Bill Would Clarify End-of-Life Treatment for Terminally Ill

When a terminally ill patient reaches the end of their life, Dr. Arlo Weltge wants the laws to be clear about dealing with the already difficult situation.

“For the most part, the physician and the patient are on the same page,” said Weltge, who practices emergency medicine in Houston. “But sometimes there’s disagreement on what is best.”

Sen. Robert Deuell, R-Greenville, filed legislation Thursday, SB 303, that provides clarification to Texas’ Advanced Directives Act, which sets out the end-of-life care for patients. Deuell’s bill adds language that specifically addresses patients “for whom life-sustaining treatment would be medically inappropriate and ineffective,” Weltge said. It also sets out a longer timeline for notifications and an appeals process for families or surrogates of terminally ill patients who disagree with the patient or the doctor’s wishes for treatment.

Current law requires a family or surrogate of the ill patient who disagrees with the doctor's recommendations to find a willing medical provider within 10 days. Deuell's bill would allow them 14 days. If the question goes before an ethics committee, current law provides 48 hours of notice before the meeting would be held. Deuell's bill would require one week's notice and would grant the family a patient liaison to guide them through the process. 

“Good intentions in legislation doesn’t mean the words get translated into practice so it does clarify in terms of terminable, irreversible conditions what the process will be,” Weltge said.

Most families will never deal with the end-of-life rules. Of the millions of admitted patients in Texas hospitals, only a “handful” of cases require the invocation of TADA, Weltge said, citing a report by the Texas Hospital Association.

Deuell proposed similar legislation in 2009, and it passed in the Senate but was delayed in the House and never voted on.

Still, some hospitals took the guidelines in his 2009 proposal to heart, integrating the language into their own policies, Deuell said.

A coalition of hospital organizations, religious groups and anti-abortion advocates have endorsed Deuell’s current bill, calling it a “tremendous step forward in empowering families and surrogates [and] protecting physicians and hospitals from having to provide morally unethical treatment,” in a press release on Thursday.

One pro-life group, Texas Right to Life, has supported more stringent legislation in the past. In 2011, state Rep. Bryan Hughes, R-Mineola, proposed a “treat to transfer” measure that would require doctors to continue treating terminal patients as long as they or their families wanted, or until they found another medical provider. But the legislation died in committee. 

A spokeswoman for Texas Right to Life declined to comment on the specific legislation but said the group is working on reforms to the Advance Directives Act.