"We will not be silent. We are your bad conscience. The White Rose will give you no rest."
Posted on 05/08/2006 6:44:55 AM PDT by Cat loving Texan
Odd political bedfellows working together to change law that allows doctors to withdraw treatment, transfer patients
Monday, May 08, 2006
Some unlikely political bedfellows want to change the state's "medical futility" law, saying it gives doctors too much power to make life-and-death decisions and families who disagree too little time to fight back.
The law has received renewed attention in recent days after doctors in Austin and Houston sought to withdraw treatment from patients whose families wanted to keep them on life support.
A collection of conservatives and liberals, Republicans and Democrats, Texas Right to Life members and disability rights advocates — all members of the Texas Advance Directives Act Coalition, which helped craft end-of-life legislation in Texas a decade ago and is considering changes to the medical futility provision — are largely in agreement that the deadlines imposed on families are too burdensome. But so far they haven't been able to persuade many of the doctor and hospital representatives in the coalition of the need to extend the deadlines.
Under the law, families are given 48 hours' notice that attending physicians want to withdraw a patient's treatment and to prepare for a meeting of the hospital ethics committee. If the ethics committee agrees with the doctors, the family then has 10 days to prepare for the withdrawal of life-sustaining care or to find another doctor or facility where the patient can be treated.
Texas Right to Life and the other groups want the Legislature to consider changing the law during its next regular session in January. Coalition member Bob Kafka, Texas organizer of the disability rights group Not Dead Yet, opposes the concept of "medical futility." There is no universally accepted definition of futile care, but it's generally considered any treatment that is not restorative, curative or palliative.
"We're talking about a person's life," said Kafka, who says he is a liberal and sees withdrawing treatment as a denial of civil and human rights. "I have friends rolling around in wheelchairs who were brain-injured when doctors and hospitals said it was futile care. . . . I want to make sure families and individuals are not rushed to judgment."
For once, he said, he is aligned with Texas Right to Life, which is probably best known for its work in opposition to abortion and appeals to a more conservative base. Elizabeth Graham, director of Texas Right to Life, said families are too emotionally devastated to face down doctors and hospitals on medically complex issues in a short time.
"Doctors say families are emotional and haven't come to grips with the fact that their loved ones are dying," she said. "The families are summarily dismissed."
Dr. Robert Fine, a member of the coalition, said that doctors are sensitive to suffering families and that physicians take an oath to do no harm. When a physician thinks that further treatment is prolonging the suffering and dying of a patient, that doctor can't be required to continue treatment.
However, if another doctor is willing to do so, no one will stand in the way, said Fine, director of the Office of Clinical Ethics for the Baylor Health Care System and director of Palliative Care Consultation Service at Baylor University Medical Center.
He sees no need to change the Advance Directives Act, which the Texas Legislature passed in 1999 and revised in 2003.
"Ten days is longer than we typically need to know . . . if there's a willing provider" to take over treatment, Fine said.
Often, families are divided on whether to continue life-sustaining treatment, Fine said, and some are relieved to hear of the futility law.
"We've had families welcome this process," he said.
Greg Hooser, the coalition's co-chairman, said he formed the Advance Directives Act Coalition a decade ago to bring disparate groups together to write legislation on end-of-life care. The 10-day deadline was a compromise, and nobody knew how it would work.
Since then, too many families have had a hard time finding a hospital, nursing home or other long-term care facility that will take a patient branded as "medically futile," said Jerri Ward, an Austin lawyer who represents the families of Lang Yen Thi Vo, 63, of Austin and Andrea Clark of Houston in medical futility cases and is taking part in the coalition meetings.
Families also have found the 48 hours extremely difficult, Ward said, especially since the clock can tick over a weekend, when lawyers, experts and others who can offer assistance can be tough to reach.
In the Clark case, St. Luke's Episcopal Hospital found an Illinois facility to take over her care, but the facility changed its mind when it got more information on her condition.
In Vo's case, North Austin Medical Center gave her family 10 days to find another facility but later extended the time by more than a month. The hospital says Vo is in a persistent vegetative state, but her family disputes that and wants time to find a Texas facility to take her.
Ward said she was grateful that the outcomesin those cases are working in favor of the families so far. But she said the law does not compel hospitals or doctors to be flexible on deadlines with families, only to assist by providing lists and information about potential options for treatment.
If no alternative provider is found, for example, the law says treatment may cease on the 11th day after notice from the ethics committee unless the family obtains a court ruling forbidding it.
Graham said most of the cases that Texas Right to Life helps with involve uninsured minorities.
"These people are sick, and the hospital doesn't want to pay when they don't have insurance," she said.
Hooser and Fine said they don't think the issue has anything to do with money or insurance. Nor do they believe that doctors are basing decisions on color, although they said cultural factors may influence how racial and ethnic groups view the withdrawal of life-sustaining treatment.
Of five large urban hospitals in the Dallas-Fort Worth and Houston areas that reported data to the coalition over a five-year period, Hooser said, 65 medical futility cases were referred to ethics committees. That's an average of about three cases per hospital per year.
He did not have a breakdown of patient ethnicity, but Fine provided data from Baylor University Medical Center at Dallas. Of 12 futility cases at Baylor, six of the patients were African American, three were Caucasian, two were Hispanic and one was Arabic, he said.
Although there is wide variation among individuals in groups, many non-European immigrant cultures "have great trouble accepting our model of starting a treatment to see if it works and if it does not, then seeking permission to stop," Fine said. Hooser cited a recent study in the Archives of Internal Medicine that showed African Americans were more likely than whites to distrust health care providers: 45 percent of blacks reported low levels of trust, compared with 34 percent of whites.
Among the Baylor group, only one patient lacked insurance. Of the rest, one had commercial insurance, and the others were on Medicare, Medicaid or some combination.
"A doctor is paid quite well for dialysis and ventilator patients," Fine said. "The doctor actually loses money when the patient dies. . . . It's really not at all about money."
All sides said that if anyone can build consensus, Hooser can. He has become convinced that the law needs "more procedural safeguards" and is optimistic about crafting proposed legislation. State Reps. Eddie Rodriguez, D-Austin, and Bryan Hughes, R-Mineola, have indicated an interest in sponsoring a measure. But not everyone is optimistic that consensus can be reached.
"We know it's going to become a hot-button issue during the next session," Kafka said.
maroser@statesman.com; 445-3619
Thank you for posting this. I would never have seen it if not posted here.
Looks like we no longer get to live until we naturally die. What gall that suddenly - man determines when man dies rather than God.
Now watch all of the little minions follow along meekly. Why, because they so want to be able to usher relatives out the door rather than seeing estate funds spent on care.
And, this greed will bite them in the back a few years later as they become those "ushered".
Man continues to amaze me at man's utter stupidity. Man willfully pays the man who will decide he must die and fully gives that man the authority to do so.
God no longer determines when it is time for us to depart this life - the doctor does. Do you trust your doctor?
Ping
Right to life? No right to life if you have a doctor.
If this law is sustained, Terri Schiavo died for nothing. This is the Terri Schiavo coalition coming together again.
Let's fight for Terri's memory by stopping this law.
Some people sure are bloodthirsty. Some people can't wait to get the law on their side so they can klill those who are inconvenient to them. That is how totalitarian police states operate.
Actually these cases are long past the time when one would have "naturally died". So that is an entirely bogus comment. Why don't we just bankrupt all medical institutions by making them "treat" hopeless cases indefinitely?
"We will not be silent. We are your bad conscience. The White Rose will give you no rest."
Remember that when it is you or your child.
"Futile care law" -- like every other Death Cult law -- means a legal license to kill. The laws specifically exempt killers from any charges of murder, manslaughter, negligent homicide or any sort of wrongful death crime.
People are not hopeless cases. Not even you. There's always the chance that some day, you will see the light. Probably not until it is you being killed, but anything's possible.
Some medical conditions are beyond the power of doctors and medical science. MOdern medicine performs near miracles and rarely, if ever, gives up too soon on hopeless cases. Quite the contrary.
There comes a time to let go. Death is not the End.
Some, not all.
MOdern medicine performs near miracles
God performs actual miracles.
and rarely, if ever, gives up too soon
Not true. I see an average of about three news articles per day about doctors giving up on patients that are very likely to survive with minimal care.
on hopeless cases.
How many times must you be told that people are not hopeless cases?
Quite the contrary.
You should know all about "contrary." Almost everything you've ever posted about life and death has been contrary to the known facts.
There comes a time to let go.
Yes, but that time is not during a murder that can be prevented.
Death is not the End.
Brain damage is not the end. Death is the end of life on earth. Murder is not rewarded with everlasting life.
I have been through it already so have no need to remember theoretical possibilities.
Like it or not agree or not but the best sources for medical knowledge is the medical profession. Not families, not clergymen, not Pro-life zealots but actual doctors and nurses. They are not infallible and are human but those are the realities.
America spends more resources and effort in prolonging life (ANY life) than any society ever has or ever can. Why do you think medical costs are escalating so wildly when people seem to think they should squeeze every last drop from life no matter the cost to others?
For one thing - man is not given the option of when he dies - that is God's duty.
Remember "Thou shall not commit murder"?
And, once you start giving man the ability to condemn others to die, it spreads like a rampant virus. First it is immediate family with doctor input, then it is doctor in lieu of family, then it is doctor over family (you now have exalted the position of doctor to a god which is what many of them feel they are).
You then move on to those chronically over time ill (when money is the factor - money becomes the god), then why not the wheelchair bound, why not severe burns, why not the first stages of cancer (after all - why waste all that money - they will eventually die anyway).
Now, in the meantime, you now have doctors judging whether an infant should live, you have doctors taking bribes from relatives wanting the funds of a sick elderly.
In other words, you have a slaughter house with the goal the assets of the weak, or to prevent "the others" from having to spend their funds on the weak of society. Instead you will have medical facilities using funds spent on charity care, spent on perks for the administrators, nice offices, etc.
Our society is now selfish, disconnected from family and really just ignorant. They cannot comprehend the dangers of making the first step over the line between allowing nature to take its course and in deciding FOR nature when death occurs.
Notice that usually the wishes of the one being killed are not even a consideration. Only the dollar.
And, once society has chosen this cold, harsh path - you will never ever reclaim it as you have created a society of vultures.
So, and that gives you the right to decide for all others how they should give "death" to their loved ones to save "funds"?
Oh, and don't in any way lump all society into those that abuse the medicaid/medicare system. Most people are paying their own way and, by golly, if they choose to seek medical "HELP" for their loved one, they dang well better be given it.
If they are only visiting a "slaughter house", it would behoove all to take medical courses so that they can just allow the medical community to go without any of their fees as they will take care of their own.
Another example of stupidity - the medical community turning itself from the hippocratic oath for healing into the slaughter house with the "Deathmaster" in charge. Who in their right mind would PAY to go to a slaughter house?
Hm........seems to me, it would just be a lot easier to just withdraw myself from medical care and take my chances. A lot, lot cheaper to just die at home and I just might live a great deal longer.
There comes a time to let go - fine - but you don't push someone into death. Death is not the end and precisely the reason man does not need to send other men to their death. It is not the end and each man has only this life to get right with God and determine where that man will spend eternity.
Another man does not have the right to cut short his time on this earth. What if that man is not right with God? They are condemning the man to eternity when that man might have found God. Many times serious illness makes a person turn to God and wake up.
Man can withdraw useless care, but man does not have the option to initiate death on a non-dying person. It steps over into the rhelm of murder. Do you really want to face God someday and answer for murder or do you want your children to face God with that?
Some things are better left alone and should just be handled with prayer and consideration of the person, their suffering and gently help them walk through the final days WITHOUT even considering the funds. After all, that money belongs to the one dying and was earned to carry them through life.
If on charity - a bit different, but still, we do far much more harm to our own character as people and a nation if we choose killing instead of love and respect for a life.
Note: I am in no way discussing your prior case as I have no knowledge of it - I am discussing policies.
Not spending millions on every case no matter how hopeless is in no way "murder".
And if you don't believe these decisions are made hundreds of times every day then you need to look into things more.
Or if you believe they are being made too much then you should explain how indefinite expenses can be funded indefinitely.
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