Friday, March 30, 2012

Navigating Health Care's Difficult Decisions

By Beverly B. Nuckols, MD

Bud Kennedy's article in the Fort Worth Star-Telegram, "Texas has had 'death panels' since 1999," gave a distorted view of the Texas Advance Directives Act and hospital ethics committees.

Medical treatments require doctors to make repeat decisions guided by medical judgment — a combination of medical ethics (moral right and wrong) and medical knowledge and experience (discernment between harm and healing). The act is a legislative attempt to balance the interests of vulnerable patients with the professional integrity and conscience of the physician. It is invoked when the patient's doctor and the patient or patient's family disagree about treatment.

The ethics committee is usually a mix of doctors, nurses and community members, appointed by the local hospital, not any government or outside agency. Because of the varieties of sizes and staffing of our hospitals in Texas, the act doesn't even specify the makeup of the committee. It requires that the doctor ask the ethics committee to meet and review the patient's record and determine what is medically appropriate. The committee must give the family at least two days' notice before the meeting.

When the committee agrees with the patient, the act requires the doctor to continue writing orders and supervising treatment unless he or she can arrange transfer to another doctor. If the committee agrees with the doctor, notice is given to the family that the treatment is not medically appropriate and will be withdrawn after 10 days, unless the family can arrange transfer to another doctor or another facility.

Groups of legislators, patient advocates, doctors and representatives of religious, hospital and medical associations have deliberated the directives act for years. We came close to a compromise on amending it in May 2007. The revision, SB439, would have required hospitals to give more time and assistance for families to prepare for the committee meeting and to find alternate care.

Unfortunately, the agreement fell apart during debate on the Senate floor when one group backed out and tried to force all of these cases to court, where judges would practice medicine by orders to doctors, and lawyers could sue for damages.

Beverly B. Nuckols, MD, is a board-certified family physician in private practice in New Braunfels. She was appointed to the board of the Texas Institute for Health Care Quality and Efficiency by Gov. Rick Perry and serves on the board of Texas Alliance for Life.

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