End-of-life bill dead this session, key legislator says

Updated: 9:20 p.m. Friday, May 17, 2013 | Posted: 9:21 p.m. Friday, May 17, 2013

A bitter split within the anti-abortion movement and like-minded organizations has helped derail legislation seeking to resolve disputes that arise when family members oppose a doctor’s order to halt treatment and allow a seriously ill patient to die.
The bill, intended to balance patient rights against a doctor’s ethical obligation to do no harm with end-of-life treatment, was approved by the Texas Senate but will not get a vote in the House Public Health Committee because of deep divisions among House Republicans, said state Rep. Lois Kolkhorst, R-Brenham.

“There are vast differences between members,” said Kolkhorst, chair of the committee. “It’s a judgment call by a chairman. It was not a judgment call made without a lot of prayer.”

Some Republicans and most Democrats favor the bill by state Sen. Bob Deuell, R-Greenville, which would provide more time to find alternative care after a doctor determines that continued treatment would prolong suffering and artificially delay death. The vast majority of such patients are unresponsive and represented by family or other surrogates.

A group of conservative Republicans, however, wants to scrap the current process for ending care, requiring hospitals to continue treatment until a new health care provider can be found, no matter how long that takes.

The split mirrors a rift between two leading Texas groups that oppose abortion: Texas Right to Life, which has led opposition to Deuell’s bill, and the Texas Alliance for Life, which helped draft it.

Much of the dispute surrounds hospital ethics committees. In Texas, if doctors believe continued treatment would inhumanely extend suffering, they can overrule family wishes by asking a hospital ethics committee for approval to halt life-sustaining care — which can include withholding dialysis, ventilators and food and water administered via tubes.

If the committee — often comprising uninvolved doctors, social workers and clergy — agrees, treatment can be halted in 10 days.

In practice, according to hours of testimony at legislative hearings, families can be left scrambling in an unfamiliar system, with an impractical deadline, to find a caregiver willing to take the patient.

Senate Bill 303 by Deuell would give families more time to prepare for the ethics committee meeting — seven days instead of two — and require hospitals to provide care throughout the process. If family members disagree with a committee’s decision to end care, they would have 21 days to find alternative treatment.

Also under the bill:

• If a patient or surrogate objects, a doctor cannot place “do not attempt to resuscitate orders,” known as DNARs, on a patient’s chart without ethics committee approval.

• The hospital must supply a liaison to help the family navigate the ethics committee process.

• Up to five family members can be in the meeting, and medical records must be supplied without charge.

At Kolkhorst’s request, state Rep. Susan King, R-Abilene, this week drafted a revised version of the bill, focused on banning DNARs without patient or family notification and requiring water and nutrition to be provided to patients. The hope was to find something that could pass the committee without opposition, but even that version proved to be “too complicated,” Kolkhorst said.

Deuell said that by his count, there were only 27 House Republicans who opposed the bill. “We had the votes. But that’s the power of the (chairwoman’s) gavel,” he said of Kolkhorst’s decision.

Opponents, led by Texas Right to Life, have labeled hospital ethics committees as “death panels” and say Deuell’s bill puts all the power into the hands of hospitals and doctors — charges Deuell called distorted and duplicitous.

Right to Life supports a practice known as “treatment until transfer,” requiring hospitals to provide care until an alternative provider can be found. End-of-life choices belong with the family, not hospital bureaucrats, they say.

Doctors object, saying treat until transfer amounts to government-imposed care that forces physicians to violate their ethics. Heroic, life-sustaining treatment frequently has painful consequences, including infections, they say.

Deuell worked out a presession compromise with doctors, hospitals, religious leaders and the Texas Alliance for Life. The Senate voted 24-6 to approve the bill. All the opponents were conservative Republicans.

King picked it up in the House and added language ensuring that “no patient is discriminated against based on disability, age, gender, ethnicity or financial or insurance status.” The change was intended to address concerns by disability rights groups, who complained that they were not invited to previous negotiations, King said.

All 13 Catholic bishops in Texas support Deuell’s bill, signing a letter saying it “respects the natural dying process.” It was countered by a letter from leaders of Eagle Forum, National Right to Life and almost 20 affiliated groups who criticized the bill, saying it improperly allows doctors “to make value judgments on the lives of these ailing patients.”

Deuell said that defeating his bill — negotiated with powerful lobbies including doctors, hospitals and religious leaders — would doom future attempts to beef up patient protections. A similar compromise effort in 2007 passed the Senate but also died in the House.

Treat to transfer, he noted, isn’t a viable option. Treat-to-transfer bills have not gotten out of committee in either chamber during the past four legislative sessions.

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