On Sunday (May 8, 2011), the Austin American-Statesman published an update of sorts on the continuing stalemate over the Texas “futile care statute,” which translates as a “win” for supporters of the status quo.
It’s a fascinating article – for many reasons. But perhaps the most fascinating are the many contradictions contained in the article – but don’t get recognized as contradictions.
Here’s an excerpt from “Sensitive topic of futile medical care faces long road in Legislature” by Chuck Lindell:
For the fourth consecutive session, Texas legislators are struggling with the delicate issue of how and when doctors can allow patients to die by withholding life-sustaining treatment against the wishes of family members.
But, a few paragraphs down, the law is described this way:
Texas’ “futile medical care” law was enacted in 1999 and is unique in the nation for its efforts to protect doctors and hospitals from wrongful death lawsuits while trying to balance patient and family rights, legal experts say.
How do you get from the first sentence – which accurately states that doctors can “allow” patients to die through treatment withdrawal over family objections – to saying the law makes an effort to “balance patient and family rights”?
How’s this for “balance”? Briefly mentioned late in this article is the fact that the current statute says that only two days notice is required to alert families about the ethics meeting where withdrawing treatment will be put forward. In practice, that’s led to at least one phone call to me – when we were back in Illinois from a man whose sister-in-law was to be the subject of one of these ethics meetings. His message: We got a call yesterday that they are gonna have this meeting tomorrow.
Anyone who is familiar with professional panel knows what is behind this kind of maneuver – have completely unprepared family members be overwhelmed in numbers and expertise by a “steamroller” masquerading as some kind of fair hearing. In the case I mentioned, I was able to hook this family up with an advocate who could attend the meeting. The gentleman called me the next week to say that the whole tune of the committee changed when they brought an outside advocate in. (I think my remark was that “ethics committees are like vampires – they don’t like the light.”)
The author states that “end-of-life cases can also be stressful for doctors,” and yet is followed by something very different shortly after in a discussion of one legislator’s efforts to get the current 10-day limit (treat for ten days followed by withdrawal of treatment or transfer to a different facility or setting).:
This session, as in the 2009 session, debate over the state’s medical futility law is being led by Rep. Bryan Hughes, R-Mineola, who again filed a bill that would require hospitals to continue treatment until a family finds an alternate caregiver, no matter how long it takes.
Known as “treatment until transfer,” the policy would answer one of the law’s most glaring problems — it doesn’t specify that patients must have a terminal condition before doctors can halt care — by requiring family-ordered care be given to all patients, Hughes said.(Emphasis added.)
If the patient doesn’t have to have a “terminal condition” doesn’t that beg the question of just what the heck is meant by “end of life”? Does it mean one or more things to doctors and something entirely different to families? Does it mean that a person is dying? Does it mean the person’s life is being ended? Both? Either?
As interesting as these aspects of the article are, it looks like the main purpose was to introduce to new public relations players for supporting the status quo and opposing the rights of families through “treatment til transfer.”
Unlike other articles, in which the main supporters quoted have been ethicists, physicians or hospital representatives, the main defenders of the current “futile care statute” are two allegedly “pro-life” organizations.:
“Such a policy is not in the best interest of patients because it only prolongs patient suffering and artificially delays death with no real benefit,” said Jennifer Allmon with the Texas Catholic Conference.
“A natural death with dignity is part of our teaching. Aggressive medical treatment interferes with God calling a patient home, and that is not our role,” she added.
I wish I could say I was surprised by this, but quite frankly the Catholic Church has been all over the board on “right to die” issues from Larry McAfee to Terri Schiavo.
Also defending the “futile care” statute is the Texas Alliance for Life. I’ve been suspecting that some of the larger “family values” organizations that put fiscal conservativism on as high a plane as other issues might start to fall this way. I mean, how long can you rail against universal health care and yet fight “futile care” decisions, which typically involve fairly involved and expensive healthcare? Texas Alliance for Life has made its choice, as you can see from remarks Joe Pojman, representing the organization:
Texas Alliance for Life is opposed because the policy would ignore the ethical integrity and judgment of doctors and caregivers, Pojman said.
“I have had numerous pro-life physicians come to me saying, ‘Please don’t let the Legislature require that we do everything, all the time, that families want, because that would be doing harm, too,’ ” he said.
That first sentence is crap. Just how would “treatment until transfer” ignore the ethical integrity and judgment of caregivers? Unless of course, he’s talking about medical caregivers – and he’s just ignoring what families think is best. And since when does his organization stand behind the concept of the ethical integrity and judgment of doctors? It’s certainly not evident when it comes to women’s reproductive medical care.
To be fair, there are plenty of Democrats and so-called “progressives” supporting the status quo on “futility” decisions. But most of them also support the idea of universal access to healthcare. It looks like at least some on the Right want to gives us the worst of all worlds.
This whole idea of “futile” and “quality of life” can be a slippery slope upon which the elderly, as a matter of public policy, are sent off sooner rather than later in order to cap the costs of intervening life-saving procedures.
But, of course, the health care industry doesn’t want any public policy that would deem “treatment” itself to sometimes be declared futile for the elderly. The for-profit cancer clinics sell hope out the front door to elderly patients and when these patients start to run up high costs because of complications of the treatment, they can cap the costs by implementing the DNR/DNI code status made possible by the advanced directive or living will, etc.. provided to the hospital by the elderly patient.
Truly, hospitals are dangerous and inhospitable for the very old –and the elderly can really only protect themselves by confirming that they have full-code status and THEN negotiating a DNR/DNI based upon timely consultation with their physician(s) as to choices for the end of their lives.
For this reason, isn’t a durable power of attorney that leaves code status open to negotiation a better choice for the elderly and their family member(s) who have the elderly patient’s power of attorney.
Don’t most attorneys and physicians preserve their full-code status by means of the power of attorney? — Do THEY surrender this right of full-code status by means of an Advanced Directive that authorizes the DNR/DNI? I don’t think so!
Hello, my name is Jeanette Jeter i experince a different kind of medical futility. MY spouse was brought into one of Ohio ed department said spouse had anoxic brain injury and the only infomation was given was that spouse was goinig to be put on cooling treatment. I the spouse was not ask about a living will nor a DNR order nor did a anyone come to me about spouse being admitted. The next day family and myself ask about spouse condition we was told that they could not tell us anything until spouse finished this cooling treatment which supposed to took 36 hours.To make this story short my spouse died two days being in the icu i have yet to meet or talk with his doctor whom i never met only to find out when i got the medical records that stated the doctors name. the doctor said in the mr that he talk with spouse and family and dicussed spouse condition ( it never happen ) then the mr states that i agreed for my spouse to be in a study and i sighned a informed consent and they gave me a copy once again ( it never happen ) if no one came to discuss my spouse condition how or would i agree to a study. The study was to take place after 48 hours of ventilation which is when the time frame spouse past away. In the mr the study has a irb# which states the study is for VAP but when i look up the study on the hospital clinical trail site it does not come up as VAP it come up as Glioblastoma Multiforme. I feel that this hospital medical futility was an attemp to keep my spouse alive and do this study because the medical record say at the start that patient has a high probability of sudden, clinically significant deteriotation. I hope someone could give me so insight on this matter because i believe that because no doctor came and discuss with me his condition nor did i had to sighn for his admittance which spouse stayed in hospital for two day before being dead, or was he dead when he first arrive ??? this make me to believe that they only kept spouse going to do this study and giving futile treatment which the y billed me for $80,000 which no kind of surgery was done.