Who decides whether a patient’s life is worth living?

Pursuant to a draconian Texas law which sanctions imposed death or involuntary euthanasia (Chapter 166.046 of the Texas Health and Safety Code), patients across Texas must fight for a hospital not to end their own life or the life of their loved one.  The Texas Advance Directives Act, also known as the death panel law or the futility law, authorizes a hospital committee to decide whether a person’s life is worth living, and by extension, worth treating.  The same section of state law renders meaningless and irrelevant the directive or wishes of the patient and their surrogate decision-maker.   

One example of the widespread misapplication of this statute took center stage between Thanksgiving and Christmas when Houston Methodist Hospital invoked the statutory process on Chris Dunn, a 46-year old former Homeland Security employee.  The hospital told Chris and his mother that Chris’s treatment would be withdrawn and discontinued within ten days, thereby speeding his death.  Although Chris was quite ill, his death was not yet imminent, and Chris and his mother fought the hospital, turning to Texas Right to Life for help.  Chris passed away December 23.

At the heart of opposition to this draconian law is who decides?  Who decides whether a patient’s life is worth living?  Who decides whether a patient’s “quality-of-life” would be meaningful enough to live?

Most people believe that the answer to the previous questions includes you, your family, and/or documents prepared clearly outlining which medical interventions you and your loved ones would desire or refuse.  However, the truth lies in Chapter 166.046: such a decision can legally be made by an ad hoc nameless hospital committee, comprised of hospital personnel and providers for the sole purpose of making futility determinations.  Many of the committee members and administrators have never even met the patient prior to the futility review, but nevertheless have a vote in what kind of life the patient would want to lead.

Recognizing that many, not all, of the patients whose lives are discussed in these proceedings are indeed ill, the reason that withdrawal of treatment is being considered is because the treatment is working—in other words, the patient is stable, perhaps improving, albeit ailing and disabled.  The judgment of futility is applied to the quality of the patient’s life, not to the efficaciousness or futility of the treatment.  Inherent in the uses of Chapter 166.046, subjective quality-of-life judgments are thrust upon patients as if such judgments were objective, universal truths.  In the Pro-Life community, such value applications are routinely rejected as utilitarian, inhumane, and unjust.

Each hospitalized patient himself should decide for himself which benefits or burdens he will accept or reject in consultation with the care team.  The patient is the very person who will benefit or suffer the consequences of these decisions, for better or worse.  For cases in which patients are unable to speak for themselves, life and death determinations are best left to those who know the patient best.  The patient and his surrogate can balance the risks and benefits.

These decisions are likely to be different for every single patient, every family, depending on lifestyle, faith, and a myriad of other factors.  Those decisions cannot be adequately made by a panel of people who have never met the patient whose life is at stake prior to hospitalization.

Yet, such situations have been occurring in Texas for the last fifteen years.  When the determining factors in who decides are “How sick is the patient?,” “Or is there meaningful hope of recovery?,” “Will the patient be self-aware?,” etc., then subjective criteria along with the personal and professional biases of the committee members influence each and every life and death decision for each patient rendered futile.  There is no uprighting this slouch toward offing the useless eaters.  Does needing dialysis render a patient futile?  What if the dialysis is efficacious for someone who is brain-injured?  Does dependence on a wheelchair makes someone “too disabled” to warrant help with respiration?

An opinion—and hence a life and death decision imposed on another—based solely on how sick the patient is opens wide that slippery slope that is dangerous and incompatible with the Pro-Life position. 

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