April 18, 2013
Members of the Texas State Legislature
Dear Elected Officials:
As advocates for the defense of innocent human life, we are deeply concerned about the underlying principles and values that shape policies affecting medical care and treatment of our ailing and disabled loved ones. Most physicians seek to provide compassionate care and effective medical treatment, but the steps to do so can vary dramatically with each patient and with each physician. In a society where the value of human life is undermined and when some efforts have been successful to assign an efficiency value to health care, protections for patients must encompass all safeguards against arbitrary quality of life judgments.
Current Texas law (Chapter 166.046, Health & Safety Code) allows for doctors and hospitals to withdraw life-sustaining treatment from any patient for any reason after providing ten days notice despite an advance directive, a surrogate's decision, or a patient's expressed wishes.
Neither SB 303/HB1444 nor its revised versions improve the current law, but rather specifically clarify that treatment can be withdrawn from people with non-terminal and irreversible conditions (i.e., the disabled) and those with terminal illnesses; however, the four criteria under which treatment can be withdrawn from "terminal" and "irreversible" patients in SB 303/HB1444 and the revised versions are so broad and subjective that all hospitalized patients, conscious or otherwise, would meet one, some, or all of the criteria and, thus, become victims of the statutory process. These definitions and criteria require physicians to make value judgments on the lives of these ailing patients, rather than decisions based on the efficacy of a medical treatment or course of action.
Current Texas law is silent on in-hospital Do-Not-Attempt-to-Resuscitate (DNAR) orders. SB 303/HB1444 leaves too many loopholes in the DNAR notification process to afford any real protection to patients (such as “incompetent” patients, when death is “imminent,” which is undefined, and when CPR would be “medically ineffective”). SB 303/HB1444 puts power—power unspecified under current law—into the hands of facility, leaving no real recourse or say to the patient whose life is at stake.
SB 303/HB1444 and the revised versions does not make the advance directive dispute resolution process better. The law changes the transfer time to 21 days, still hardly enough time to clear the red tape for patient transfers.
Other concerns regarding SB 303/HB1444 include, but are not limited to the following issues:
• Notice of the futility review is moved to 7 days, but only after a subcommittee meeting or a pre-meeting is held with the family. The subcommittee or pre-meeting is not subject to any of the rules for the required ethics committee meeting.
• SB 303/HB1444 uses the term "medically ineffective" in regard to treatment throughout the bill, but all the criteria for the decisions are value judgments as opposed to a more objective standard of whether the treatment is reaching its intended goal, such as antibiotics curing an infection.
• Limiting the number of people who can accompany the family to the ethics committee meeting heightens the inequality of an already imbalanced, intimidating process as the ethics committee of the treating hospital is not limited and often comprised of more than a dozen experts affiliated with, if not paid by, that particular facility.
• The reporting requirements in SB 303/HB1444 will yield little insightful data regarding frequency, outcomes, transfer attempts, or the number of patients who died and at what point they died during the review or transfer process.
While recognizing the need to substantially reform the current Texas Advance Directive Law, we, the undersigned, urge the Health and Human Services Committee and full Senate to reject SB 303/HB1444 in its current form and the revised versions as a bill that would further jeopardize the lives of the disabled, the terminally ill, and the infirm who are hospitalized in Texas. Other reform bills to the Texas Advance Directive Act have been filed during this 83rd Legislative Session that we fully support. We encourage you to support the measures that honor and protect patients, their autonomy, and their dignity.
Thank you for your thoughtful consideration.
President, Texas Eagle Forum
Burke J. Balch, JD
Executive Director, Robert Powell Center for Medical Ethics
President, American Life League
Dr. Joseph Graham
President and Founder, Texas Right to Life
Julie Grimstad, LPN
Chair, The Pro-Life Healthcare Alliance, a committee of Human Life Alliance
David E. Hargroder, MD
Chairman, John Paul II Bioethics Commission
President & Founder, Life Advocates
Steven F. Hotze, MD
President, Conservative Republicans of Texas
Elizabeth R. Keeler, MD
Assistant Professor, MD Anderson Cancer Center
President, Texas Home School Coalition
Mary Catharine Maxian, MD
Anesthesiologist, Houston, Past Chair of Healthcare Professionals for Life
Ron Panzer, LPN
President, Hospice Patients Alliance
President, Texas Leadership Coalition
International Chair, Euthanasia Prevention Coalition
Executive Director, Terri Schiavo Life & Hope Network
Andy Schlafly, JD
General Counsel, Association of American Physicians & Surgeons
President, National Right to Life
Director, Human Life Alliance
Executive Director, US Pastor Council