Austin, TX (Texas Tribune) — Texas lawmakers have grappled year after year over whether families or medical professionals should make the final decision on when to end a terminally ill patient’s life-sustaining care. This year, they seem closer to a compromise.
“If we were only making decisions based on medical facts, everything would be straightforward,” said Dr. Leigh Fredholm, the medical director of Seton Palliative Care at the University Medical Center Brackenridge in Austin. “But that’s not how we make decisions.”
State law allows physicians to discontinue treatment they deem medically futile. If a physician’s decision to end treatment contradicts the patient’s advanced directive or the judgment of the patient’s surrogates, state law gives patients or their families 10 days to find an alternative provider and appeal the physician’s decision to a hospital ethics committee.
Advocacy groups that identify as “pro-life” say existing law does not go far enough to protect the interests of patients or their families. But they are divided on how legislators should reform it. While support in the Legislature’s upper chamber seems to be coalescing around Senate Bill 303, which would tweak the existing process, some endorse bills that would prohibit physicians or hospital ethics committees from making the final decision to end treatment.
“There are times when medical treatment is inappropriate and death is inevitable,” said state Sen. Bob Deuell, R-Greenville, a physician and author of SB 303. Prohibiting physicians or an ethics committee from participating in the decision-making process could “let a family subject a loved one to a lot of truly unnecessary, perhaps painful and harmful treatment,” he said.
SB 303 would alter the existing dispute process by extending the timeframe to find an alternate provider to 14 days, and by ensuring the patient or patient’s surrogate has assistance navigating the appeals process, access to free copies of medical records and adequate representation at an ethics committee hearing. The bill has the support of the Texas Medical Association, the Texas Hospital Association, two church-affiliated groups and the Texas Alliance for Life.
Notably missing from that list is Texas Right to Life. John Seago, the group’s legislative director, said Deuell’s bill would still allow an ethics committee to override a patient or surrogate’s desire to continue treatment and does not alleviate the burden put on families to find a new provider.
“An inmate on death row has more appeals and due process than a patient before an ethics committee,” Seago said.
Texas Right to Life supports two other measures, Senate Bill 675, which would prohibit a physician from withdrawing life-sustaining treatment based on the doctor's medical or value judgments, and House Bill 1464, which would eliminate the 10-day timeframe and require the physician or hospital to continue life-sustaining treatment until the patient is transferred to another facility.
So far, none of the bills have advanced out of committee. Deuell said he plans to add additional protections to SB 303 based on input he has received and hopes the Senate Health and Human Services Committee will approve his bill this week.
In 2012, the Texas Hospital Association surveyed 202 private hospitals — a third of all hospitals in the state — and found the end-of-life dispute process had been used 30 times between 2007 and 2012. Of those cases, a third of the patients passed away during the appeals process, six patients were transferred to another provider and four continued treatment past the 10-day period. The ethics committees agreed with the physician’s decision to end treatment in 7 of the 10 cases that got that far.
Fredholm said she has at times felt “morally conflicted” about continuing painful treatment for a dying patient. But she has never discontinued treatment against the patient or surrogate’s wishes.
“Legislating the end of life is tricky, but for us, how you prepare for the end of life is much more important,” she said, “because we all have to die.”