In Re the Welfare of Bowman
1980 Wash. LEXIS 1386, 617 P2d 731, 94 Wash. 2d 407 (1980)
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Rule of Law:
An individual is legally dead if they have sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem. The determination of death must be made in accordance with accepted medical standards.
Facts:
- William Matthew Bowman (Matthew), a five-year-old child, was admitted to a hospital on September 30, 1979, after suffering massive physical injuries inflicted by a caretaker.
- Matthew was unconscious and was placed on life support systems, including a ventilator to enable him to breathe.
- His neurological condition gradually weakened over the next several weeks.
- By October 17, 1979, numerous medical tests, including an electroencephalogram (EEG) and a radionuclide scan, showed a total absence of brain activity and blood flow to the brain.
- Physical examinations revealed that Matthew's pupils were dilated and nonreactive, and he had no reflexes, no response to deep pain, and no signs of spontaneous breathing.
- The attending physicians unanimously concluded that Matthew's brain was dead according to the most rigid medical criteria available.
- The physicians advised that Matthew's cardiovascular system would inevitably fail within 14 to 60 days, despite the continuation of life support.
- Matthew's mother consented to the medical recommendation to remove him from the ventilator.
Procedural Posture:
- The Department of Social and Health Services filed a dependency petition for Matthew Bowman in Snohomish County Superior Court (trial court).
- The court appointed a guardian ad litem to represent Matthew's interests.
- At a dependency hearing, the guardian ad litem opposed a motion that would have led to the termination of Matthew's life support.
- After hearing testimony from the attending physician, the trial court ruled that under Washington law, the irreversible cessation of brain activity constitutes death and that Matthew Bowman was legally dead.
- The guardian ad litem requested, and the court granted, a temporary injunction preventing the hospital from removing life support systems to allow for an appeal.
- The guardian ad litem appealed the trial court's ruling directly to the Supreme Court of Washington.
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Issue:
Does the legal definition of death in the State of Washington include the concept of 'brain death,' defined as the irreversible cessation of all brain functions, even if circulatory and respiratory functions are artificially maintained?
Opinions:
Majority - Utter, C.J.
Yes, the legal definition of death in Washington includes the concept of brain death. The common law definition of death, based on the cessation of circulatory and respiratory functions, is inadequate in an era of modern medical technology that can artificially maintain those functions. It is the proper role of the law to define the standard for death, while it is the role of the medical profession to establish the criteria for determining when that standard has been met. This court adopts the standard of the Uniform Determination of Death Act, which recognizes two alternative bases for determining death: the irreversible cessation of circulatory and respiratory functions, or the irreversible cessation of all functions of the entire brain, including the brain stem. This approach harmonizes the traditional common law definition with modern medical realities and provides clear guidance for legal and medical purposes.
Dissenting in part - Rosellini, J.
Yes. While agreeing with the adoption of a brain death standard, the dissenting opinion proposes a more concise rule. It states simply that an individual who has sustained irreversible cessation of all functioning of the brain, including the brain stem, is dead, and that such a determination must be made in accordance with reasonable medical standards. This formulation omits the alternative prong related to circulatory and respiratory functions that the majority adopted from the Uniform Act.
Analysis:
This decision judicially updated Washington's common law to address the challenges posed by modern life-sustaining technology. By formally recognizing 'brain death' as a legal standard of death, the court aligned the state with a growing national trend in both legislatures and courts. The decision provides crucial legal clarity for medical professionals and families facing end-of-life decisions, reducing the risk of legal liability for withdrawing life support from a brain-dead patient. The court's distinction between the legal standard of death and the medical criteria for its determination creates a durable legal framework that can accommodate future advances in medical science without needing constant judicial or legislative revision.
