Anti-Abortion Groups Disagree on End-of-Life Legislation

The state’s two leading anti-abortion groups agree on where life begins, but not on a law governing how it may come to an end. 

Texas Right to Life wants doctors and hospitals to continue treating terminal patients as long as they or their families want — or until they can find another medical facility that will. They’re endorsing a “treat to transfer” bill, HB 3520, authored this session by Mineola Republican Rep. Bryan Hughes. The legislation will be considered today by its third committee over three legislative sessions. 

Texas Alliance for Life opposes the bill and wants to preserve the right of medical professionals to end the treatment of a patient who is irreversibly ill and suffering. Under Texas’ Advance Directives Act — a compromise endorsed by doctors and anti-abortion activists when it passed more than a decade ago — Texas doctors and hospital officials who disagree with families on an end-of-life plan can cease treatment after an ethics hearing and a 10-day search for another facility to take the patient.

Their disagreement marks a rare division for the two organizations, which are working side by side to endorse abortion sonogram legislation and cuts to family planning — and, more directly, Planned Parenthood — in the current session.

Elizabeth Graham, director of Texas Right to Life, said she can’t understand why the Alliance for Life would continue to support a system she says sets an arbitrary end date for a person’s life, and forces grieving family members into a frantic search for another hospital or nursing home bed — or worse, into the courtroom — when they should be at their relative’s bedside. She said family members — not people on the hospital’s payroll — should be the ones who make the often painful and very personal decisions to end a relative's life.

“I’m not advised as to why they think doctors in hospitals should be able to pull the plug after 10 days,” Graham said of the Alliance. “We really recognize the injustice of the law.”

Joe Pojman, founder and executive director of Texas Alliance for Life, said his organization believes Texas’ end-of-life laws need reforming, including, as a starting point, extending the 10-day rule to something closer to 21 days. But he said “treat to transfer” — which he said effectively requires physicians to care for patients indefinitely, when there is no cure — doesn’t balance a family’s desires with a health care provider’s professional integrity. In some cases, he said, the family may demand treatment that has an extremely low chance of success and is actually painful or harmful to the patient.     

Doctors “need to be able to practice their ethical discretion,” Pojman said. “Several pro-life doctors have come to me over the years and said, ‘Please don’t let the law require me to do everything the family wants.’”

Hughes, the bill’s author, said he’s glad families making tough end-of-life choices have the counsel of medical professionals. But he said the ultimate question — is this life worth living? — must be made by the patient and the family. His bill is not about overriding the will of patients who have decided they don’t want life-sustaining treatment, he said. It’s about protecting patients and families when they agree they want to continue treatment, but the health care professional has a different opinion.

“It’s not about forcing people to accept treatments they don’t want,” said Hughes, who has carried this bill for a few sessions, and is hopeful that this is the year it will finally get to the House floor. “It’s not about forcing them to prolong their lives.”

But health care professionals say that sometimes care is futile and that continuing care can, in the long run, cause greater pain — and send medical bills soaring. Hospital data show it costs between $60,000 and $80,000 a year to provide life-sustaining treatment for a patient in a vegetative state. Experts say the average person spends 10 to 15 percent of his or her lifetime health care costs in the final year of life — costs generally covered by private or government insurance, or handled by hospitals as charity cases.

“What ‘treat to transfer’ is ultimately saying to medical providers is, ‘You can practice medicine up until the end, but at the end, we don’t want you to practice,’” said Troy Alexander, associate director of legislative affairs with the Texas Medical Association.

And in the overwhelming majority of cases, doctors and hospitals say, families reach resolutions with health care professionals long before an ethics panel must be convened. 

“We have a finite amount of resources for health care in this state and we want to use those in the best way possible,” said Denise Rose, senior director of government relations for the Texas Hospital Association. “When you have emergency rooms that are on diversion, when you’ve got a full ICU, where do you send those patients?”

Pojman acknowledges this is the rare issue on which his group and Texas Right to Life have historically not aligned. On most everything else, from abortion sonogram legislation to budget amendments that aimed to steer funding away from Planned Parenthood, he said, they’re on the same page.

“We’re both part of the pro-life family,” Pojman said. “But members of a family don’t always agree on everything.”