SB 675 Eviscerates Texas Advanced Directives Act

TMA Testimony by Arlo Weltge, MD

Senate Health and Human Services Committee
Senate Bill 675
March 19, 2013
 

Good morning, Madame Chair and members of the Committee. Thank you again for hearing my comments today.

Once again, I am Dr. Arlo Weltge. I am an emergency medicine physician in Houston. I am here today testifying on behalf of the 47,000-plus physician and medical student members of the Texas Medical Association – and our patients.

I am speaking to OPPOSE Senate Bill 675. Although the bill is quite short, its impact would be quite large. If passed as written, SB 675 would eviscerate a very good law – the Texas Advance Directives Act. It would subject terminally ill patients to unneeded pain and suffering, and expose physicians and caregivers to a very vague new cause of legal action.

Let us remember that the most important goals of the 1999 Advance Directives Act are to encourage patients to discuss their end-of-life wishes with their families well before needed, AND to provide families a reasonable process to resolve differences of opinion if difficult treatment decisions occur.

SB 675 would weaken and cloud the ethics committee review process that provides reasonable opportunity for resolving disagreements about the appropriateness of care.

SB 675 would be bad for terminally ill patients. As drafted, SB 675 states that a physician may not refuse to honor a patient’s advance directive or a health care or treatment decision made by or on behalf of a patient. Physicians and other health care providers should not be required to provide care we believe is harmful, medically inappropriate, substantially painful, or unethical. Under this language, due to lack of clarity neither families nor health care practitioners could turn to the ethics committee review process to resolve these differences at such a difficult moment.

No law can stop us from grieving at the loss of a loved one; but we should not have to compound our grief with the guilt of wondering whether we had done too much or too little to prolong life. We can improve the Advance Directives Act to better respect patients and their loved ones in one of the toughest moments of life.

SB 675 prohibits physicians from making medical judgments based on certain “value factors.” It is not clear how the ethics committee members or any observer could determine whether a particular value consideration did or did not have an impact on a physician’s decisionmaking, as required by this bill.  This contributes to the lack of clarity.

As always, physicians remain liable for the decisions they make that are outside of the standard of care. However, SB 675 would establish a new standard of care for a physician to provide unlimited treatment even when unethical and immoral. That standard would no longer be based upon science or what is in the best interest of the patient.

The ethics process in current law provides protection for patients and their families by requiring a totally new review of the treatment decisions. However, the language of SB 675, would complicate these rare and sensitive reviews and likely result in the abandonment of this reasonable process.

Furthermore, the Advance Directives Act focuses on the care of terminally ill patients. SB 675 would cloud the use of that law with language about non-terminally ill persons, such as the elderly and people with disabilities. Current law already specifies exactly who is terminally ill. Physicians are trained to save lives. Physicians provide care and comfort for all patients no matter what stage of life, even when the patient is dying.

As a physician, I regard my responsibility to my patients as paramount. I take seriously, every day, the directive to seek to do no harm. As a physician, I am personally, morally, and ethically committed to the highest professional ethics standards – and that includes putting my patients’ needs above everything else and valuing the life of every patient.

I didn’t become a physician and go to medical school and residency training for years to dishonor or devalue my patients.

The language of SB 675 implies physicians devalue patients. The language seems to cast significant doubt on the trust patients place in their physicians. This is helpful to neither the patients, their families, nor the physicians and providers entrusted with their care.

Thank you very much for your time. I would be pleased to answer any questions. 

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