What are Futile Care Policies?
Futile care policies are rules established by hospitals that grant doctors or hospital ethics committees (usually composed of doctors from the hospital) the right to remove life-sustaining treatment from a patient, regardless of the patient’s or guardian’s stated desires. Thus, even if a patient or his guardian wishes to continue life-sustaining treatment, a doctor or ethics committee may overrule the patient and/or his written advance directive. Doctors can use subjective criteria (such as the patient’s quality of life, chance of "meaningful recovery," or economic factors) to determine whether a patient should live or die. Medical futility is not when a doctor suggests that a possible treatment would be futile; it is when a doctor decides that a treatment that is currently working should be discontinued because the patient’s life is considered futile by the doctor.
Futile Care in Texas
According to Wesley J. Smith, “Texas has become ground zero for futile-care theory.” In 1999, Texas passed a law that explicitly permits a hospital ethics committee to refuse wanted life-sustaining care. Under the Texas Health and Safety Code, if the physician disagrees with a patient’s desire for treatment, the doctor can ask the hospital ethics committee to review the decision. A futility review meeting is then scheduled during which all interested parties explain their positions (including the family of the patient) and then the members deliberate in private. If the committee decides to refuse treatment, the patient and family receive a written notice. The letter informs the family that the patient and family have a mere ten days to find another facility willing to provide care, after which, according to the statute, “the physician and health care facility are not obligated to provide life-sustaining treatment.”
Texas Right to Life has been involved in countless cases involving medical futility. Elizabeth Graham, Director of Texas Right to Life, described one case in which an attending physician was recommending that all medications, blood tests, and nutrition and hydration be stopped:
I was invited to participate in the futility review process at the Houston facility, and the whole meeting made me sick to my stomach. The attending physician stated that the patient was definitely NOT brain dead, simply brain damaged from a stroke. The patient is NOT experiencing organ failure, meaning her lungs, heart, kidneys, liver … everything is working. The patient has a trach collar, but she breathes on her own, and she processes food and hydration appropriately. She is free from infection. During the meeting, I pointed out that the withdrawal of food and water would effectively dehydrate the patient to death, and the doctors dismissed me as if I did not understand medical science. At this point, the 81 year old mother of the patient shook her head in disgust as she left the meeting.
Texas Right to Life receives calls regularly from families thrust into this situation. Texas Right to Life is working to change the futility laws in Texas so that families will not face such difficult battles while trying to care for their loved ones and to protect patients from involuntary euthanasia. Doctors or other medical professionals should not be able to determine what lives are worth saving. As German physician Christoph Wilhelm Hufeland wrote in 1806, “It is not up to [the doctor] whether… life is happy or unhappy, worthwhile or not, and should he incorporate these perspectives into his trade… the doctor could well become the most dangerous person in the state.”
