Resolution of Futility by Due Process: Early Experience with the Texas Advance Directives Act

Fine, Robert L.; Mayo, Thomas Wm.

doi:10.7326/0003-4819-138-9-200305060-00011

Cited by 116 publications

(49 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…8 Withdrawal of treatment of infants EB Eason et al discontinuance of support without concurrence of the family, this outcome occurred in less than half of the cases. Third, all cases were brought before the MARC because of documented concern that the treatments were not only ineffective but also were causing harm to the patient.…”

Section: Discussionmentioning

confidence: 99%

“…TADA chose the syntax of 'medically inappropriate,' rather than 'futile', supporting the stance that these issues are fundamentally medical decisions, and should be made by medical professionals. [8][9][10] TADA created a unique process for physicians, hospitals, patients and their surrogates to resolve conflict. The statutory process has been summarized elsewhere, and is presented in Table 1.…”

Section: Discussionmentioning

confidence: 99%

“…If the 10-day period ends without transfer of the patient, the physician may discontinue the inappropriate treatment with immunity from civil or criminal prosecution. [8][9][10] In response to TADA, Memorial Hermann Hospital developed policies to provide families with additional support, beyond that required by statute (Tables 1 and 3). First, before the case can go before the MARC, the responsible physician must document in the chart careful discussions with the patient or surrogate regarding the nature of the patient's ailment, the options for treatment, the prognosis and the reasons why the physician considers the …”

Section: Discussionmentioning

confidence: 99%

“…Modern advances in patient care have created more opportunities for such disputes, but there is no uniform agreement how best to resolve these conflicts. [1][2][3][4][5][6][7][8][9] The State of Texas addressed issues of medical futility through the Texas Advance Directives Act (TADA), which is unique in state law. TADA took effect in 1999, after being signed into law by then Governor George W Bush.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, TADA addressed 'medically inappropriate treatment', allowing medical professionals to discontinue inappropriate life sustaining treatments, even when the patient or patient's surrogate decision maker requests otherwise. 8,9 TADA requires the physician to follow a defined protocol that formally involves the family or other surrogate decision maker at multiple steps (Table 1).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Withdrawal of life sustaining treatment in children in the first year of life

Eason

Castriotta

Gremillion³

et al. 2008

J Perinatol

View full text Add to dashboard Cite

Objective: Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe the characteristics of these patients and the role of the MARC in this process.Study Design: A single reviewer retrospectively reviewed the cases for patient diagnoses, demographics, related ethical issues and the actions of the MARC.Result: Each of the six patients required life-sustaining therapy, and each patient had a Do Not Resuscitate order on the chart. The MARC determined that it would be appropriate to withdraw life-sustaining support in four of the cases and to continue support in two of the cases. Five of the patients died in the hospital before discharge: two after discontinuation of support, one during the 10-day waiting period, and two died on full support after the Committee determined that continued treatment was medically appropriate. One patient was transferred to another hospital during the 10-day waiting period.Conclusion: These cases document the application of the TADA/MARC process in infants, even in circumstances where care was withdrawn without concurrence of the family. We found the MARC process to demand a very high degree of certainty of diagnosis and prognosis to determine continuation of care to be inappropriate. We conclude that the MARC promoted communication and provided additional protections to patients, families, physicians and staff.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Withdrawal of life sustaining treatment in children in the first year of life

Eason

Castriotta

Gremillion³

et al. 2008

J Perinatol

View full text Add to dashboard Cite

show abstract

The Courts, Futility, and the Ends of Medicine

White¹,

Pope²

2012

JAMA

View full text Add to dashboard Cite

On august 13, 2010, the appellate division of the Superior Court of New Jersey declined to rule in the matter of Betancourt v Trinitas Hospital, 1 a case that raised questions about the limits of medicine in patients with advanced illness. In declining to rule, the judges wrote that resolving such issues in "the context of overheated rhetoric in the battlefield of active litigation" would not positively contribute to the policy debate around medical futility. These comments raise important questions about whether there is a role for the courts in helping to shape the boundaries of medical practice near the end of life.One view is that courts should not provide guidance on medical futility disputes. Texas has formalized this belief into law. The Texas Advance Directives Act bars substantive judicial review when intractable conflict arises between clinicians and patients or their surrogate decision makers. It gives physicians and hospital committees authority to unilaterally withdraw life-sustaining treatment when they believe attempts to extend a patient's life are inappropriate. 2 The state medical associations in California, Washington, and Wisconsin have considered resolutions supporting similar legislation. Another view is that the possibility of appeal to the courts should be preserved because courts have an important role in ensuring fair deliberations between parties (eg, families and physicians) of unequal power. 3 Both perspectives neglect a complexity: although judicial intervention is undesirable for the vast majority of decisions in medicine, preserving the possibility of appeal to the courts in medical futility cases may have beneficial effects at the societal level that are distinct from the benefits sought in individual cases. This viewpoint presents a justification for a limited judicial role in intractable futility disputes and delineates 3 potential benefits of preserving this option. Justification for a Limited Judicial RoleThe point of controversy in most futility cases-including Betancourt-is not whether it is possible to extend the patient's life but whether the life should be extended. Such disputes involve "moral conflicts concerning our most deeply held beliefs about the value of life," 4 about which there inevitably are diverse and incommensurable views within a pluralistic

show abstract

Unilateral Termination of Life-Sustaining Treatment in Neonatal Care: A Legal Overview

Rohde

2008

AMA Journal of Ethics

View full text Add to dashboard Cite

Resolution of Futility by Due Process: Early Experience with the Texas Advance Directives Act

Cited by 116 publications

References 11 publications

Withdrawal of life sustaining treatment in children in the first year of life

Withdrawal of life sustaining treatment in children in the first year of life

The Courts, Futility, and the Ends of Medicine

Unilateral Termination of Life-Sustaining Treatment in Neonatal Care: A Legal Overview

Contact Info

Product

Resources

About