Reform the Texas Advance Directives Act: Support SB 1944

My name is Bishop Michael Olson and I am testifying on behalf of the Texas Catholic Conference of Bishops in support of SB 1944.

The Texas Advance Directives Act dispute resolution process protects patients and physicians by providing a fair and reasonable process to resolve disagreements regarding end of life care decisions. While this law is not often used, it is generally used appropriately and compassionately. Even with its advantages, however, some aspects of the TADA would benefit from more specificity and clarity. For this reason, the Texas Catholic Conference of Bishops and the Catholic Healthcare Association of Texas have sought reform of this act for more than a decade.

The foundational Catholic principle of respecting the inherent dignity of human life from conception to natural death is at the heart of our call for access to ethically responsible healthcare.[1] Pope St. John Paul II emphasized the clear right to life in his encyclical, Evangelium Vitae, in which he affirmed that the sanctity of human life exists in every human being, regardless of age, stage, or disability, and specifically condemns euthanasia as a “grave violation of the law of God.[2]

We maintain at the outset that all human life, no matter how disabled or critically ill, is of inherent dignity and incomparable worth; thus it is no less entitled to adequate health care.  Our position takes a balanced approach to end-of-life care that equally respects the rights of patients in the natural process of dying and the conscience of health care professionals providing their care. While illness and other circumstances can make life very difficult, they cannot diminish the inestimable worth of each human life created by God. Life itself always has quality that can never be lost. Still, we need not cling to this life at all costs, for our ultimate destiny is eternal life with Christ in heaven.

The current statute provides for certain protections for physicians and dignity of patients through a process to address disagreements between families and physicians regarding end-of-life care.  It can often be difficult for a family to accept that their loved one’s death is imminent and inevitable. However, in the reasonable medical judgment of the physician and the hospital ethics committee, continued medical intervention will delay natural death and further the severe suffering of the patient with no real benefit.

There is still inconsistency amongst hospital leaders in the application of this process. Therefore, the law could benefit from improved clarity on (1) the ethics committee’s composition, and (2) the decision–making process to help eliminate ambiguity. While the process is designed to provide an objective ethics committee review of the case, further safeguards are needed to reduce the potential for conflicts of interest or mistaken quality of life decisions.  In addition, reforms are needed to provide more timely and compassionate communication between medical professionals and patient families when disagreements arise. It is time to correct the deficiencies to demand accountability and consistency of process. To accomplish these goals, this bill will

  • Establish criteria for committee composition;
  • Ensure that patients with disabilities are not discriminated against based on their disability;
  • Extend the time for notice to the family of the ethics committee meeting;
  • Require patients or patient’s family to be invited to present in the ethics committee meeting;
  • Extend the dispute resolution process to provide seven calendar days of notice of the committee meeting and to up to fourteen calendar days for transfer after the committee meeting;
  • Correct the Do-Not-Resuscitate (DNR) revocation processes to ensure that surrogates may only revoke a valid DNR if the surrogate authorized the DNR and must follow the patient’s known wishes and values related to DNRs;
  • Require hospitals to report data on 166.046 dispute resolution process; and
  • Clarify the circumstances under which interventions may be withheld or withdrawn, for example, if they are outside the ordinary standard of care.

As uncomfortable as confronting death may be, we must nonetheless prepare ourselves and our loved ones for the inevitability of the end of life. Acceptance of natural death is neither euthanasia nor giving up on life, but is an expression of profound Christian hope in the life that is to come.

[1]USCCB, Ethical and Religious Directives, 6th edition, no. 23

2Evangelium Vitae, no. 65