A Texas bill has been proposed that would allow doctors the right to impose Do Not Resuscitate (DNR) orders on patients, in some cases, regardless of the expressed wishes of the patient or his/her surrogates, thus possibly resulting in involuntary death.
Senate Bill 303 is proposed by Texas State Senator Bob Deuell, vice chair of the Texas Senate Committee on Health and Human Services. "This is about getting a better process in place and having more safeguards so everybody is able to make informed decisions. At the same time, we have to address the fact that there are situations where treatment to transfer is just not viable," Deuell said.
Senator Deuell's legislative director, Scot Kibbe, says the goal of these reforms is to get everyone to the table. In the past, legislature for this delicate issue has been difficult "and one in which every side needs to have its views respected," Kibbe added. "We are hoping this time that happens."
The National Right to Life Committee (NRLC) is calling for a defeat of the bill. Founded in 1968, NRLC is a federation of 50 state right-to-life affiliates and over 3,000 local chapters. It claims to be the nation's oldest and largest grassroots pro-life organization. It works through legislation and education in an effort to protect innocent human life from abortion, infanticide, assisted suicide and euthanasia.
Burke Balch, director of National Right to Life's Powell Center for Medical Ethics stated, "Texas S.B. 303 violates the most fundamental tenet of patient autonomy by allowing doctors to strip patients (or their surrogates), of the right to dictate their wishes with regard to CPR. It gives doctors the unilateral authority to deny CPR, thus imposing involuntary death on patients, with little recourse for patients or their surrogates to seek relief from an imposed DNR order."
The bill provides that the most a patient or surrogate who wants the DNR removed can do is pay for "a second opinion at the patient's or surrogate's expense and after the opinion has been obtained an appeal to the health care facility's ethics committee can be made," Balch said.
"If the patient should go into cardiopulmonary arrest in the meantime, the patient will suffer involuntary death without resuscitation," Balch added. "In some circumstances, the patient would be denied even the opportunity for a second medical opinion or resort to the facility committee."
Balch went on to say, "The bill also states that they are 'not civilly or criminally liable or subject to review or disciplinary action' and that the section does not create a cause of action or liability against a physician, health professional acting under the direction of a physician, or health care facility."
Under Section 4 of the bill, a member of clergy can make a decision to withhold or withdraw life-sustaining treatment if the patient does not have a legal guardian or an agent under a medical power of attorney. The bill does not specify whether or not the member of clergy has to know specifics about the patient's medical conditions or wishes.
Arlo Weltge, an emergency medicine physician in Houston and a member of the Texas Medical Association's end-of-life workgroup, is in favor of the bill passing. "Different circumstances bring different levels of complexity to end-of-life care decisions, but one thing stays the same, as physicians, our job is to act in the best interest of the patient, but with the ethical responsibility of not doing any intentional harm."
That responsibility does not end just because a patient is nearing his or her final days. "We need a law that is nuanced enough to recognize that there are very different contexts in which these decisions are made," Weltge said. "As filed, this bill would maintain protection of physicians against forcing them to violate their own religious beliefs, moral conscience, and professional ethics."