Court Opinion

ID: 9566735
Source: CourtListenerOpinion
Date Created: 2023-08-21 19:42:33.48839+00
Date Added: 2024-06-11T09:39:11.448711
License: Public Domain

Andersen, J.
(concurring in part, dissenting in part)— The majority allows the life of this unfortunate young woman, Barbara Grant, to be terminated by authorizing removal of artificial life support systems. I concur with that part of the majority decision because it allows the patient's family to make the decision for her that the Natural Death Act (RCW 70.122) would have permitted her to make for herself had she been competent and conscious. Such decisions are well within the traditional functions of probate courts handling guardianships of incompetent persons.
I disagree, however, with the majority's further decision which allows the patient's life to be taken by withholding intravenous nutrition and hydration or, to use less polite phraseology, to let her die of thirst or starvation. Call it whatever the majority will, this is pure, unadorned euthanasia.7 It is a step upon a slippery slope, one that I would not take. If mores have changed to the extent that such conduct can now be sanctioned, I would let that change arrive through the moral judgment of the people as expressed through their duly elected legislators, not by the expedience of judicial fiat.
Accordingly, I would defer this part of the order until such time as the Legislature may authorize it. The Legislature had this identical issue under serious consideration at a recent legislative session and would undoubtedly consider it again except, perhaps, for the majority's holding in the present case.
My reasons are these.
As infants, we were given food and drink when we were too helpless to nourish ourselves. And for many of us, as *571with the patient in this case, a day will come before we die when we are once again too helpless to feed ourselves. All living beings need food and water in order to live, but such nourishment does not itself heal or cure disease. When we stop feeding the permanently unconscious patient, we are not withdrawing from the battle against any illness or disease; we are withholding the nourishment that sustains all life.
Mark Siegler, M.D., and Alan J. Weisbard, J.D., have recently written a particularly perceptive piece for a prestigious medical journal, urging doctors and family members to exercise less haste and more consideration before deciding to discontinue fluids and nutritional support. As they observe:
The powerful rhetoric of "death with dignity" has gained intellectual currency and practical importance in recent years. Initially, this rhetoric was a plea for more humane and individualized treatment in the face of the sometimes cold and impersonal technologic imperatives of modern medicine. As such, it brought needed attention to the plight of dying patients and prompted legal and clinical changes that empowered such patients (and, at times, their representatives) to assert some control over the manner, if not the fact, of their dying. The death with dignity movement has advanced to a new frontier: the termination or withdrawal of fluids and nutritional support.
As recently as five years ago, or perhaps three, the idea that fluids and nutriment might be withdrawn, with moral and perhaps legal impunity, from dying patients, was a notion that would have been repudiated, if not condemned, by most health professionals. They would have regarded such an idea as morally and psychologically objectionable, legally problematic, and medically wrong. The notion would have gone "against the stream" of medical standards of care. [However,] . . . this practice is receiving increased support from both physicians and bioethicists. This new stream of emerging opinion is typically couched in the language of caution and compassion. But the underlying analysis, once laid bare, suggests what is truly at stake: That for an increasing number of patients, the benefits of continued life are perceived as *572insufficient to justify the burden and cost of care; that death is the desired outcome, and — critically—that the role of the physician is to participate in bringing this about.
This is an unexpected development and one that runs counter to the traditions of medical care. We feel compelled to speak out to prevent the all-too-rapid acceptance of this new emerging standard medical practice, that of withdrawing fluids or nutritional supports from some classes of patients. This development may threaten patients, physicians, the patient-physician relationship, and other vital societal values. While we recognize that particular health care professionals, for reasons of compassion and conscience and with full knowledge of the personal legal risks involved, may on occasion elect to discontinue fluids and nutritional support, we, nevertheless, believe that such actions should generally be proscribed, pending much fuller debate and discussion than has yet taken place.
Siegler & Weisbard, Against the Emerging Stream: Should Fluids and Nutritional Support Be Discontinued?, 145 Archives of Internal Med. 129 (1985).
These same authors also pose this grim warning:
We have deep concerns about accepting the practice of withholding fluids from patients, because it may bear the seeds of unacceptable social consequences. We have witnessed too much history to disregard how easily a society may disvalue the lives of the "unproductive." The "angel of mercy" can become the fanatic, bringing the "comfort" of death to some who do not clearly want it, then to others who "would really be better off dead," and finally, to classes of "undesirable persons," which might include the terminally ill, the permanently unconscious, the severely senile, the pleasantly senile, the retarded, the incurably or chronically ill, and perhaps, the aged. ... In the current environment, it may well prove convenient — and all too easy — to move from recognition of an individual's "right to die" (to us, an unfortunate phrasing in the first instance) to a climate enforcing a "duty to die."
Siegler & Weisbard, at 130-31.1 share this concern.
They conclude on this note:
*573The issue is complicated, the tradition of medicine long, and therefore, a slow and conservative approach would seem advisable.
Siegler & Weisbard, at 131.
Engrossed Substitute Senate Bill 5401 was considered at length in the 1987 regular session as well as at the first special session of the State Legislature recently concluded. The bill contained amendments to broaden the Natural Death Act (RCW 70.122) to cover terminal patients and comatose patients without hope of recovery who had not signed a "living will" stating their wishes about withholding or withdrawing life support procedures. ESSB 5401 did not pass the Legislature, primarily because of a dispute between the House and the Senate over the provisions in the bill that would have authorized discontinuance of artificial nutrition and hydration.8 The House supported such provisions and the Senate opposed them.9
A great deal of statewide public attention was drawn to this proposed legislation. Press reports closely followed the progress of the bill. Legislative records indicate that numerous individuals and professional health care and hospice people had input into the legislative hearing process. Some of these groups are the following:
Washington State Catholic Conference
Washington State Senior Citizens' Lobby
Nursing Home Registered Nurses
Washington State Nurses Association
Alzheimer's Society of Washington
State Task Force on Life Supports
American Association of Retired Persons
Resident Council of Pierce County Homes
Washington Health Care Association
Group Health Cooperative Senior Caucus
Nursing Home Residents Council
*574Washington State Medical Association
Physicians for Moral Responsibility
Washington State Human Life
National Association of Pro Life Nurses
So far as the appellate record in this case reflects, those caring for the patient in this case have not yet been required to provide her with nourishment or liquids through artificial means. That being so, and because, concurrently with this court, the Legislature has been giving earnest consideration to whether artificial nourishment and hydration may be withheld or discontinued, I would defer to the Legislature on the question of whether artificial nutrition and hydration may be withheld from Barbara Grant in the event she needs it.
I am not convinced that the members of this court and the lawyers before it have a better ability to understand and decide the underlying issue of very basic public policy than have the electorate or their elected representatives in the Legislature. In addition, the legislators have two very real advantages that this court does not possess. They have the direct input by phone and letters of the citizens of this state to whom this is literally a life and death issue. The Legislature also has the benefit of being able to hold publicized public hearings on the issue where everyone concerned, including professionals of all types, can be heard and have their views given full consideration. The Legislature enacted the Natural Death Act and if, with the benefit of all its resources, the Legislature can pass a law allowing the withdrawal of food and water while protecting the infirm and helpless, then well and good; if not, that too should tell us something. For these reasons, I consider the Legislature to be the preferred body to deal with this issue and would defer to it.10
Brachtenbach and Durham, JJ., concur with Andersen, J.

"Euthanasia" has been defined as "the act or practice of painlessly putting to death persons suffering from incurable conditions or diseases". Webster's Third New International Dictionary 786 (1971).

See House Bill Report, 50th Legislature (1987), at 3; Senate Bill Report, 50th Legislature (1987), at 2.

See Senate and House versions of Engrossed Substitute Senate Bill 5401, 50th Legislature (1987), at 3, lines 10-12.

See Halvorson v. Birchfield Boiler, Inc., 76 Wn.2d 759, 765, 458 P.2d 897 (1969).