Opinion ID: 2600299
Heading Depth: 1
Heading Rank: 5

Heading: Standard of Care Claims

Text: ¶ 36 The plaintiffs also claim negligence based on the respondents' failure to follow the standard of care in providing medical treatment. Similarly, amicus Washington State Trial Lawyers Association Foundation argues that although the wrongful birth and wrongful life claims recognized in Harbeson may be inapt, the principle recognized in that casethat a disabled life may itself be a legally cognizable injury when the alternative is nonexistencemay be exported to support a negligence claim under our medical malpractice statute. RCW 7.70.040. ¶ 37 Relying on Dr. Bodenstein's affidavit, the plaintiffs contend that an issue of fact exists as to whether Dr. Vaughn breached the standard of care by failing to stop the resuscitation after 15 minutes of asystole. The basis for Dr. Bodenstein's conclusion is that the resuscitation continued well beyond the point that the medical literature indicates that severe disability would be unavoidable if the infant survived at all. CP at 200. Further, according to Dr. Bodenstein, the standard of care required Dr. Vaughn to involve Mr. Graves in the decision whether or not to continue resuscitative efforts inasmuch as he and his wife would be responsible to care for their severely brain damaged child assuming Liam survived as he did in this case. CP at 202. ¶ 38 We reject the plaintiffs' claim and hold that, as a matter of law, we will not recognize a standard of care that requires a health care provider to withhold treatment of a newborn infant based on the likelihood that the infant will be severely disabled, if it survives. ¶ 39 As recognized by statute and case law, under certain circumstances, an adult may choose to refuse life-sustaining treatment in exercising the right to bodily integrity and the constitutional right to privacy. See ch. 70.122 RCW (Natural Death Act); [4] In re Guardianship of Grant, 109 Wash.2d 545, 747 P.2d 445, 757 P.2d 534 (1987); Hamlin, 102 Wash.2d 810, 689 P.2d 1372; Colyer, 99 Wash.2d 114, 660 P.2d 738. [5] It arises from a person's constitutional right to privacy and right to bodily integrity. The right is not absolute, however, but may be overcome by countervailing state interests, including: (1) the preservation of life, (2) the protection of innocent third parties, (3) the prevention of suicide, and (4) maintaining the ethical integrity of the medical profession. Grant, 109 Wash.2d at 556, 747 P.2d 445; see also Cruzan, 497 U.S. at 284, 110 S.Ct. 2841 (the state may require clear and convincing evidence of an incompetent patient's wishes as a condition for allowing the withdrawal of life-sustaining medical treatment). ¶ 40 As this court has recognized, the State's interest in the preservation of life may permit the State to compel a patient to accept life-sustaining treatment. Colyer, 99 Wash.2d at 124, 660 P.2d 738. However, if the patient's condition is hopeless and there is `no reasonable possibility of returning to a cognitive, sapient state,' the patient's right of privacy outweighs the State's interest in preserving life. Id. at 134, 660 P.2d 738 (quoting Superintendent of Belchertown State Sch. v. Saikewicz, 373 Mass. 728, 370 N.E.2d 417 (1977) (recognizing right to withhold life-sustaining treatment from a formerly competent adult in a permanent vegetative state)). Similarly, the State's interest in preserving life weakens considerably if treatment will merely postpone death for a person with a terminal and incurable condition. Grant, 109 Wash.2d at 556, 747 P.2d 445. However, this court has stress[ed] the distinction between treatment which is expected to result in some measure of recovery and that which merely postpones death. Hamlin, 102 Wash.2d at 815, 689 P.2d 1372 (allowing the withholding of life-sustaining treatment from a never-competent adult in a persistent vegetative state). Accordingly, there must be agreement by at least two physicians as to the patient's prognosis. Grant, 109 Wash.2d at 566, 747 P.2d 445. In the case of a newly born viable infant requiring emergency resuscitation, the preservation of life is an important interest. Whether the infant's condition is hopeless cannot be determined on the basis of statistics and probabilities but requires assessment of the infant's actual condition once the infant is stable. [6] ¶ 41 The State's interest in protecting innocent third parties also may prevail over a patient's right to refuse life-sustaining treatment. This interest is implicated when an immediate family member disagrees with the decision to withhold life-sustaining treatment from an incompetent patient. See id. at 556-57, 747 P.2d 445. In Grant, this court reasoned that the State's interest in protecting innocent third parties was not implicated because the patient's immediate family members unanimously agreed that withholding life-sustaining treatment was in the patient's best interests. In this case, there was no unanimous agreement of Liam's immediate family members because his mother was unconscious. Where, as here, a parent is temporarily unavailable to participate in the decision, the State's interest in protecting innocent third parties weighs heavily against finding a right to refuse life-sustaining treatment. ¶ 42 The remaining interest identified in Grant, which is implicated here, is the State's interest in maintaining the ethical integrity of the medical profession. By statute, health care providers are protected from liability for refusing to comply with a patient's advance directive to withhold or withdraw life-sustaining treatment. RCW 70.122.060. In allowing the withdrawal of life-sustaining treatment from a never-competent, terminally-ill patient, this court reasoned that the ethical integrity of the medical profession was not implicated because the prevailing ethical standards recognized that this may be in the patient's best interest. Grant, 109 Wash.2d at 557, 747 P.2d 445. Moreover, under our case law a physician who disagrees with the decision to withhold or withdraw life-sustaining treatment may seek judicial intervention. Colyer, 99 Wash.2d at 132-33, 660 P.2d 738. The ethical integrity of the profession would be gravely compromised by recognizing the right of a newborn viable infant, through its guardian, to refuse life-sustaining treatment when the infant is neither terminally ill nor comatose, but suffers from some as-yet unquantifiable level of disability. Unlike in the case of the terminally ill and comatose, there is no emerging medical consensus that it is ethically appropriate to withdraw life-sustaining treatment from the disabled, even the severely disabled. [7] ¶ 43 Even if we were to recognize that a patient may choose to refuse life-sustaining treatment as a personal medical decision, that is not to say that a physician may unilaterally impose such a value preference under the guise of an expert medical judgment. The right to refuse life-sustaining treatment belongs to the patient. Until the patient exercises that right, physicians are under an ethical, moral and legal duty to treat the patient so as to advance his recovery and alleviate his suffering. Hamlin, 102 Wash.2d at 819, 689 P.2d 1372. Physicians must presume that life is preferable to death, even if that means a severely disabled life. ¶ 44 This court has repeatedly acknowledged that the withholding of life-sustaining treatment implicates important policy considerations that the legislature is best able to address. Id. at 822, 689 P.2d 1372 (The Legislature is the better forum in which to fashion the necessary procedures to safeguard the rights and liabilities of the many persons and institutions involved in this complex arena.); Colyer, 99 Wash.2d at 118, 660 P.2d 738 (noting that the Natural Death Act is a salutary step towards establishing legislative guidance in this area). By enacting RCW 70.122.060, the legislature expressed an unequivocal policy to absolve health care providers from liability for refusing to participate in the withholding or withdrawal of life-sustaining treatment. Although the Natural Death Act does not apply here, holding the defendants liable for wrongfully prolonging Liam's life would be inconsistent with the public policy expressed in the act. ¶ 45 Dr. Bodenstein's conclusion regarding the standard of care rests on the premise that death is preferable to a severely disabled life as a matter of medical judgment. But that is a value judgment that may not be resolved by expert medical opinion. Just as Dr. Bodenstein's opinion was insufficient to raise an issue of material fact as to the existence of a medical emergency, it is insufficient to raise an issue of material fact as to the standard of care. See Guile v. Ballard Cmty. Hosp., 70 Wash.App. 18, 25, 851 P.2d 689 (1993) (expert's unsupported assertion that a physician violated the standard of care held insufficient to raise a genuine issue of material fact). ¶ 46 Accordingly, we affirm the trial court's grant of summary judgment.