ROBERT POWELL CENTER FOR MEDICAL ETHICS
at the National Right to Life Committee
512 10th Street NW Washington, DC 20004
(202) 626-8815 (voice) (202) 737-9189 (fax)
FROM: Burke J. Balch, J.D., Director, Powell Center for Medical Ethics
DATED: April 7, 2015
RE: ASSESSMENT OF TEXAS HB2351
In order to avoid supporting genuine legislation to prevent the involuntary denial of life-saving medical treatment discriminatorily based on disability sanctioned by current Texas law, HB 2351 has been put forward in the evident hope that legislators who vote for it will have the excuse of claiming that they have done something to limit this injustice.
In fact, HB 2351's apparent limit on disability discrimination is utterly meaningless. Under it, health care facilities would adopt policies that they themselves would have full discretion to draft “to prohibit consideration of a patient's permanent physical or mental disability during a review [under the existing Texas law allowing facility ethics committees to authorize involuntary denial of life-preserving medical treatment]unless the disability is relevant in determining whether a medical or surgical intervention is medically appropriate.”
The bill leaves completely open to facility and facility committee interpretation whether a patient’s disability “is relevant in determining whether a medical or surgical intervention is medically appropriate.” Many medical ethicists have published articles and books maintaining that if a person’s “quality of life” is deemed too poor for life to be worth living, or to justify expending medical resources on preserving it, then life-preserving treatment is for that reason not “medically appropriate.” And all too many consider that certain levels of physical or mental disability bring a person’s “quality of life” below a tolerable minimum. A judgment whether the quality of one’s life is worth living is a very subjective one. Current Texas law takes that judgment away from the person whose life it is, or that person’s family or other legally authorized surrogate, and puts it in the hands of health facility committees – and HB 2351 would fully preserve their ability to judge whether the degree of a person’s disability makes preserving that patient’s life “medically appropriate.”
It is one thing to support an incremental measure that falls short of the ideal but makes a substantive improvement in an existing bad law. It is quite another to promote a bill whose content makes no substantive difference in providing protection to people with disabilities. HB 2351 is not merely useless; it is worse than useless because its self-contradicting language can be employed in an attempt to mislead constituents into thinking their representatives did something – when in fact they did nothing – to protect people with disabilities from being forced to die against their will.
 The bill even confines the policy to those with “permanent” disability – so that it would not even apply to someone who becomes disabled as a result of the illness or injury that led him or her to be treated in the health care facility.