Texas: Supporters of Texas "Futile Care" Law Continue to Maintain the Status Quo, Preventing Change

On Sunday (May 8, 2011), the Austin American-Statesman published an update of sorts on the continuing stalemate over the Texas "futile care statute," which translates as a "win" for supporters of the status quo.

It's a fascinating article - for many reasons.  But perhaps the most fascinating are the many contradictions contained in the article - but don't get recognized as contradictions.

Here's an excerpt from "Sensitive topic of futile medical care faces long road in Legislature" by Chuck Lindell:

For the fourth consecutive session, Texas legislators are struggling with the delicate issue of how and when doctors can allow patients to die by withholding life-sustaining treatment against the wishes of family members. 

But, a few paragraphs down, the law is described this way:

Texas' "futile medical care" law was enacted in 1999 and is unique in the nation for its efforts to protect doctors and hospitals from wrongful death lawsuits while trying to balance patient and family rights, legal experts say.

How do you get from the first sentence - which accurately states that doctors can "allow" patients to die through treatment withdrawal over family objections - to saying the law makes an effort to "balance patient and family rights"? 

How's this for "balance"?  Briefly mentioned late in this article is the fact that the current statute says that only two days notice is required to alert families about the ethics meeting where withdrawing treatment will be put forward.  In practice, that's led to at least one phone call to me - when we were back in Illinois from a man whose sister-in-law was to be the subject of one of these ethics meetings.  His message: We got a call yesterday that they are gonna have this meeting tomorrow. 

Anyone who is familiar with professional panel knows what is behind this kind of maneuver - have completely unprepared family members be overwhelmed in numbers and expertise by a "steamroller" masquerading as some kind of fair hearing.  In the case I mentioned, I was able to hook this family up with an advocate who could attend the meeting.  The gentleman called me the next week to say that the whole tune of the committee changed when they brought an outside advocate in.  (I think my remark was that "ethics committees are like vampires - they don't like the light.")

The author states that "end-of-life cases can also be stressful for doctors," and yet is followed by something very different shortly after in a discussion of one legislator's efforts to get the current 10-day limit (treat for ten days followed by withdrawal of treatment or transfer to a different facility or setting).:

This session, as in the 2009 session, debate over the state's medical futility law is being led by Rep. Bryan Hughes, R-Mineola, who again filed a bill that would require hospitals to continue treatment until a family finds an alternate caregiver, no matter how long it takes.

Known as "treatment until transfer," the policy would answer one of the law's most glaring problems — it doesn't specify that patients must have a terminal condition before doctors can halt care — by requiring family-ordered care be given to all patients, Hughes said.(Emphasis added.)

If  the patient doesn't have to have a "terminal condition" doesn't that beg the question of just what the heck is meant by "end of life"?  Does it mean one or more things to doctors and something entirely different to families?  Does it mean that a person is dying?  Does it mean the person's life is being ended? Both? Either?

As interesting as these aspects of the article are, it looks like the main purpose was to introduce to new public relations players for supporting the status quo and opposing the rights of families through "treatment til transfer."

Unlike other articles, in which the main supporters quoted have been ethicists, physicians or hospital representatives, the main defenders of the current "futile care statute" are two allegedly "pro-life" organizations.:

"Such a policy is not in the best interest of patients because it only prolongs patient suffering and artificially delays death with no real benefit," said Jennifer Allmon with the Texas Catholic Conference.

"A natural death with dignity is part of our teaching. Aggressive medical treatment interferes with God calling a patient home, and that is not our role," she added.

I wish I could say I was surprised by this, but quite frankly the Catholic Church has been all over the board on "right to die" issues from Larry McAfee to Terri Schiavo.

Also defending the "futile care" statute is the Texas Alliance for Life.  I've been suspecting that some of the larger "family values" organizations that put fiscal conservativism on as high a plane as other issues might start to fall this way.  I mean, how long can you rail against universal health care and yet fight "futile care" decisions, which typically involve fairly involved and expensive healthcare?   Texas Alliance for Life has made its choice, as you can see from remarks Joe Pojman, representing the organization:

Texas Alliance for Life is opposed because the policy would ignore the ethical integrity and judgment of doctors and caregivers, Pojman said.

"I have had numerous pro-life physicians come to me saying, 'Please don't let the Legislature require that we do everything, all the time, that families want, because that would be doing harm, too,' " he said.

That first sentence is crap.  Just how would "treatment until transfer" ignore the ethical integrity and judgment of caregivers?  Unless of course, he's talking about medical caregivers - and he's just ignoring what families think is best.  And since when does his organization stand behind the concept of the ethical integrity and judgment of doctors? It's certainly not evident when it comes to women's reproductive medical care.

To be fair, there are plenty of Democrats and so-called "progressives" supporting the status quo on "futility" decisions.  But most of them also support the idea of universal access to healthcare.  It looks like at least some on the Right want to gives us the worst of all worlds.