Senator Bob Duell

Sen. Deuell challenges Texas Right to Life over “slanderous” ads | Dallas Morning News

Remember: Senator Bob Duell was instrumental in convincing the medical community to adopt voluntary procedures to protect patients and families affected by the Texas Advance Directive Act, even though actual amendments to the law have been blocked by the very people attacking him.

How much “freedom” does a third party Political Action Committee have in their paid ads? Is it wrong to challenge them legally when the ads are blatantly false?

In this case, the ad opens by implying that Senator Duell is responsible for the too-short 10 day period allowed to find alternate care when the family or patient disagrees with the doctor at the end of life.

Senator Duell was not in the Senate when the Texas Advance Directive Act was passed in 1999. Members of the PAC, Texas Right to Life, were present and lobbied in favor of the Act.

In contrast, Senator Duell has for years been a strong advocate for amendments that would have increased the power of families to protect their loved ones in the case of disputes with the doctor.  The amendments would have changed the waiting period to at least a month before any disputed decisions by the doctor would take effect.

As to the challenge, Senator Duell has excellent support for his case:

The Texas Catholic Conference and Catholic Bishops of Texas, who supported Deuell’s bill, have debunked the claims. They said that Texas Right to Life “has tried to stoke fear through ridiculous claims of non-existent death panels and assertions that doctors are secretly trying to kill patients. Both claims are absurd.” The Catholic Conference also ripped Texas Right to Life for spreading “fabrications” about the position of Catholics on the issue.

via Sen. Deuell challenges Texas Right to Life over “slanderous” ads | Dallas Morning News.

Denouement: The Death of #SB303

The 83rd Legislature of the State of Texas still has a couple of weeks to go, and it ain’t over ’till both the House and Senate are sine die, but it appears that SB 303 did die over the weekend.

Representative Susan King, who broke her leg last Sunday, just the day before the marathon meeting of the House Public Health Committee, has done an incredible job of working with Senator (Dr.) Bob Duell in their attempt to reform our State’s Advance Directive Act through SB 303.

The Committee Substitute which Representative King presented in the Committee had all of the benefits I wrote about last week, as well as a revision to prohibit a doctor from writing a DNR order against the wishes off a competent patient.

(Talk about unintended consequences: current law is silent on “DNRs,” so it’s apparently legal for a doctor to order that resuscitation not be performed on a competent patient without any discussion with the patient, much less obtain consent!  I have sincere doubts that any doctor would do so, but there have been allegations. Even though the ones who claim to have knowledge – and who have not produced one iota of proof – are the same disingenuous cynical scaremongers (I’ll call them “CS2”) I’ve mentioned before, this reform would be a good.   And should be accepted on its face.)

Because of the egregious misrepresentations of the  CS2, Committee Chair Lois Kolkhorst declined to allow SB303 out of the Committee as it was written. Rep. King tried one more time, with a bare bones CS1 containing the protection against DNRs for competent patients and the prohibition against withdrawal of Artificial Hydration and Nutrition, except when it would harm the patient or hasten his death.

So, for the next two years, when you hear the CS2 complain about Texas “death panels” or read a plea for funds to fight “secret DNRs” and withdrawal of food and water in Texas hospitals, remember the CS2 who killed pro-life reform in the 83rd Legislature.

Update on the Texas Advance Directive Act (SB 303)

The Texas Advance Directive Act of 1999 (TADA) describes “Advance Directives to Physicians” (what most people would call a “Living Will”) and contains Section 166.046, an attempt to outline the procedure for resolving a disagreement between a doctor and patients or their surrogates about what is medically appropriate treatment.
The law currently in effect requires the doctor to notify the patient or the surrogate when he or she believes that their request is medically appropriate. If there is still a disagreement, the doctor asks the hospital to convene a meeting of their ethics committee. If the committee agree agrees with the doctor, and no other doctor is willing to take over the care of the patient, the treatment in question can be withheld or withdrawn. TADA doesn’t allow “Physician Assisted Suicide” and certainly doesn’t allow euthanasia, where the patient might be killed on purpose.

The Texas Senate passed Senator Bob Duell’s Senate Bill 303, which significantly improves current law.  SB 303

• Requires the doctor to notify the patient or his surrogate before writing a “Do Not Attempt Resuscitation” order,
• Prohibits the withdrawal of artificially administered hydration and nutrition except in extreme circumstances and
• Gives families 5 days instead of 2 to prepare for the ethics committee meeting and 21 days instead of 10 before the patient must transfer care to another doctor,
• Outlines the duties of the hospital to  treat all patients the same, regardless of age, disability, or ability to pay, to provide a trained liaison to assist the family, and requires timely copies of the medical records.

Because SB 303 still needs to pass in the House, Texas Alliance for Life asked me to help them make a video explaining how it reforms current law.

If you agree that SB 303 is a pro-life reform Bill please call your State Representative at 512-463-4630 and ask him or her to support SB 303.

My “Ethics 101” on the law: “Back to Basics on Texas Advance Directive Act”

Obama Gives $13 Million Grant to Texas Planned Parenthood! @txprolife

We’ve all been hearing about the supposed “War on Women” by Conservative law makers – and, by extension, voters – in Texas. Well, President Obama and Secretary of Health Kathleen Sebellius just fired another shot in the war against Texas and State’s rights.

UPDATE: In an emailed statement, Texas Department of State Health Services spokeswoman Carrie Williams says that the agency just received notice that it will lose the Title X grant and is “reviewing the information to get a sense of the full impact.” The agency hopes the transition is smooth and the provider base remains strong, she wrote.
EARLIER: The federal government has pulled from the state of Texas millions in family planning funding, granting the money instead to a coalition led by the Women’s Health and Family Planning Association of Texas, which says it can serve a greater number of women with the available funds.
For more than four decades, federal Title X funding has been dedicated to funding family planning services and covering clinics’ infrastructure costs. The funds are generally granted to providers (like Planned Parenthood) and/or to state health agencies. In Texas since 1980, the majority of the funding has been administered by the Department of State Health Services — roughly $18 million in 2012, for example; since 2009, DSHS has been the sole grantor of Title X funds.

(Edit, maybe it’s only half of that.)

A Little History

Before this year, Federal tax dollars came back to Texas in two major funds: the Women’s Health Program and Family Planning, or Title X funds. Texas “matched” a certain amount and the Texas Department of Health and Human Services administered the dispersion of the money. Because the money paid for or freed up other funds for staff, marketing, and “infrastructure” or office overhead, PP was helped to keep their abortion clinics running. The overall effect was that State matching tax dollars helped PP to funnel patients, if not dollars, to their abortion clinics.

Texas was forced to make severe Budget cuts across the board in 2011, including Family Planning funds. This led to prioritizing what little money we had:

“State lawmakers cut funding for family planning services by two-thirds in the last legislative session, dropping the two-year family planning budget from $111 million to $37.9 million for the 2012-13 biennium. They also approved a tiered budget system for family planning funds, which gives funding priority to public health clinics, such as federally qualified health centers and comprehensive clinics that provide primary and preventative care over clinics that only provide family planning services.”

Texas Tribune

Back to Basics on Texas Advance Directive Act

Laws relating to ethics debates are generally behind medical advances. This is good because it means that there *are* medical advances.

However, the debates often become emotional and heated, and the individuals who are affected face real dilemmas and emergencies. When law-making is controversial, it’s best to go back to the basics of ethics for guidance: the inalienable rights to “Life, Liberty and the Pursuit of Happiness,” the Declaration of Independence, and Constitution.

 
All laws limit our rights, but good laws strike a balance between seemingly conflicting rights: they are meant to prevent one person from harming another. Most laws prohibit or punish harmful actions, they don’t *compel* a desired action against our will. Nor do they prohibit actions based on thoughts and opinion. In other words, laws prohibit harming or taking from another, but they usually don’t make you protect, nurture or give to another.

 
However,since the right to life trumps the right to liberty and property, there are very rare circumstances when it is appropriate for laws to compel individuals to act for the benefit of another. Parents are required to care for and protect their minor children. Doctors and lawyers must be licensed, obtain certain levels of education, and follow specific, positive actions when they wish to withdraw from a professional relationship with a patient or client. These laws should only go so far as to protect the life and safety of the vulnerable, for a limited time with the goal of allowing safe transfer of the obligation of the person with more power to someone else.

 
On Tuesday, March 19, 2013, the Texas Senate Health and Human Services Committee, under Chair Senator Jane Nelson, heard testimony on two Bills that would change TADA: SB 303 from Senator (Dr.) Bob Duell’s  and SB 675 by Senator Kelly Hancock.

 
The Texas Advance Directive Act of 1999 (TADA), in addition to describing “Advance Directives to Physicians” (a “Living Will),  was an attempt to outline the procedure for resolving the disagreement between a doctor and patients or their surrogates regarding end of life care.

When I first read the Act, I (naively) thought it was malpractice protection for doctors who did not want to withdraw or withhold care, such as the Houston Methodist Hospital doctors who invoked the act when they repaired Dr. Michael Debakey’s aortic aneurysm against his previously stated wishes – http://www.theheart.org/article/762619.do – in 2006.

 
Most of the time, however, TADA is invoked in cases when the attending physician disagrees with a request to actively administer medical treatment that he or she believes is medically inappropriate. The steps laid out in the law involve the doctor’s notification of the patient or the surrogate, rules for assisting with transfer of care to another doctor who believes the treatment request is appropriate, and convening an ethics committee at the hospital. If there is no other willing doctor can be found and the ethics committee agrees with the doctor, the treatment can be withheld or withdrawn. It does not allow patients to be killed by medicines.

 
Unfortunately, the Act has become known as the “Texas Futile Care Law,” and divides even the pro-life community. One side says doctors and hospitals have too much power and are killing people. While I’ve heard horror stories about doctors who have abused or broken the law, I maintain that there is no “Futile Care Law,” only a difference of opinion as to who should decide what is medically appropriate treatment. In the few cases that have come under the Act, patients and their advocates report trouble finding other doctors willing to provide the treatment the first doctor thought was inappropriate. In my opinion, that difficulty is due to physicians’ common education and shared experiences.

Although TADA lays out requirements for hospitals and hospital medical ethics committees, the fact is that it applies to the “attending physician” who could be forced to act against his conscience. Texas law is clear that only doctors may practice medicine by diagnosing and treating patients directly or “ordering” other medical personnel. These treatments are not one-time events and they aren’t without consequences. They are interventions that must be monitored by observation and tests, and adjustments need to be made so that the treatment is effective and not harmful. Medical judgment is how doctors utilize our education, experience, and consciences as we plan and anticipate the effect of each medical intervention.

Senator Duell’s Bill, SB 303, significantly improves TADA. Among other things, the Bill would add protection of the patient’s right to artificially administered hydration and nutrition, increased access to assistance, records, and time before and after the ethics committee meeting, and prohibits so-called “secret DNR’s.”

Senator Hancock’s Bill, SB 675, focuses on the intentions and motives of the doctor, requiring the medical committee to decide whether the disagreement is due to: “(1) the lesser value the physician, facility, or professional places on extending the life of an elderly, disabled, or terminally ill patient compared to the value of extending the life of a patient who is younger, not disabled, or not terminally ill; or “(2) a disagreement between the physician, facility, or professional and the patient, or the person authorized to make a treatment decision for the patient under Section 166.039, over the greater weight the patient or person places on extending the patient ’s life above the risk of disability.”

Our laws normally prohibit actions and only very rarely compel people to act. Under the conditions laid out in SB 303, the doctor can be forced to act against his conscience and best medical judgment, but only for a limited, stated time. SB 303 improves the Texas Advance Directive Act by protecting the patient’s access to artificially administered hydration and nutrition. It also adds time to prepare for the ethics committee meeting and to transfer care a new doctor. It is an attempt to balance the patient’s wishes for medical intervention with the right of conscience of the doctor. In contrast, SB 675 would attempt to legislate intentions or thoughts, with none of the added protections of SB 303.

Edited 4/27/13 to fix the link to the article about Dr. Debakey and 4/30/13 for grammar and formatting – BBN.