Wednesday, August 12, 2009

AMNews: May 14, 2007. Battle over futile care erupts in Texas ... American Medical News

AMNews: May 14, 2007. Battle over futile care erupts in Texas ... American Medical News:

Disability rights and pro-life activists are pushing for changes in Texas law that would force physicians and hospitals to provide life-sustaining treatment indefinitely in medically futile cases.
Under an advance directives law hammered out by medical, disability and pro-life groups in 1999, the families or proxies of patients on life support have 10 days after hospital officials formally notify them that they plan to withdraw treatment to find another facility to care for the patient.
But the Terri Schiavo controversy and a number of heavily publicized cases in which Texas families scrambled to transfer their loved ones and sued hospitals to continue treatment have taken place since then. Bills now being considered in the Texas Legislature would eliminate that 10-day time limit. A measure in the 150-member House has garnered 80 co-sponsors.
The Texas Medical Assn. argues that these so-called treat-until-transfer bills would force doctors to continue treatment in cases when it's medically inappropriate and that further intervention inflicts pain on patients without any corresponding medical benefit.
The Texas law, which applies only to terminally ill patients with an irreversible condition who are unable to make their own health care decisions, is also unusual because it requires the hospital's ethics committee to review any medical futility case before the 10-day clock starts ticking. While hospitals in other states usually review any decision to withdraw care, such procedures are not legally required. Virginia is the only other state to place a time limit, 14 days, on how long an effort to transfer the patient must continue before life support is withdrawn.
Texas hospitals have used their state's advance directives law 27 times to withdraw treatment over family objections, said Robert L. Fine, MD, one of the 1999 law's architects.

Although, as the article points out, AMA ethics policy is consistent with this approach, I am surprised that it has ben used so often in Texas. But then, this is the death penalty state, and so, I suppose we shold not be surprised.

I can't see doing this, personally, but I can tell you that the irrationality of some families is impenetrable, and the strain on ICU staff - which should count for something - in engaging in what most of us would consider behavior tantamount to cruelty leads to early burnout of some very fine individuals for no benefit other than the acquiescence to this irrationality.

BTW, the law was not updated and stands as it was.

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