Defend Patient Decisions at the End of Life

Perhaps no decision we make is more personal, difficult, or profound as choosing how we wish to spend our final days, and it’s one physicians encourage patients to make long before the need arises.

Texas physicians abide by the principle, “First, do no harm.” For this reason, TMA supports the Texas Advance Directives Act as signed into law by then-Gov. George W. Bush. Its aim is to allow patients to make their care preferences known before they need care, and to protect patients from unnecessary discomfort, pain, and suffering due to excessive medical intervention in the dying process.

TMA strongly opposes any bill to legalize physician-assisted suicide or euthanasia, as these practices are fundamentally inconsistent with the physician’s role as healer.

Conversely, in previous legislative sessions, there have been drastic proposals that, if passed, would have set a dangerous precedent for the legislature to mandate physician services and treatments that could be medically inappropriate. Because medicine is an art and no human can dictate the final stages of disease, physicians need clear pathways to resolve conflict with the surrogates of our sickest patients, especially in their final days when additional care may be medically inappropriate and/or conflict with a physician’s morals and ethics.

Yet legislation proposed in 2019 would have required hospitals, physicians, nurses, and other health care professionals to provide medically inappropriate care for an unlimited time to terminally ill patients.

It also would have required a hospital – even after its ethics or medical committee under the dispute resolution process determines further treatment would be medically inappropriate – to continue providing unlimited medical interventions until the patient is transferred to another facility. Mandating care in perpetuity would prolong the dying process and potentially exacerbate suffering for patients and loved ones. A physician should not be required to use his or her skills and technologies in a medically inappropriate manner.

In 2017, legislation was passed that allows patient surrogates to override a patient’s expressed wishes on a do-not-resuscitate (DNR) order. Physicians often are the person to whom patients disclose their wishes when faced with death. Patient wishes should be honored over those of family and friends.

A medical power of attorney (MPOA) is a useful statutory tool for patients to identify a single decisionmaker for their care when the patient is no longer able to make decisions. Stakeholders such as probate attorneys have sought to change the Texas medical power of attorney form and to muddle this ability by allowing multiple agents to be listed with simultaneous equal authority, removing the effectiveness of having a single surrogate decisionmaker and further complicating an already legally complex process. Medicine has provided pathways to simplify the MPOA but preserve the intent of a single decisionmaker.

Requiring care in perpetuity prolongs the dying process, exacerbates suffering for both patients and loved ones, and violates the physician’s ethical principal of “First Do No Harm.”

TMA’s Legislative Recommendations 

  • Ensure physicians are not forced by law to violate the ethical principle of “First Do No Harm” or have their moral and ethical conscience usurped in end-of-life care.
  • Amend the Chapter 166 revocation provision of current law regarding do-not-resuscitate orders to ensure patient wishes regarding DNRs are honored over surrogate wishes.
  • For medical powers of attorney, ensure dual agents are not enabled to complicate an already difficult process.
  • Oppose changes that escalate conflict and legal jeopardy in end-of-life care.
  • Oppose attempts to legalize physician-assisted suicide or euthanasia.

Download a PDF of TMA's legislative brief on Respecting Patient Wishes at End of Life.

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Last Updated On

February 11, 2021

Originally Published On

February 11, 2021