Advance Directives Act

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The Texas Advance Directives Act (1999), also known as the Texas Futile Care Law, describes certain provisions that are now Chapter 166 of the Texas Health & Safety Code. Controversy over these provisions mainly centers on Section 166.046, Subsection (e),^[1] which allows a health care facility to discontinue life-sustaining treatment against the wishes of the patient or guardian ten days after giving written notice. For the hospital personnel to take advantage of legal immunity from prosecution for this the following process must be followed:

The family must be given written information concerning hospital policy on the ethics consultation process.
The family must be given 48 hours' notice and be invited to participate in the ethics consultation process.
The ethics consultation process must provide a written report to the family of the findings of the ethics review process.
If the ethics consultation process fails to resolve the dispute, the hospital, working with the family, must try to arrange transfer to another provider physician and institution who are willing to give the treatment requested by the family and refused by the current treatment team.
If after 10 days, no such provider can be found, the hospital and physician may unilaterally withhold or withdraw the therapy that has been determined to be futile.
The party who disagrees may appeal to the relevant state court and ask the judge to grant an extension of time before treatment is withdrawn. This extension is to be granted only if the judge determines that there is a reasonable likelihood of finding a willing provider of the disputed treatment if more time is granted.
If either the family does not seek an extension or the judge fails to grant one, futile treatment may be unilaterally withdrawn by the treatment team with immunity from civil or criminal prosecution. ^[2]

The bill was signed into law while George W. Bush was Governor of Texas; critics have compared this law and its effects with Bush's response to Terri Schiavo's situation, in particular his signing of the Incapacitated Person's Legal Protection Act. ^[3]The Houston Chronicle noted that Schiavo's case wouldn't be applicable in Texas if she lived in the state.[1] (broken link) However, prior to the passage of this law, no protections or "grace period" existed.[2]

1 Cases
2 Criticism
3 Notes
4 See also
5 External links

[edit] Cases

On March 15, 2005, six-month-old infant Sun Hudson was the first person to die under the Texas Futile Care Law. [3]

In December 2005, Tirhas Habtegiris, a young woman and legal immigrant from Africa, was removed from a respirator.[4]

In April 2006, relatives of 53-year old Andrea Clark were given the 10-day notice under this act.[5] [6] She had reportedly signed a statement she did not wish to die and was cognisant although having difficulties communicating while under heavy medication. After publicity from both right and left political groups, St. Luke's hospital in Houston agreed to review the case again, eventually retracting the original decision this further review. Andrea Clark, once deemed a "futile" case, then began to recover [7], but ultimately died on May 8, 2006 after an infection. [8]

Although there is much press about these cases, as of July, 2005, there were only 7 disputed cases under this law. the law is a first effort to deal with futile care see Futile medical care

[edit] Criticism

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Under the Advance Directives Act, Texas hospitals and physicians have the right to withdraw life support on a patient whom they declare terminally ill, if that patient doesn't transfer to another facility within 10 days. The 10 day cushion provides a family with a choice about whether life sustaining treatment will continue, as would be the case if the patient is transferred. If no facility will accept the patient, which can happen with gravely ill patients, the hospital is legally permitted to withdraw life support from the patient, and hasten the patient's death. This situation can occur (as it did in the Andrea Clark case) when the patient is fully insured, and able to pay for treatment.

Furthermore, life support may be withdrawn even if the patient has indicated a desire to continue treatment. In cases where there is a dispute, the decision is made by the hospital's ethics committee.