Opinion ID: 1454631
Heading Depth: 1
Heading Rank: 8

Heading: natural death or euthanasia?

Text: Washington's Natural Death Act does not permit the removal of nutrition and hydration from terminally ill patients. Nothing in the Natural Death Act suggests that such basic treatment falls within the ambit of life-sustaining procedure. In fact, upon close examination, the language of the Natural Death Act suggests the opposite. [17] The concept of natural death itself suggests a death caused by neither act nor omission, but rather by the patient's own unimpeded illness. Under this reasoning, only the removal of treatment directly addressing a terminal condition could be congruent with the Natural Death Act. The provision of food and water, however, certainly does not combat a terminal affliction. The withdrawal of food and water causes a premature unnatural death. To say a person died naturally because of an inability to feed oneself is absurd. Such logic could support the withdrawal of treatment from unwanted babies, the handicapped or the developmentally disabled. Using this reasoning, the New York Court of Appeals disallowed the termination of blood transfusions that were administered to a terminally ill, profoundly retarded patient. In re Storar, 52 N.Y.2d 363, 420 N.E.2d 64, 438 N.Y.S.2d 266 (1981). In Storar, the court found it unrealistic to attempt to determine whether [the patient] would want to continue potentially life prolonging treatment if he were competent. Instead, the court likened the developmentally disabled patient's condition to that of an infant and held that a guardian may not deprive a child of life-saving treatment, however well intentioned. (Citations omitted.) 52 N.Y.2d at 380. The court further reasoned that the transfusions were analogous to food  they would not cure the cancer, but they could eliminate the risk of death from another treatable cause. 52 N.Y.2d at 381. The Court of Appeals, therefore, reversed the lower court decision to withhold the blood transfusions. The Court of Appeals did, however, authorize the lower court's holding permitting the removal of artificial ventilation. 52 N.Y.2d at 381. In doing so, it implicitly recognized the difference between extraordinary care, such as ventilation, and basic care, such as the provision of food. [18] This court should plainly recognize the same today, that the provision of food and water is simply the most basic care, the withdrawal of which would certainly not cause a natural death. It is openly accepted that life-sustaining treatment was not meant to include basic, ordinary medical care. What could be more basic than feeding a patient? Proponents of withholding nutrition and hydration often argue that physicians equate such treatment with extraordinary methods of life support such as ventilation. This statement, however, cannot speak for the medical profession as a whole. Many physicians reasonably and genuinely believe that nutrition and hydration are not life-sustaining treatment within the Natural Death Act, but rather typify the administration of intimate care necessary to maintain patient comfort, essential to the doctor-patient relationship. [19] The fact is that artificial nutrition and hydration are different from other forms of treatment, just as eating and drinking are different from breathing or, for example, the blood-cleansing function of kidneys. Whereas, eating and drinking are voluntary functions, breathing and blood cleansing are reflexive, involuntary functions. At various times in our lives we are unable to feed ourselves. It is a fact of human life that we are fed as helpless, newborn infants and often as helpless invalids. The inability to breathe or cleanse blood, however, merits extraordinary or heroic measures such as artificial ventilation or kidney dialysis. The Legislature contemplated such heroic measures, which often only prolong the inevitable cessation of life, when it adopted the language [l]ife-sustaining procedure in the Natural Death Act. The argument that artificial nutrition and hydration are withholdable because they are more intrusive than other forms of ordinary feeding is without merit. The most basic forms of patient care, such as ordinary bottle feeding and spoon feeding or catheterization, involve forced bodily intrusion to a degree sufficient to implicate a person's privacy interests. Because such treatment is necessary to maintain patient comfort, however, it is considered basic care. Artificial nutrition and hydration are objectively no different. Both forms of treatment involve forced bodily intrusion sufficient to implicate a privacy interest, and both are necessary to maintain patient comfort. Any attempt to differentiate artificial nutrition and hydration from other forms of basic care is based on emotion and confuses form with substance. The Natural Death Act's evident concern for patient comfort further supports my belief that nutrition and hydration are not withholdable. The Natural Death Act expressly excludes the administration of medication ... necessary to alleviate pain. RCW 70.122.020(4). The text of the act, therefore, suggests that the Legislature did not sanction the removal of nutrition and hydration, which would inevitably cause pain. [20] Legislative concern that terminally ill patients forgo pain or prolonged death is congruent with the philosophy of euthanasia. Webster's Third New International Dictionary (1963), at 786, defines euthanasia as, the act or practice of painlessly putting to death persons suffering from incurable conditions or diseases. But bringing about a premature death by starvation and dehydration is profoundly inconsistent with even the philosophy of euthanasia. It would be less painful and, therefore, more humane, to administer lethal injection, an action which the Natural Death Act certainly does not condone. The argument that the removal of nutrition and hydration is humane because incompetents have no sensation is equally unconvincing. If the patient cannot feel pain or contemplate death, then the purpose of terminating treatment to afford a death with dignity disappears. Such a patient will experience neither the indignity of a prolonged death caused by an unimpeded illness, nor the pain of a death caused by starvation and dehydration. If, however, an incompetent person maintains any awareness at all, then the manner of death does become a subject of concern. The Natural Death Act's exclusion of medication ... necessary to alleviate pain suggests that the Legislature recognized an ever-present possibility that the patient might not be completely insensate. RCW 70.122.020(4). Nancy Cruzan, for example, was oblivious to her environment except for reflexive responses to sound and perhaps painful stimuli and her highest cognitive brain function [was] exhibited by her grimacing ... indicating the experience of pain.... 110 S.Ct. at 2845 n. 1. Patients in such degenerated states will not be aware of lofty concepts such as dignity or the passage of time, but they will be aware of pain. Thus, for the barely sentient patient, a painless if lengthier death by an unimpeded illness is more merciful than a short but painful death by starvation. Where a persistently vegetative patient is indeed completely insensate, this entire debate concerns not the feelings of the terminally ill and incompetent, but the feelings of family and friends of the unfortunate patient. I sympathize with the feelings of loved ones. I recognize that the pain of watching a loved one degenerate to a less than human state can be unbearable. I am certain that the cost of care can be financially crippling. Although the Legislature must have recognized the plight of loved ones, it did not enact the Natural Death Act so that loved ones could construe their own self-interest, rationalizing their actions as in the patient's best interest, and then impose this will on the helpless invalid. Because such an interpretation of the Natural Death Act offends the senses, risking error and inviting abuse, I reject the majority's gloss. Rather than charging off on an emotional crusade for the right to die, we should follow the United States Supreme Court's rationale in Cruzan and defer to the Legislature. First, legislative action will inevitably be more attuned to public opinion than any decision the judiciary could make. Secondly, that the Legislature has defeated every attempt to modify the Natural Death Act and establish nutrition and hydration as life-sustaining treatment, signals the Legislature's intent that these basic forms of treatment do not fall within the Natural Death Act. [21] Finally, the Legislature is currently addressing the issue. Initiative 119, currently before the Legislature, specifically allows position assisted suicide, which proposes medically assisted euthanasia for terminally ill patients. The failure of the Legislature to enact a law congruent with the ethical views of this court does not license us to venture into judicial policymaking and ultimately preempt the legitimate exercise of legislative authority.