Senate Panel Considers End-of-Life Bills

A panel of state senators on Tuesday considered two bills that would take drastically different approaches to modifying laws regarding end-of-life care in Texas.

Senate Bill 303 would give patients and their surrogates more discretion under the state's existing advance directives law, while preserving physicians’ ability to make a medical judgment to end treatment. Senate Bill 675 would prohibit physicians from discontinuing a patient's life-sustaining care against a family's wishes.

Both bills — which drew emotional testimony — were left pending by the Senate Health and Human Services Committee.

Holly Nelson, who testified against SB 303 and for SB 675, said her mother was brought to a hospital in Bedford for dehydration, yet physicians refused to treat her with intravenous hydration because they said she was terminally ill. 

“I watched my mother being starved to death and dehydrated to death,” Nelson said. “She didn’t die of liver failure or cancer, she died because the hospital wanted her to die.”

Sen. Bob Deuell, a Republian physician from Greenville who authored SB 303, and has for years been working on a compromise for end-of-life legislation, said under his bill, Nelson "would have had a process to prevent most... if not all of what you described for your mother.” 

Under the state's 1999 advance directives law, if a physician decides to discontinue treatment for a terminally ill patient, the patient or his or her surrogate has 10 days to find an alternate provider. SB 303 would extend the time patients have to find an alternate provider to 14 days. It would also set up a process for patients or their family to be notified of a “do not resuscitate” order issued by a physician, and gives them the ability to appeal the order. And it ensures that the patient or surrogate has a liaison to guide them through the appeals process, and a free copy of the patient’s entire medical record.

Deuell's compromise bill has the support of the Texas Medical Association, the Texas Hospital Association and multiple groups that identify as “pro-life,” such as the Texas Alliance for Life, the Baptist Life Commission and the Texas Catholic Conference.

“We had to be realistic about what we could pass,” Deuell said, adding that he worked with physician, patient and family stakeholder groups to find a compromise that would add patient protections to the advance directives law. “It’s a step forward, but there are more steps to be taken."

In stark contrast to SB 303, SB 675, authored by Sen. Kelly Hancock, R-Fort Worth, would prohibit a physician from withdrawing life-sustaining treatment based on the doctor's medical or value judgments. More specifically, a physician could not order medical staff to discontinue dialysis or artificial administration of food or water based on the belief “that extending the life of an elderly, disabled or terminally ill person is not as valuable as that of a younger, non-disabled, non-terminally ill patient,” or the belief that further treatment is not worth the risk of future disability for the patient. The bill has support of Texas Right to Life.

“I don’t think a [medical ethics] committee should determine that we’re going to expedite someone’s death,” said Hancock, adding that his law intentionally gives patients and their surrogates the right to determine end-of-life care, rather than a physician or a hospital.

Others testified that the language of SB 675 would cloud the medical ethics review process, and could harm patients by requiring physicians to continue treatment that causes unnecessary pain and suffering.

“Death is not the issue, we’re all going to die. The issue is can we provide comfort and care for that individual in that dying process,” said Dr. Arlo Weltge, an emergency room physician in Houston who testified against SB 675 on behalf of the Texas Medical Association. “The way this is worded is that I am obligated to continue treatment even when it is not in the best interest of the patient.”

John Seago, who came to Tuesday's hearing on behalf of Texas Right to Life, argued that Deuell's bill "allows doctors to make moral and ethics decisions and not medical decisions, and that’s our biggest concern."

Disability groups testified in opposition to Deuell's bill, arguing that the measure did not go far enough to protect patients’ rights. They argued they were not among the stakeholders consulted on SB 303 before it was filed, but Deuell said he has since spoken with many of those groups and offered a committee substitute to address some of the concerns raised.

“I believe it gives too much power to the doctors who I’ve depended on much of my adult life,” said David Witte, a member of the disability rights group ADAPT of Texas. “A stakeholder meeting should really be asked for before the bill moves forward, because what could be more important than who decides who lives or dies.”