TMA Testimony: Dr. Tucker against HB 3520

Texas Medical Association Testimony to

Testimony: CSHB 3520 by Rep. Bryan Hughes (R- Mineola)

Human Services Committee

 By: Paul Tucker, MD
April 12, 2011

Good afternoon, Chairman Raymond and members of the committee. My name is Paul Tucker, MD.  I am a practicing cardiologist from Austin.  Today I’m testifying on behalf of the Texas Medical Association, which represents nearly 45,000 physicians and medical students, and the Texas Hospital Association. I would like to thank the committee for the opportunity to testify before you today in opposition of the Committee Substitute for House Bill 3520, which, if passed, would make dramatic changes to the Texas Advance Directives Act.  

When the current Texas Advance Directive Act was signed into law by then-Governor Bush, it had unanimous support by all the stakeholders who deal directly with end-of-life patient care on a daily basis, including physicians, nurses, hospitals, nursing homes, and hospice care facilities.  We believed then, as we do now, that the current Texas Advance Directives Act serves the best interests of terminally ill patients, their families, and the providers who care for those patients.     

The Texas Advance Directives Act provides for a living will that allows patients to either request or reject life-sustaining treatment in the setting of terminal illness. It prohibits physician-assisted suicide or “mercy killings.” It also prohibits withholding or withdrawal of medication or treatment necessary for a patient’s comfort. Additionally, the act provides for a dispute resolution process when ethical disagreements arise among physicians, hospitals, and the families of terminally ill patients who can’t speak for themselves.  The Texas Advance Directives Act is a balanced approach on how to address one of life’s most difficult decisions.  We believe that Committee Substitute for HB 3520, while certainly well intended, changes this balanced approach and instead creates situations in which dying patients have to undergo more suffering and pain.    

Currently, the Texas Advance Directives Act requires the hospital ethics committee to review cases in which the family of a dying patient disagrees with the suggested treatment made by the treating physician.  In cases in which the ethics committee decides that discontinuing lifesaving treatment is in the best interest of the patient, and the family disagrees with that decision, the family is given 10 days to find a different facility to place the dying patient. During those 10 days, treatment is continued until the transfer of the patient or until the end of the 10 days. Usually, the terminally ill patient has been in the hospital for weeks, even months, before the case goes before the hospital’s ethics review committee.  

CSHB 3520 would take away the 10-day requirement for the family to seek another treatment facility and instead would require continued treatment until a transfer to another facility can be found, no matter how long that may take.  Treatments such as artificial nutrition and hydration may not be withheld, even if the hydration is harming the patient, as in the case of an already fluid-overloaded patient with renal failure or heart failure who can’t be dialyzed.  If passed, CSHB 3520 could cause greater suffering for the patient and in some cases even accelerate the patient’s death.  

CSHB 3520 could cause physicians at major referral centers to refuse to accept transfers of critically ill patients and could cause physicians at tertiary care centers to not accept critically ill patients from smaller hospitals if doing so commits the physician to open-ended treatment irrespective of the physician’s reasonable medical judgment.  This bill also neutralizes the deliberations of the ethics committees; their decision-making would become a meaningless exercise.  Regardless of what the committee recommends, life-sustaining treatment would have to be carried forward indefinitely if that is what the family requests. Committees would cease to have a reason to diligently do their important work.   

Passage of CSHB 3520 also sets a precedent for the legislature to mandate the provision of physician services and treatments that may be medically inappropriate, outside the standard of care, or unethical.  Just as surgeons should not be required to perform surgery they believe to be medically inappropriate, other physicians should not be required to use their skills and technologies if they believe doing so is not in the best interest of the patient or is medically inappropriate.  

In closing, CSHB 3520 would interfere directly with the physician-patient relationship.  Patients and families have autonomy, including the right to request a particular treatment and the right to refuse a particular treatment. They do not have an unlimited right to require the physician to do anything the patient or family requests. When a patient asks a physician to do something that the physician believes is medically inappropriate, the physician can refuse to do so, and the patient may choose to seek another provider.  However, not in this case. 

The current Texas Advance Directives Act provides a fair, rational process for resolving such disputes without arbitrarily forcing physicians or family members to abandon their consciences.   We ask that you vote ‘no’ on the passage of CSHB 3520 out of this committee. 

Again, thank you for allowing me to share my testimony on this bill.  I am open for any questions you have.

82nd Texas Legislature Testimonies 


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