In this week’s installments of “Ask an Attorney” we will discuss life support issues. For more detailed answers, you should consult an attorney.
My sister lives in Texas, and her father-in-law is on life support in Dallas. She and her husband want to remove him from life support because his brain shows no function, but the doctor (who is billing Medicare) doesn’t want to remove him. Is it true that in Texas, life support can be legally provided to a patient when the doctor disagrees with the family? — John L., Baton Rouge
Yes. There is a process dealing with that situation outlined in the Texas Advance Directive Act (TADA). Every state has similar laws to deal with this type disagreement about life-sustaining treatment. Texas stands alone, however, by including detailed legal steps to help resolve the issue. This part of Texas law has drawn attention from across the nation because it allows removal, or provision, of life support against the will of the family.
Two legal principles are very important to remember. First, all people have the right to refuse or decline any treatment. It follows that no person can demand — and expect to receive — any treatment they wish. The second principle flows from the first; no provider (nor facility) can be forced to participate in, or provide treatments when it conflicts with personal conscience or professional standards. To a large extent, these principles do not apply in an emergency setting.
When a person afflicted with a terminal and irreversible condition is being treated in an acute health care setting (most often in an intensive care unit), there comes a time when science can no longer offer cure or recovery. The best care available is focused on the hope for comfort and dignity, care which recognizes that death is a natural occurrence of life. When the known wishes of the patient — usually represented by a surrogate — conflict with the treatment opinions of the doctor, open and honest communications usually clarify which goals can be achieved.
When all else fails to bring agreement — and no doctor and facility will accept transfer — the law specifies timetables and meetings of those concerned, guided by an ethics committee. Usually, resolutions are accomplished along the way, but if not, the outcome may be removal of life-sustaining treatment against the will of the family or against the will of the physician (where the family wished to allow a natural death, but the doctor disagreed).
The law does allow petition of a local court to extend the time limits for the purpose of finding another doctor and facility to accept the patient. This is a moot point, however, because by this time all prospects have been contacted. In addition, the Texas Department of Health keeps a public website listing facilities who will accept these patients.