediate postnatal care from an infant. ¶ 31 The plaintiffs attempt to distinguish Montalvo on the basis that, unlike Wisconsin law, Washington law extends the right to refuse life-sustaining treatment to persons suffering a terminal condition. Br. of Appellants at 35 (citing RCW 70.122.010, the Natural Death Act). The Natural Death Act applies to competent adults, not minors, and carefully conditions the right to refuse life-saving treatment on fulfillment of a number of procedural safeguards that are absent under the circumstances presented here. Our case law recognizes the constitutional right of an incompetent adult to refuse treatment that serves only to prolong the dying process, given the absence of countervailing state interests. In re Welfare of Colyer, 99 Wash.2d 114, 120, 660 P.2d 738 (1983). This right may be exercised by a guardian on behalf of an incompetent patient whose wishes cannot be known, when treatment would provide no measure of recovery but would merely postpone death for someone in the advanced stages of an incurable, terminal illness. In re Guardianship of Hamlin, 102 Wash.2d 810, 815, 689 P.2d 1372 (1984). ¶ 32 The right to withhold life-saving treatment as recognized by statute and case law does not support a wrongful birth claim by Liam's parents. First, Liam was neither terminally ill nor in a persistent vegetative state. Second, when recognized, the right to withhold life-saving treatment is personal to the patient, it does not belong to the person who exercises that right on behalf of an incompetent. Thus, even assuming Liam had a right to withholding of life-sustaining treatment, his parents could not assert a cause of action based on the violation of that right. Accordingly, we hold that a health care provider owes no duty to the parents of an infant to discontinue resuscitation when it becomes highly probable that the infant will be severely disabled. ¶ 33 The plaintiffs also contend that Liam should be permitted to pursue a wrongful life cause of action recognized in Harbeson. As mentioned, the Harbeson court recognized a cause of action not only for wrongful birth but also for wrongful life. The wrongful life cause of action is the child's equivalent of the parents' wrongful birth action. Harbeson, 98 Wash.2d at 478, 656 P.2d 483. In recognizing a wrongful life claim, this court reasoned that it would be anomalous to permit recovery by the parents alone. Allowing recovery by the child would provide a comprehensive and consistent compensation scheme and would deter malpractice. Id. at 481, 656 P.2d 483. Hence, the duty of health care providers to provide nonnegligent prenatal counseling and medical care extends to children not yet conceived or born. Id. ¶ 34 Relying on Harbeson, Liam insists that he may assert a wrongful life claim regardless of whether this court recognizes his parents' claim of wrongful birth. The respondents contend that the failure of Liam's parents' wrongful birth claim precludes Liam's wrongful life claim because the latter is derivative of the former. ¶ 35 Whether a wrongful life claim is described as derivative of a parent's wrongful birth claim or whether the claim is viewed as an independent cause of action is irrelevant. As discussed above, Harbeson applies when a health care provider breaches a prenatal duty to parents and children; it does not apply when the breach occurs after birth, as allegedly occurred in this case.