For the last ten years, Texas Right to Life has been the ONLY organization helping hospitalized patients navigate the transfer process when the hospitals move to withdraw lifesaving treatment from the patients against their will.
Even if a patient is conscious, able to feed himself, walk, or pay for his own care, Texas law authorizes hospitals and physicians to override the medical decisions of a patient and remove care after providing ten days notice. Such withdrawal and denial of care can and has sped the death of patients and is covered with complete legal immunity for the hospitals.
While a couple of small local groups want to change the Texas Advance Directive Act, Texas Right to Life is the ONLY advocacy organization that actually helps patients and families find new physicians or different care settings. Our officers and directors have accompanied over one hundred families to the hospital ethics committee meetings at which the fate of their ailing loved one is determined.
Due to our direct, hands-on experience in helping infirm and disabled patients, we can speak directly about the shortcomings and misapplications of the statute that passed in 1999 [Section 166.046 of the Texas Health & Safety Code] to which we then agreed since the 1999 law was the best deal we could negotiate from a room full of people and organizations who were overwhelmingly against us and our belief that patient autonomy always trumps institutional autonomy. Thus, we have led efforts to reform the law by pushing for more patient protections.
Although reforms and patient protections are needed either through incremental steps or total repeal of Section 166.046, HB 3074 OFFERS NEITHER A STEP FORWARD NOR ANY PATIENT PROTECTIONS. In fact, HB 3074 by Representative Drew Springer (R-Gainesville) further strengthens the hospital committee’s authority by codifying broad circumstances in which food and water can be denied and withdrawn.
Texas Right to Life unequivocally believes that food and water, called “artificially administered nutrition and hydration” or “AANH” in HB 3074, should always be provided to the patient unless doing so is physiologically ineffective. In other words, if the patient’s body can no longer process the AANH or if the fluid is collecting in his abdomen, then there would be no moral obligation or medical reason to continue that treatment or any treatment that is not achieving the intended curative or restorative purpose.
However, HB 3074 takes a different, hollow approach and offers no real patient protections or steps forward toward positive reform. The exceptions under which AANH can be withdrawn outlined in HB 3074 are built on a quality of life ethic, and if passed, the bill would not save one single patient from dying of dehydration or starvation.
In order to remove AANH against the wishes of the patient, under HB 3074, the ethics committee, run by the treating hospital, has only to decide that the food and water will:
(1) hasten the patient’s death;
(2) seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment;
(3) result in substantial irremediable physical pain, suffering, or discomfort not outweighed by the benefit of the provision of the treatment;
(4) be medically ineffective; OR
(5) be contrary to the patient’s clearly stated desire not to receive artificially administered nutrition or hydration.
While exceptions (1) and (5) would be acceptable for state law, exceptions (2), (3), and (4) as currently written, are boundless and subjective and foster quality of life value judgments to be imposed by the hospital ethics committee even if the patient or patient’s family disagree with those ethical principles… AND EVEN IF THE PATIENT IS CONSCIOUS AND CAN COMMUNICATE FOR HIMSELF TO REQUEST THE NUTRITION AND HYDRATION.
HB 3074 encourages doctors and hospitals to consider moral and ethical values when deciding which patients live and which patients die. The role of the physicians and hospital committees is to provide the medical information and to discuss or recommend care options with the family or the patient, not to determine if, when, and how the patient dies. The family or the patient then decide on the prevailing values—such as whether living with a physical disability is worth continuing to live after an injury—not whether the doctors see value in his disabled life.
However, HB 3074 steals the values framework from families and entrusts the hospital ethics committee to consider whether “the benefit of the provision of the treatment,” such as the continuation of AANH for a person with a disability, outweighs making other health conditions worse.
Like current law, HB 3074 neglects the patient’s views on his own suffering or discomfort and leaves the hospital ethics committees to impose their own views on this patient. These are highly personal and moral questions that should be made by the patient and family with the input of physicians and care-givers, but not relegated solely to those who are on the payroll or the board of the treating facility.
Another glaring problem with the exceptions in HB 3074 are the nebulous definitions for key terms and phrases. When discussing the authority of doctors and hospitals to make life and death decisions against a patient’s will, legislation must be precise. Terms such as “medically ineffective,” “suffering,” and “discomfort” have a wide range of meaning to various patients, to various hospitals, and to various ethics committees in Texas.
Clear definitions and objective standards are the only way to move forward with real patient protections. HB 3074 includes neither.
Texas Right to Life has met with Representative Springer about HB 3074 to share our experience as patient advocates and alert him to these new deadly loopholes that would further jeopardize the lives of patients who are already threatened by current law. Of course, alternative language was offered that would enable Texas Right to Life to support the bill.
Texas Right to Life has filed two bills that adequately apply Pro-Life principles and patient protections to the current ten-day law. (Remember, we know from experience what patients need.) However, these bills have not yet been scheduled for a committee hearing. Meanwhile, controversial and deadly bills that further empower hospitals are being heard and advanced as demanded by Big Medicine as the time remaining in the 84th Texas Legislative Session quickly evaporates.
As written and filed, Texas Right to Life must oppose HB 3074 until this legislation is amended with Pro-Life protections to the current ten-day law.