Testimony: CSHB 3520 by Rep. Bryan Hughes (R- Mineola)
Human Services Committee
By: Amy Arrant, MD
April 12, 2011
Good afternoon. My name is Dr. Amy Arrant. I have been a hospitalist for 12 years and currently serve as chief of staff of St. David’s South Austin Medical Center. I deal with end-of-life care decisions all too frequently. End-of-life care is an important aspect of medical practice. The care of patients near the end of life has a moral, psychological, and interpersonal intensity that my words today cannot adequately describe.
We as physicians are guided by a simple ethical touchstone of “first do no harm.” House Bill 3520 would cause us to violate that very code of ethics in its attempt to force doctors to provide futile care indefinitely.
I believe in every human’s right to be treated with respect throughout the dying process. Despite the advances in science and medical care, we will all die. The right to life should be inextricably connected to the right to die with respect and dignity. This bill fundamentally takes away that right. The bill takes away the right for patients to be treated in the most compassionate manner when they are the most vulnerable and are unable to speak for themselves. When the time comes that our abilities to sustain the physical being can no longer succeed, we must realize that it is our foremost duty to not inflict further suffering.
According to the American College of Physicians code of ethics (and consistent with the American Medical Association, as well), in the circumstance in which no evidence shows a specific treatment desired by the patient or his or her surrogate will provide any benefit from any perspective, the physician need not provide such treatment. The more common and much more difficult circumstance occurs when the treatment might offer some small prospect of benefit but at a great burden of suffering, yet the patient or family nevertheless desires it.
According to our governing bodies, physicians are not ethically obligated to deliver care that, in their best professional judgment, will not have a reasonable chance of benefiting their patients. Patients should not be given treatments simply because someone demands it. Denial of treatment should be justified by reliance on openly stated ethical principles and acceptable standards of care. It is our duty to understand the intricacy of the treatment we can offer and the risk and benefit of every treatment we give patients. When the risk to the patient greatly outweighs the benefit of a treatment, it would be unethical for us to continue to provide that treatment.
HB 3520 would change law already in place to deal with such situations. We understand all too well that there is no easy, automatic solution. However, the Texas Advance Directives Act works well on this front by providing a dispute resolution process when these disagreements arise between doctors and families of terminally ill patients who cannot make their wishes known. It takes a balanced approach to guide us on the best way to address one of life’s most challenging decisions.
HB 3520 rejects the medical judgment of physicians in favor of allowing surrogate decision-makers to dictate health care ― effectively allowing people to practice medicine without a medical license by dictating to the physician what treatment must be given against the judgment of those who are trained and licensed to practice medicine in the State of Texas.
When a treatment is medically inappropriate and can cause only the burden of pain and suffering, we are ethically obligated to avoid it. If treatment is simply prolonging the dying process, our responsibility must shift toward allowing death to occur naturally with as little pain and as much dignity as possible.
My career has offered me many opportunities to save and improve the quality of life. It has also afforded me the unenviable task of standing at the bedside of a young 23-year-old woman whom I could not save. She had been diagnosed with kidney failure and had not started on dialysis. She suffered a cardiac arrest as a result of her kidney failure, and the prolonged time without adequate oxygen resulted in the failure of all of her organs.
She had no hope of survival. I cannot adequately express how I felt when I had to look her husband, mother, and brothers in the eyes and tell them this news. They did not believe me and did not initially agree with the plan to withdraw what was believed to be futile care by four physicians. The system in place allowed for a collaborative consultative process to be employed. If HB 3520 were to be passed, this family could have forced us to continue futile care indefinitely. Not only would that have prolonged this woman’s suffering but also would have prolonged the family’s suffering, as well.
Let me be perfectly clear: Standing in her room days later and withdrawing the mechanical ventilator support was not easy. Watching her family’s despair as she never took a breath was horrendous. Knowing she’d never get to share in her 3-year-old daughter’s life will remain with the nurses, the respiratory technicians, the chaplain, and me forever. As I stood in that room and watched this family’s grief, my thoughts often drifted to my 3-year-old twins at home.
This is part of what I do, day in and day out. I am speaking to you not only as a professional who deals with end-of-life care all too frequently but also from a personal standpoint. Know that I carry each of these cases with me. Thinking of these cases reminds me of why I am committed to excellence and compassion in all that I do. I ask you today to not pass this bill out of committee ― this bill would not only allow surrogate decision makers with no medical training to dictate the treatment of patients but would also force me to violate my professional ethical standards.
82nd Texas Legislature Testimonies