Human Exceptionalism

Report on Texas Futile Care Law Shows Danger of Duty to Die Impositions

Critical Care Medicine, the journal for intensive care doctors, has published a study (no link available) of the Texas futile care law (Crit Care Med 2007 Vol. 35, No. 5), which allows hospital ethics committees to order unilateral termination of life-sustaining treatment, and only gives patient families 10 days to find another hospital. In reading the below, it is worth noting a few things about the society: First, Critical Care has previously published a guest editorial advocating for doing away with the dead donor rule for organ procurement, in which the doctor-authors argued that organs should be allowed to be procured from living patients if they are either cognitively devestated or imminently dying. Second, it is worth noting that way back in 1997, when the concept was relatively new, the Society of Critical Care Medicine Ethics Committee supported futile care theory–partially as a way of preserving hospital resources.

With these points in mind, here is the conclusion of the report based on hospital surveys:

A minority of hospitals reported using the TADA provision (n = 58, 30%), and an even smaller number reported actual cases via usable surveys (n = 40, 20%). Hospitals reviewing cases tended to be urban, nonteaching, nonspecialty, with >I50 beds. Most cases were resolved before the end of the 10-day period as a result of patients’ deaths, patients or representatives agreeing to forgo treatments, or patient transfers. In a small number of cases, patients improved after review committees agreed with physicians that treatments were medically inappropriate. Discontinuation of life sustaining treatment against patient or representative wishes occurred for only a small number of reported cases.

Note the part I italicized. A few patients improved after their families were told that their continued support was not to be countenanced. This isn’t surprising, people don’t die by the numbers and not even doctors always know for sure when patients will live or die. (Example: Janet Rivera surviving the removal of her respirator.)

Finally, one reason the numbers of duty to die impositions have apparently been few may be the small band of intrepid lawyers and activists willing to wage battle in the media and in court to prevent futile care theory from being forced on families. Hospitals know it isn’t good PR to tell people their loved ones lives aren’t worth supporting. Thus, the klieg lights remain the most potent tool in holding back this tide.

Hopefully, in the next session of the Texas Legislature this pernicious law will be repealed. Either that, or someday it will be taken down as unconstitutional in court.

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