Posted: Mar 10, 2013 10:15 AM
Updated: Mar 10, 2013 10:16 AM
AUSTIN, Texas (AP) A battle is brewing at the Texas Legislature among right-to-life groups, but rather than debating when life begins, they are fighting over the rules that govern the end of a terminally ill person's life.
The dispute revolves around what should happen when the patient's family wants to continue medical treatment when the doctors think it would only prolong the suffering.
Under current law, the doctor is required to refer the case to the hospital's ethics committee, which can either agree or overrule the doctor's recommendation. If the family still disagrees, they have 10 days to find another facility to take the patient, after which the doctor's orders take effect.
Texas Right to Life says the Texas Advance Directive Act of 1999 robs "the ailing and disabled of their civil liberties by giving power over their lives to an unelected body of hospital administrators and employees." The group is lobbying lawmakers to revise the act to require doctors and hospitals to provide indefinite treatment as long as the patient or the family desires.
The group backs House Bill 1464 by Rep. Brian Hughes, R-Mineola, which eliminates the time limit on finding another facility and requires the hospital to continue treating the patient. Critics call this "indefinite treatment" because it gives the doctor and hospital no say in deciding whether to treat the patient.
On the other side of the debate is the Texas Alliance for Life, Christian Life Commission and the Texas Catholic Conference, which are backing a bill that would extend the 10-day period to 14 days but not force doctors to keep treating patients. House Bill 1444 would only require doctors to continue feeding and hydrating patients as long as it doesn't cause them pain.
The Texas Medical Association and the Texas Hospital Association also support the bill, filed by Rep. Susan King, R-Abilene.
"Requiring physicians and hospitals to continue to provide non-beneficial treatment that they rightly believe is unethical and inappropriate violates their freedom of conscience," the Texas Catholic Conference says.
Changing the law has created a rare division among the highly influential right-to-life lobby, which is capable of mobilizing Republican primary voters. The frantic debate over the law also reflects how right-to-life groups have moved beyond opposing abortion to expand their political portfolio.
These groups have tried to change the law every session since 2007, sparking hours of emotional testimony and hyperbolic debate. These bills and many similar ones will likely bring more of the same when they come up at committee hearings.
Yet, the Texas Advance Directive Act is rarely ever used. The Texas Hospital Association surveyed 202 hospitals across the state of all sizes and found that between 2007 and 2011, doctors and the families disagreed in 30 cases out of 3.7 million patients admitted. The Ethics Committee agreed with the doctor's conclusion 70 percent of the time.
In those cases, the patient had been in the hospital an average of 47 days and almost six days elapsed between when the doctor wanted to withdraw treatment and when the ethics committee met. In eight cases the patient died while awaiting transfer, six were transferred, four patients continued to receive treatment, two families changed their minds and two patients died before the committee could make a decision.
For those who must rely on the process, though, it is traumatic to hear that a doctor wants to allow your loved one to die, and that the only recourse is a committee made up of social workers, doctors, chaplains and community leaders. King's bill would allow family members to participate in the meetings, something not now guaranteed under the law.
Doctors, though, describe the trauma on the patient when they undergo treatments that will do nothing to save them from the inevitable. Even feeding a patient through a tube can cause them incredible abdominal pain, or placing them on a ventilator can break their ribs and bring pain with very breath.
Professionals also point out that the vast majority of money spent on health care goes to treating the elderly, and that science is now capable of prolonging the life of people with terminally illnesses far longer than ever before. Many question if this is the wisest way to spend federal Medicare dollars when they do little to improve the patient's life.
Conservative Republicans are listening to both sides, and in the weeks ahead, will have to decide who will ultimately make the life or death decision when a family and a doctor disagree.
Follow Chris Tomlinson on Twitter at https://twitter.com/cltomlinson,
Chris Tomlinson is the AP's supervisory correspondent in Austin, responsible for state government and political reporting.