Beginning of End for Texas Futile Care Law?
Readers of Secondhand Smoke know how adamantly opposed I am to futile care theory. Texas, as the moment, is the prime offender. The law permits hospital ethics committees to order the refusal of wanted life-sustaining treatment, at which point, the patient and family have a mere ten days to find another hospital to care for the patient--which may be more than a daunting task.
There have been at least 5 public futile care controversies since the law came into effect in 1999. Some of these have been reported about here. Now, it appears that the law is in well-deserved trouble. Not only is Governor Rick Perry moving toward seeking reform, if not outright repeal, but so too are the Democrat candidates for governor.
Let us hope that soon, the sickest patients will not be able to be coerced by hospital ethics committees and bioethicists into having wanted life support removed in Texas. If that law gets repealed or significantly reformed, it will be a tremendous setback for the medical futility movement.
posted by Wesley J. Smith @ 8:16 PM
4 Comments
4 Comments:
Wesley,
I'm a little perplexed. I thought the Texas law was the best they could get down there and that it was better than nothing. That's how President GWB's signing of it was explained to me during the Terri Schiavo ordeal when they were calling the President a hypocrite for signing the bill. Were they going to pass a bill that was worse and the only thing they could do was get a 10 day period?
Yes, that is what happened. But now, with increased publicity, I think perhaps legislators (some of whom have changed)may be ready to see the error of their earlier apprach.
I know I have had a heck of a time convincing people that these plans permit the refusal of wanted care. People refuse to believe it, and think I am being alarmist. But the public cases have illustrated the deadly seriousness of futile care theory.
In any event, I think the political environment has changed and is now ripe to repeal that law.
Then, there's this one, that sounds like brain death, as there was no blood flow to the brain:
Beaumont Enterprise.
Hospitals don't practice medicine. Lawyers and judges shouldn't. But sometimes the law is needed when there are disagreements.
The doctor determines what he or she can do. The committee agrees whether or not the doctor's decision is medically appropriate.
However, the law recognizes the fact that doctors may disagree on the point of "medically appropriate" in a few cases. It's rare to find such a disagreement, since doctors actually try not to fail (and we consider even the contemplation of the death of a patient as failure - see the "Cheerful Oncologist," here ), and we know that the course of system, organ, tissue and cell breakdown follow a certain course.
Just as in the case at Herman Memorial, in the case of Andrea Clarke, another doctor stepped in and took over her care in the same hospital. A gallbladder procedure did not find the speculated stones or localized infection, and the poor woman died soon after, of her disease by way of the overwhelming infection, according to news at the time. Unfortunately, the signs of sepsis were mistaken as signs of improvement by the family at the time.
"First, do no harm." The physician must weigh the good against the harm. Eventually, the procedures we do only prolong dying while increasing the times we - or the nurses and techs, because of our orders - hurt and manipulate a patient.
Instead of being a conspiracy or even a "gentleman's agreement," it's evidence that our experience and knowledge of the usual consequences are consistent. Doctors aren't so easy to intimidate - if there were disagreement on the benefit to the patient, there'd be more than one doctor on this list.
For more on the law, here's commentary from Houston Lawyer.com.
lifeethics,
As for the case in Beaumont, it is a perfect example of why the law is so barbaric. The family was repeatedly informed, prior to, and at the ethics committee meeting that there was no evidence of brain damage. The reason that there was no evidence is because a blood flow study had not been performed.
We found a new doctor to step in who went in on Saturday, assessed the patient (and believed she was responsive and not brain dead upon clinical assessment), and discovered, to his surprise, that the brain flow study had not been performed. He asked the family for permission to perform it--telling them that he thought it would show blood flow.
To his dismay, it showed no blood flow and objectively confirmed brain death. The new physician met with the family that very day for almost 2 hours and answered every question, explained everything and prayed with them. He left the decision with them.
They decided to withdraw the life support. The doctor went to the hospital with the family on Sunday and prayed with and consoled them. He let them say goodbye and then witdrew the life support.
That is how this should have been handled in the beginning--and would have been handled if the law required treatment pending transfer. There shouldn't be a trigger like this law which allows physicians to get away with giving only partial information to families, failing to do objective testing, and in general--acting like a horse's behinds like this doctor did. (He also violated HIPAA by giving protected health information without authorization for that news article)He even left town during the ten day period when he was supposed to be assisting with a transfer.
When the son, concerned about getting assistance for a transfer and making sure his mom was stabilized for same, asked the covering physician some questins she told him that she hadn't looked at the chart, that she wasn't going to look at the chart, that his mother was brain dead and that he should just let her go because she was a burden on society.
This is the kind of behavior that the law has incentivized by giving a trigger leading to a "drop dead" date.
The most important point in this case is that the new doctor let the FAMILY decide. He didn't force his values upon them.
You should have heard the other examples given at the hearing yesterday by family members. You would understand how truly brutal this law is.
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