Impacts of “Futile Care Theory” in Texas

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The Texas Advance Directives Law was amended in 1999 to allow physicians to refuse to provide life-sustaining treatment (including nutrition and hydration) which patients or their authorized decision-makers (agents) have requested. In a dispute, the hospital ethics committee makes the final decision. The usual outcome is that this hospital-appointed committee agrees with the physician. The patient/family/agent then has only 10 days to try to arrange transfer to another physician and facility willing to provide the desired life-sustaining treatment.

This law is based on “futile care theory,” the proposition that physicians and hospitals are entitled to refuse to provide medical treatment which they deem futile. Granted, healthcare providers should not be required to provide objectively useless or even harmful treatment simply because patients demand it. However, futile care decisions are often based on subjective criteria, such as quality of life judgments and cost of care. In other words, it’s not the treatment that is considered useless; it’s the patient.

The bottom line is that “futile care” laws give legal immunity from prosecution to physicians and hospitals that commit involuntary euthanasia by omission.

Willie

In March 2012, a family called Texas Right to Life pleading for help to save their father Willie’s life. Willie went to a Houston hospital complaining of chest pains. The diagnosis was pneumonia, and, shockingly, leukemia. Surgery and chemotherapy were suggested. Before being sedated, Willie looked into his daughter’s eyes and said, “Fight for me, baby. I ain’t done living.”

Armed with Willie’s medical power of attorney, his family told doctors to continue treatment. The doctors decided otherwise. The hospital ethics committee met and told the family to move Willie out of their hospital within 10 days or treatment would cease.

Willie’s family could pay for his transfer to another facility, and he also had ample health insurance. A hospital social worker told them she would try to find another facility. As the 10-day deadline approached, she told them no facility would accept Willie and she could do nothing more. Too late, they realized that the social worker had painted a picture of a patient no hospital wants, one whose quality of life was gone, with no hope of recovery.

Finally, this desperate family turned to Texas Right to Life. The CEO of a hospital with a religious-sounding name was contacted, but refused to take Willie. A team of pro-life people contacted many attorneys to take the case and asked politicians to pull strings to save Willie’s life. All were happy to try to help, but neither the law nor time was on their side.

Willie’s family watched helplessly as, one by one, each treatment was stopped. He wasn’t fed or given water. In a couple of days, Willie was dead.

Zachary

In 2012, 12-year-old Zachary suffered a gunshot wound to the head. Within 48 hours of arriving at Cook’s Children’s Hospital in Dallas, the conversation from the medical staff focused on the quality of his life if he did recover instead of the potential treatments and surgeries that would foster his healing and recovery. Even though Zach was seriously injured, his brain stem was not harmed and he was breathing on his own. A week after his injury, the hospital ethics committee decided to withdraw treatment. At the beginning of the ten-day countdown, the family discovered a DNR (Do-Not-Resuscitate) order in his medical records. The family brought the unwanted DNR order to the attention of the facility and it was revoked.

After being moved to another facility and receiving necessary treatment and surgeries, Zach recovered his ability to speak, see and walk, and his full cognitive abilities.

(Case descriptions were condensed from cases reported by Texas Right to Life.)