Mar 19, 2013

Dueling End-of-Life Bills to Face Off in Committee

Dr. Weltge

The Senate Health and Human Services Committee is taking up two bills on end of life today.

One measure is an agreed-to bill supported by TMA, the Texas Hospital Association, the Texas Catholic Conference, and the Texas Alliance for Life. Senate Bill 303 by Sen. Bob Deuell, MD (R-Greenville), amends the Texas Advance Directives Act (TADA) to allow patients to make their care preferences known before they need care and to protect patients from discomfort, pain, and suffering due to excessive medical intervention in the dying process. This bill would maintain protection against forcing physicians to violate their religious beliefs, moral conscience, and professional ethics. Rep. Susan King (R-Abilene) is carrying the bill in the Texas House (House Bill 1444).

The other bill, Senate Bill 675 by Sen. Kelly Hancock (R-North Richland Hills), significantly changes TADA and interferes in the physician’s ability to exercise his or her medical judgment. It could subject terminally ill patients to unneeded pain and suffering, and expose physicians and caregivers to a very vague new cause of legal action. TMA opposes this bill.

"I have come to realize that this is an issue that requires the wisdome of Solomon and the patience of Job," Senator Deuell said at the outset of the hearing. "Lacking that, we must simply do our best to do right by patients and their families."

Houston emergency medicine physician Arlo Weltge, MD, is at the Texas Capitol today to testify for SB 303 and against SB 675 on behalf of TMA.

Here's what TMA's Healthy Vision 2020 says about this controversial and difficult issue:

Respect patients in their final days

Thanks to the advancements of medicine and science, Texans are living longer. However, these blessings bring the challenges of care and treatment decisions in life’s final stages. Advance directives allow patients to make their end-of-life treatment decisions known in the event they become incapable of communication or incompetent. Without advance directives, some of life’s most difficult decisions are being thrust upon unprepared adult children, parents, or other loved ones.

At each step, human beings are involved in both deciding on and providing treatment. We must respect the value of life and the moral conscience of those involved.

Texas physicians abide by the principle, “First, do no harm.” For this reason, TMA supports the Texas Advance Directives Act (TADA). Its aim is to allow patients to make their care preferences known before they need care, and to protect patients from discomfort, pain, and suffering due to excessive medical intervention in the dying process. The time may come when all that can be done for a patient is to alleviate pain and suffering, and preserve the patient’s dignity. For physicians, this is about medical ethics and providing medically appropriate care.

Then-Gov. George W. Bush signed TADA into law in 1997. It had unanimous support from physicians, nurses, hospitals, nursing homes, hospice care facilities, and pro-life organizations. The law provides a balanced approach to addressing one of life’s most difficult decisions.

TADA allows a patient to issue an out-of-hospital do-not-resuscitate (DNR) order, a medical power of attorney, or a directive for physicians and family members regarding the person’s wishes to administer or withhold life-sustaining treatment in the event the person is in a terminal or irreversible condition and unable to make his or her wishes known. Additionally, when an attending physician morally disagrees with a health care or treatment decision made by or on behalf of a patient, the act provides for a process whereby an ethics or medical committee reviews the physician’s refusal. The patient is given life-sustaining treatment during the process. If the ethics committee decides that discontinuing lifesaving treatment is in the best interest of the patient, and the family disagrees with that decision, the hospital must continue treatment for 10 days to allow the family some time to find a different facility for the dying patient.

Legislation has been introduced in the past two legislative sessions that would instead require indefinite treatment.

TMA has opposed the proposed legislation because it would prolong unnecessary — and often painful — care. It would require physicians, nurses, and other health care professionals to provide medically inappropriate care, even if that care violates medical ethics or the standard of care. It also sets a dangerous precedent for the legislature to mandate the provision of physician services and treatments that may be medically inappropriate, outside the standard of care, or unethical.

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