Specifics on Texas Statute Imposing Futile Care Theory
For listeners to Ron Thulin, (KAHL, San Antonio, Texas) and anyone else interested in the law permitting Andrea Clarke to be removed forcibly from wanted life-sustaining treatment: The statute permitting Texas hospital ethics committees to impose Futile Care Theory is available at this link . Scroll down to 166.046(e), which provides in part:"The physician and the health care facility are not obligated to provide life-sustaining treatment after the 10th day after the written decision required under Subsection (b) is provided to the patient or the person responsible for the health care decisions of the patient unless ordered to do so under Subsection (g)." Subsection g merely permits a time extension if another facility is likely to allow admission.
This law needs to be changed!
posted by Wesley J. Smith @ 12:25 PM
10 Comments
10 Comments:
There is definitely a need for a legal challenge to this law! I cannot fathom that a hospital ethics committee has the final say and can override the wishes of both patient and family. As I wrote here, the hospital has a tremendous financial incentive to see the patient dead. They are not the ones to provide an objective decision of what is best for this patient. I have been a physician for twenty years and am now retired. The evolution of medical practice dictated by committee is part of what made it easy to leave clinical practice.
Thanks for posting. I don't believe that the people, once they know about this, will accept it.
I too am amazed by the lack of media coverage. KHOU did a TV news spot last Saturday evening. Link is here. Other than that, all the info about Andrea is via blogs and this is reporting information obtained only from Andrea's sisters. There are a lot of holes in the information because this just doesn't make sense!
Kevin,
"The hospital's assertion that care is futile, on the other hand, is circumstantially supported by the fact that there appears to be no dissenting medical opinion on that matter"
There is no procedure provided in the statute giving the family an opportunity to either get or present a dissenting opinion for the ethics committee meeting.
There is no effective way because of the time constraints to challenge the diagnosis of "futility". I know because I am handling this case and another one at the same time.
Are you advocating that someone die on the basis of "circumstantial" evidence that, procedurally, one is not allowed to challenge?
If you are a medical person, this is precisely why such decisions should not be left only to ethics committees, I am finding that doctors and hospitals don't have a clue aboutwhat due process means.
We do not know the medical specifics about this case. As a doctor, I would want to know:
1. What happened that the hospital now wants to withdraw therapy? The family says she is clearly communicating with them, she is not comatose, and she is not brain dead. Why not continue with the status quo?
2. If the therapy were continued, what is her prognosis. Do we expect her to die in a matter of days, weeks, months, longer?
As a citizen, I want to know
1. Who is on the ethics committee and how are members selected? What financial relationships do the ethics committee members have to the hospital.
I have worked with military hospitals and civilian hospitals. Budgets are tight. Hospital administrators are under incredible pressure due to decreasing reimbursements and increasing costs. They pass this pressure on to the staff. On more than one occasion I have been bullied in an effort to influence my medical decisions in a direction that was financially better for the hospital but medically ill advised for the patient. Just trusting the hospital to do what is best for the patient can be deadly.
Dear Kevin: No. This is not a case of physiological futility. The care isn't being unilaterally refused because of the medical uselessness. It is being refused because it isn't medically useless, that is, it keeps the patient alive. It is the patient, in effect, that is being declared useless.
As far as I know there is no place for a patient on a ventilator to get dialysis except in a hospital ICU.
We don't practice medicine by due process. We practice by evidence and experience. It sounds as if the doctor has given a good trial of ventilator support and added dialysis in order to give the patient time to heal. But the heart hasn't healed, the kidneys haven't healed, and the brain is not causing the patient to breathe on her own. And the side effects are bound to be adding up.
I've covered the probable course at my blog.
Thanks for contributing. Perhaps. But I don't think the principle should be that these actions can be taken unilaterally. If there is a bona fide dispute, it should be settled openly by a dispassionate third party, meaning a judge, with full due process rights.
Kevin,
My response is too long for a comment box so please read my post here.
New developments here.
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