BUSH ACHIEVES PROTECTION AGAINST INVOLUNTARY EUTHANASIA IN TEXAS

Texas Governor George W. Bush is set to sign a bill that will protect Texans against being denied lifesaving medical treatment, food, and fluids against their will by hospital ethics committees. Medical groups agreed to the legislation in 1999 after the governor's 1997 veto of another bill that would have left intact a provision of Texas law according civil and criminal immunity to physicians who refuse to abide by patient wishes.

"Governor Bush's veto of the advance directives bill following the 1997 legislative session reflected his conviction that the lives of all human beings regardless of their medical condition are deserving of care, compassion, and necessary lifesaving medical treatment if requested," said Joseph Graham, Ph.D., president of the Texas Right to Life Committee. "He was further convinced that a law which would have had the effect of denying such treatment would violate fundamental justice."

As a result of the governor's strong stand on the 1997 bill, Texas Right to Life was invited by a number of Texas medical groups to participate in a series of negotiations beginning in 1998 to develop a new version of legislation to revise the state's advance directives law.

Influential bioethicists have been arguing for over a decade that people who in the opinion of medical personnel have a poor quality of life have no right to treatment. Spurred by these claims and the financial pressures of managed care, an increasing number of hospitals have been adopting formal procedures to deny lifesaving treatment against the will of their patients and the patients' families. The lead was taken by Houston-area hospitals that in summer 1996 publicly announced new policies to end the lives of disfavored individuals against their wishes.

Under the Houston policies, when two doctors agree that a patient ought to die, but the patient (or, in the case of a patient incapable of making health care decisions, the patient's family members or other surrogates) want lifesaving treatment, the doctors provide 72 hours' notice. If the patient has not been able to arrange a transfer to another hospital willing to provide such treatment within that time, there is a hospital ethics committee meeting at which the patient or a surrogate is allowed to plead for life, while the doctors present the case for involuntary death. If the ethics committee decision is for death, there is no appeal, and even if there is a doctor with privileges at the hospital willing to provide lifesaving treatment, any further such treatment is prohibited. Treatment may not be provided while further efforts are made to secure a transfer. Under the standard policy, it is to be cut off immediately following the ethics committee decision, although a variant permits a "grace period," presumably so the patient can say final good-byes before dying.

Under the new Texas bill to be signed by Governor Bush, treatment must instead always be provided until a reasonable opportunity has been afforded for transfer of the patient to another physician or health care facility willing to comply with the patient or family choice for life. A physician or health care facility will no longer have legal immunity if it involuntarily denies treatment in such a manner. In order to be immune, a doctor or hospital that has decided to deny life-sustaining treatment­defined as "treatment that, based on reasonable medical judgment, sustains the life of a patient and without which the patient will die"­must provide it while the patient seeks transfer to another doctor or facility willing to respect the patient's right to live. Such treatment must be provided for 10 days, a period that can be extended if a court determines there is a reasonable expectation that a physician or health care facility that will honor the patient's directive will be found if the time extension is granted.

The new Texas law is congruent with the ethical position recently promulgated by the American Medical Association's Council on Ethical and Judicial Affairs. That policy, issued March 10, 1999, allows life-sustaining treatment to be terminated against the wishes of a patient or surrogate only "if transfer is not possible because no physician and no institution can be found to follow the patient's and/or proxy's wishes."

"The provisions of the new statute radically alter the status of medical patients suffering from life-threatening conditions," said Dr. Graham. "As a direct result of Governor Bush's efforts, patients can no longer be denied their fundamental right to lifesaving treatment if requested. The passage of this bill marks a great day for the recognition of the worth and dignity of all human life in Texas. Governor Bush deserves our thanks for his crucial efforts in securing the passage of this bill."