Bishops to again tackle end-of-life issues in legislature

December 23, 2014

HOUSTON — In life, sometimes the most difficult decisions people face involve impending death. Pain and grief can’t always be avoided. Some of it can be mitigated in the end-of-life decisions one makes for themselves and loved ones. But in doing so, one must neither prolong pointless suffering nor hasten death — in accordance with the Catholic faith.

Texas’ advance directives law allows patients to make fundamental decisions about their terminal health care. Most common are so-called “Do Not Resuscitate” (DNR) directives and medical powers of attorney. DNRs tell hospitals or hospices to not attempt to keep a dying patient alive by extraordinary means. Powers of attorney allow patients to designate trusted persons to make medical decisions in their behalf in the event they become incapacitated.

The law has been on the books since 1999. But medical technologies have changed since then. And for better or worse, so has secular society’s dialogue about end-of-life issues. Texas Catholic bishops would like to make the law better — for everyone, not just Catholics. 

The Texas Catholic Conference of Bishops — working through its public policy arm, Austin-based Texas Catholic Conference (TCC) — will once again seek reform legislation when lawmakers convene the 84th Legislature in January.

Those reforms were topics of a one-day conference at the University of St. Thomas on Dec. 9, in discussions that included Daniel Cardinal DiNardo and Bishop George Sheltz of the Archdiocese of Galveston-Houston, Bishop Michael Olson of Fort Worth, Bishop Michael Mulvey of Corpus Christi and Monsignor Frank Rossi of St. Michael Catholic Church in Houston. Other speakers included TCC executive director Jeffery Patterson and associate director Jennifer Carr Allmon. Also, Joe Pojman, executive director of the Austin-based lobby Texas Alliance for Life; Houston physician Dr. Arlo Weltge and Dr. David Zeintek, an Austin cardiologist and ethicist. About 180 clergy, lay ministers, social advocates and interested individuals attended. 

Among the amendments, the bishops want the law changed to:
• Include oral and or intravenous nutrition and hydration as ordinary care in end-of-life situations, unless it would be medically harmful to the patient to do so;

• Clarify the definition of “irreversible condition” to assure that people living with disabilities are protected both from withdrawal of necessary life-sustaining treatment and from being forced to endure burdensome, non-beneficial treatment;

• Provide better and more compassionate communication to the family when there is a disagreement with physicians over treatment, but at the same time,

• Reinforce doctors’ rights and ethical responsibility to not provide medically inappropriate treatments in those rare cases where grieving families might wish to prolong a patient’s life (and suffering). 

“Our fear of death, somewhat natural, our families’ grief, the uncertainties about the appropriateness of certain emerging medical technologies at the end of life — these all become very, very powerful sources for reason and emotion,” Cardinal DiNardo said. “The Catholic Church understand the difficult and emotional complexities that may arise at these moments. For families, the pain and anguish of releasing our loved ones may adversely influence our decisions. This is the point in which the Church’s teaching offers us moral guidance within the same context of safeguarding life while providing help through the process of natural death.

“The Bishops of the Texas Catholic Conference have prayerfully developed our positions on these issues in accordance with the teachings of the faith. We seek to balance certain rights: certain autonomy rights of patients, of families and the rights of physicians.”

During the 83rd Legislature convened in 2013, the state Senate approved a bill (SB 303) which would have accomplished all this. It died in the House Committee on Public Health, despite endorsement from the Texas Medical Association. It met opposition by some patient-rights groups which reportedly objected to the provision that would have preserved doctors’ right to act within the boundaries of professional ethics over the objections of families’ wishes and demands. The Association of American Physicians and Surgeons demonized the bill in claims that it would allow hospital administrators to create “death panels” that could invoke “secret DNRs” on the basis of hospital costs.

“Physicians, along with lawyers, are in the best sense, the first true professionals,” Cardinal DiNardo continued. “What does it mean to give yourself to a professional? It means you give some aspect of their prudence to them. They help you in your prudence and you give some of it over to them.” 
The groups that objected to preserving physicians’ autonomy may have misunderstood the provision as written in SB 303. The TCC will seek a bill that clarifies that language, Patterson told the Herald. He also said the TCC would recommend to lawmakers that the advance-directives amendments be unpacked into multiple bills to smooth passage of at least some of changes. 

Currently, the law also requires extraordinarily rare disagreements between families and doctors to be reviewed by a hospital ethics committee. The bishops would like the law amended to assure that a patient advocate or liaison be appointed to these committees, especially someone familiar with end-of-life issues, hospice options and basic ethical principles. When disagreements occur, the law requires that an ethics committee be convened within 48 hours. The bishops would like to extend the period to seven days, to give families more time to respond — and require hospitals to release medical records at no charge in time for families’ access during ethics committee proceedings. When disagreements persist, current law gives families 10 days to find different facilities for the patient. The bishops would like to extend that period to 14 days.

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