FIRST-PERSON: Passive euthanasia in America

ALEXANDRIA, La. (BP)--Does a little-known Texas law allow for the passive euthanasia of critically ill patients? If you ask at least one family residing in the Lone Star State, they would say yes.

The family members of Andrea Clark have been fighting to keep St. Luke’s Episcopal Hospital in Houston from terminating treatment that is sustaining the life of their loved one.

According to a variety of reports, Clark, 54, has been a patient at St. Luke’s since November. She suffered complications following open heart surgery in January that left her dependent upon a respirator for survival. Although Clark’s motor control faculties were damaged, her family says, her cognitive abilities were unaffected.

The family contends that even though a tracheotomy impedes Clark’s ability to speak, she is able to communicate by blinking and mouthing words. They also assert that Clark wants to remain alive.

Regardless of her family’s contention, the St. Luke’s ethics committee recently voted to terminate Clark’s life support.

“Our sister is not in a coma, she's not brain dead,” Lanore Dixon told Houston’s KHOU-TV. “She's sick, but she's been sick before and she's proven doctors wrong lots of times.”

St. Luke’s has declined to comment on Clark’s condition, instead referring to its confidentiality policy regarding patient privacy and saying it is precluded from commenting on the case unless the family provides written consent.

It may come as a shock, but St. Luke’s’ decision to terminate the life support of a critically ill patient, against the wishes of both the patient and the family, is protected by Texas law.

In 1999, Texas lawmakers enacted the Texas Advance Directives Act (TADA), which was designed to guide end-of-life decisions. TADA included both a new advance medical directive –- i.e. living will, and guidelines for resolving disputes over end-of-life decisions, including medical futility disputes.

Medical futility disputes arise when, as in Clark’s case, a doctor believes a patient’s medical condition is hopeless and wants to discontinue life-sustaining treatment over-and-against the patient’s advance medical directive and/or the family’s wishes.

According to TADA, when a dispute over life-sustaining medical treatment arises between a physician and a patient or a patient’s family, the doctor can appeal to the ethics committee of the hospital where the treatment is taking place.

If the ethics committee agrees with the doctor, the hospital can discontinue life support at the end of 10 days.

“If their ethics committee makes a decision, it doesn’t matter what the patient wants,” Dixon told KHOU. “They just say, ‘Well she’s miserable.’ Well, to me that’s a quality of life decision that is up to her and her family. That is not a medical decision.”

TADA does specify that during the 10 days before the plug is pulled, the physician and health care facility must assist the patient and/or family in finding a doctor and/or facility willing to provide the requested treatment.

Finding a facility is not easy. According to Melanie Childers, one of Clark’s sisters, hospitals tend to stick together on the issue of medical futility.

“Houston hospitals have a policy that once the medical treatment of a patient has been deemed ‘medically futile,’ no other hospital in the area will accept transfer of that patient,” Childers wrote in an open letter that has been posted on several weblogs. “This means that the patient, who is usually in a very delicate condition, has to be transported over a long distance in order to receive care.”

If a physician and facility cannot be secured in 10 days, then the patient and family can start making funeral arrangements. Thankfully, in Clark’s case, contacting the undertaker will not occur.

Clark’s life support was scheduled to be terminated on April 30. However, a facility in Chicago, Ill., has agreed to accept her as a patient. Melanie Childers also said that after some rather pointed negotiations, St. Luke’s has agreed to pay for Clark’s transport.

From my perspective, TADA is a draconian law that allows for the passive-euthanasia of critically ill patients. It also opens the door for end-of-life decisions to be determined based on utilitarian concerns rather than a patient’s best interest.

With Clark’s transport to Chicago, TADA now is officially on trial. If she recovers, it will be a scathing indictment on the statute as well as on St. Luke’s decision.

“The welfare of the people is the ultimate law,” observed Cicero. Even by an ancient Roman politician’s standard, the Texas Advance Directives Act is simply bad law.


Boggs is editor of the Baptist Message newspaper in Louisiana.

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