Legislators struggle again with end-of-life decisions

For the fifth consecutive session, Texas legislators are struggling with an emotionally and politically delicate issue — how to resolve end-of-life disputes when doctors seek to let a patient die against the family’s wishes. Politically powerful lobbies have long agreed that the process established in 1999 needs reforms to better protect patients. But crafting a plan acceptable to all sides has proved impossible, leaving the festering issue as a biennial sore spot, often generating heat in committee hearings over legislation destined to die later in the process. This session, the reform bill that seems to have the brightest prospects was filed by state Sen. Bob Deuell, R-Greenville, who hammered out a pre-session compromise with doctors, hospitals, religious leaders and the Texas Alliance for Life, which seeks to protect “life from conception to natural death.” But Deuell, a physician, is opposed by Texas Right to Life and affiliated legislators, plus several leading disability rights groups, that favor scrapping the current system and transferring life-and-death decisions to patients and their families, with doctors playing a strictly advisory role.

“I have come to realize,” Deuell wistfully noted at a hearing on the bill this week, “that this is an issue that requires the wisdom of Solomon and the patience of Job.”

In Texas, if doctors believe continued treatment would inhumanely extend suffering in a way that violates their oath to do no harm, they can overrule family wishes by asking the hospital’s ethics committee for approval to halt life-sustaining care — which can include withholding dialysis, ventilators, food and water. If the committee — often comprising uninvolved doctors, social workers and clergy — agrees, treatment can be halted in 10 days, theoretically giving the family time to accept the inevitability of death or, if they still disagree, to locate a caregiver willing to accept the patient.

The process is intended to shield doctors and hospitals from wrongful death lawsuits while protecting the rights of patients and their families. But in practice, according to testimony at legislative hearings, families can be left scrambling in an unfamiliar system, with an impractical deadline, to find other sources of care. Deuell said his bill would ensure that families, or other surrogates speaking on the patient’s behalf, can attend hospital ethics committee meetings. Families also would be provided with a liaison to guide them through the process and be given a free copy of the patient’s medical records.


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