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

Heading: Hamlin-Type Situations

Text: In Colyer, we stated in dicta that there will be instances when the detached opinion of the judiciary would be required in the substantive decision to withhold treatment. For example, if there is disagreement among family members as to the incompetent's wishes or among the physicians as to the prognosis, if the patient has always been incompetent so that his wishes cannot be known, if there is evidence of wrongful motives or malpractice, or if there is no family member to serve as guardian, the court may be required to intervene. (Italics ours.) Colyer, at 136. This dicta indicates that even if all parties agreed, because Hamlin had no family and has always been incompetent, the judiciary would be required to make the substantive decision to terminate life sustaining procedures. Presented with the actual situation envisioned by this dicta, we believe the judiciary's role is not that broad. [4] Hamlin had no available family. Therefore, a surrogate decision maker must be provided to ensure that Hamlin's interests are represented. The surrogate decision maker, like a family, provides an objective viewpoint to evaluate the medical prognosis. More importantly, like a family, the surrogate decision maker guarantees that decisions in cases such as Hamlin's remain individualized. Accordingly, when a family is not available and the patient is incompetent, a guardian must be appointed pursuant to RCW 11.88.010 et seq. to represent the patient's best interests. The court will always be involved in the appointment of the guardian. As discussed here and in Colyer, at pages 128-32, the duties of the guardian are to assert the rights and best interests of the incompetent person. RCW 11.92.040(3). This includes the power to assert the incompetent's personal right to refuse life sustaining treatment. Colyer, at 131. However, the court need not always be involved in the actual substantive decision. Therefore, like the familial situation, if the treating physicians, the prognosis committee, and the guardian are all in agreement that the incompetent patient's best interests are served by termination of life sustaining treatment, absent legislation to the contrary, there is no need for judicial involvement in this decision. Thus, we believe the following procedures will best serve all interests involved in this type of case:

To the extent that these holdings modify dicta in In re Colyer, supra at 136, it is so held.