Texas Hospital Association to Oppose "Treat until Transfer" Amendment to TADA

The Texas Hospital Association identified nine “key issues” that will comprise its 2011 state legislative agenda.  Among those nine issues is defense of the unilateral treatment refusal provision in section 166.046 of the Advance Directives Act.  Here is the THA’s description of the issue:

While every state has laws regarding advance directives, Texas is one of a few states that have addressed end-of-life care comprehensively, including a structured dispute resolution process. In many other states without the protections in Texas law, a physician can make a unilateral decision to stop treatment of a terminally ill patient. Advance directives allow patients to indicate treatment preferences for a time in the future when they are unable to make their wishes known. Advance directives only apply when a patient is declared terminally or irreversibly ill and unable to participate in decision-making.  

Texas law includes a process based on American Medical Association guidelines to address disagreements between patient surrogate decision-makers and physicians about medical treatment near the end of life. In those rare cases where the family wants to continue life support against medical advice, state law provides a mechanism to transfer the patient or remove life support and protect the patient from indefinite suffering. If transfer cannot be secured, the family has the right to pursue legal action against the hospital and treating physician to prevent the withdrawal of life support.  

For several legislative sessions, attempts have been made to nullify the dispute resolution process by requiring “treatment until transfer,” which in some cases is indefinitely.  A “treat-until-transfer” provision would establish a government-mandated identical outcome for every case, damage the physician-patient relationship, compromise physicians’ moral integrity, increase the risk of frivolous litigation with attendant costs, and create a government mandate superseding a patient’s rights and the physician’s responsibility to the patient.  

Texas hospitals and physicians believe that there are revisions that could make a good law better, but “treat until transfer” is not one of those changes.