The Texas Futile Care Law Has Got to Go
A broad based coalition of disability rights activists, pro lifers, and family members of ill patients are planning to pressure the Texas Legislature to change its ridiculous futile care law that permits hospital ethics committees to refuse wanted life-sustaining treatment. The hospital associations are yammering about better communication on the front end, but the furor over the Andrea Clarke case put the bioethicists on the defensive. People should not be pressure out of life because a secret vote in a bioethics committee determined their lives were not worth living.
posted by Wesley J. Smith @ 1:45 PM
6 Comments
6 Comments:
Now we have to make sure that the cure isn't worse than the disease. As the left never tires of pointing out, Bush signed the current futile-care act and Texas Right to Life supported it. Can they be trusted now to craft something objectively better?
To my mind the most objectionable part of it is the explicit indemnification of medical people from suit if they follow the protocols. Why _should_ they thus be protected by statute? It positively encourages it. It was said that they were tossing people out with _no_ days' notice and that this was an improvement because it requires ten-days' notice. But wouldn't it have been possible to require the ten-days' notice and _not_ say that they couldn't be sued then? I've read that part of the law, and I don't see why it has to be in there.
Bush and TRTL made a mistake. The original policies put together by a group of Houston hospitals called for a 3 day period. The intent orignially was to preclude futile care, but it wasn't doable in the legislature. So the 10 days was seen as the "best" that could be gotten.
It was a mistake. Bush should have vetoed and let someone sue if a hospital imposed a futile care policy. I think it was that nobody really believed that it would really be done, and as I have said, "It can't happen here" may be the world's most dangerous sentence.
So pragmatically, your idea wd. be to have no law on the subject whatsoever and let it be hashed out in the courts in malpractice suits? That might be the best way to go. I've always been of the opinion that gridlock in the legislature (state or federal) is a good thing, so perhaps they shouldn't have gotten all hyper and passed a law at all. But if they did, it shd. just have required the 10-days' notice and let the chips fall where they may as far as lawsuits.
No, I would prefer a law against (qualitative) futile care, with any disputes being held in court in public, not in a private star chamber-like setting. But rather than permit it in some fashion, as was done in Texas, I would rather there be no law and let it be hashed out in court.
I'm one of the members of the several groups attempting to tweak the law. Most of the Advance Directive Act is uncontroversial. There's too much heat in your post, Wesley.
As we've seen, most cases are settled in the hospital, new doctors are found, etc. Most often, the patient dies before the 10 days are up, while on full "life-sustaining" therapy of dialysis, ventilation, tube feedings, pressors, and medications to make all of the above tolerable to the patient(for a patient with any consciousness at all, the dialysis causes itching, the ventilator can cause gagging, the pressors cause more damage to the kidneys and liver, resulting in bleeding and ulcers, on and on).
I still read the disputed section 166.046 as a conscience clause for the doctor who is writing the orders for the nurses, the pharmacists, and the dozens to hundreds of people involved in care of patients. The idea that doctors should not act on their consciences when they know an action is wrong seems more in tune with a conversation about abortion, the morning after pill or Oregon's euthanasia law than 166.046.
Everyone agrees the time line needs to be expanded.
We're down flat statements in the meetings, and on forums like this, that the lawyers don't trust doctors to save lives.
I view the law from the small town family doc side, where the Family Physician or Internist may know the patient for years and be acting without an AD, without any relatives, guardians, or surrogates to consult, or with a family (of more than 10 siblings, recently), none of whom want to make the decision to do "this much and no more."
It would be better to have fewer discussions about malpractice and more concern about the stalled grieving - stuck at anger - that's being fostered.
BTW, I've linked to this discussion on LifeEthics.
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