End-of-Life Care

The in-hospital DNR law, codified as Senate Bill 11 in the 2017 Texas Legislature, went into effect on April 1, 2018. Ms. Atwood and Jason Morrow, MD, medical director of inpatient palliative medicine at University Health System in San Antonio, examined the legal requirements of the complicated law and associated ethical considerations.

If you’re wondering how Texas' do-not-resuscitate laws might apply to you and your patients, the Texas Medical Association’s new on-demand webinar can help: Do-Not-Resuscitate Order: Updates and Changes.

TMA provides this ready reference guide for physicians to the key portions of Texas' new DNR law. Tap "Add to Home Screen" on your iPhone or "Add Page Shortcut" on your Android phone to keep this guide readily available.

The logistics of entering a valid in-hospital DNR order are about to become considerably more complex. A law taking effect in April lays out new requirements affecting physicians in hospitals or health care facilities.

A Harris County district judge rejected a constitutional challenge to part of the Texas Advance Directives Act, siding with TMA and several other organizations that filed a brief in support of the law.

Despite comments from Senator Charles Perry (R-Lubbock) late last week praising TMA’s thoughtful contributions to Senate Bills 11 and 80 regarding do-not-resuscitate (DNR) orders, more work is needed to clarify liability protections for physicians.

Spearheaded by some north Texas health care systems and physicians, a coalition has been gathering stakeholders together examining a Medical Orders for Scope of Treatment (MOST).  The document is similar to nationally known Physician Orders for Scope of Treatment (POLST).  Dr. Susan Nelson, MD from Louisiana briefed the coalition on January 29 about successes in her state with “LaPost” in raising physician awareness of this effort to document patient care preferences.

As of January, Medicare pays physicians for advance care planning as a separate service, a long-sought victory that promotes educating patients and physicians on the issue.

"When we can have these conversations, it turns out that our clinical practice becomes a lot more authentic and satisfying because you actually can achieve valuable clinical goals even when you can't cure someone."  

When Bellaire emergency physician Arlo F. Weltge, MD, received a chronically and terminally ill patient in the emergency department, he knew he had to make some quick and complex decisions. The man had terminal cancer and end-stage HIV-AIDS and, because he was nearing cardiopulmonary arrest, could not express his care wishes. Nor had he signed an advance directive.

The patient-physician relationship is unique in modern American life. Patients place their lives in their physicians’ hands. Not only must they trust in their doctors’ knowledge, experience, and skill, but they also must trust that their physician is acting in their best interest — neither motivated nor distracted by competing interests. In return, the physician is responsible for recommending and applying the most appropriate, science-based treatments for the patient’s individual circumstances and medical conditions. All of these pressures are magnified during the often-emotional final days and weeks of a person’s life.