Life-Sustaining Treatment under Dispute

The Texas Advance Directives Act stipulates the process by which physicians may withhold or withdraw life-sustaining treatment contrary to the wishes of the patient or medical proxy. Hundreds, perhaps thousands of families and clinicians have faced this personal and distressing dispute. Catholic teaching offers a rich tradition for assessing the ethics of life-sustaining treatment and analyzing disputes over its administration, yielding the conclusion that a Catholic defense of the Texas Advance Directives Act is untenable. Two objections rooted in patient harm and physician conscience fail. A solution that fairly respects the patient’s moral right to choose life-sustaining treatment is offered.

Requests for Nonbeneficial Treatment (DRAFT)

The 1990s were termed the “futility decade” because of greater interest in cases where the patient demands treatment that the physician is reluctant to provide. In many ways this was the converse of the “right to die” movement of the 1970s and 1980s, except it did not lead to resolution because of definitional and practical barriers. The concept of nonbeneficial treatment—a more acceptable term—has recently received additional attention in the context of soaring health care costs. Some states have proposed clear and definitive mechanisms for adjudicating such disputes (such as the Texas Advance Directives Act). Each institution should have its own policy that can be modeled after a recent consensus statement on the topic.

Texas Advance Directives Act: Nearly a Model Dispute Resolution Mechanism for Intractable Medical Futility Conflicts

<em>Increasingly, clinicians and commentators have been calling for the establishment of special adjudicatory dispute resolution mechanisms to resolve intractable medical futility disputes. As a leading model to follow, policymakers both around the United States and around the world have been looking to the conflict resolution provisions in the 1999 Texas Advance Directives Act (‘TADA’). In this article, I provide a complete and thorough review of the purpose, history, and operation of TADA. I conclude that TADA is a commendable attempt to balance the competing goals of efficiency and fairness in the resolution of these time-sensitive life-and-death conflicts. But TADA is too lopsided. It is far more efficient than it is fair. TADA should be amended to better comport with fundamental notions of procedural due process.</em>

Futility Clarified

Futility has had a rough time in recent medical ethics literature. From about 1987 to 1996, various writers and groups tried to define futility within the context of medical treatment, but without success. Baruch Brody and Amir Halevy give an excellent summary of the morass in their 1995 article “Is Futility a Futile Concept?” where they argue that none of the then-proposed definitions succeed. While a smattering of other attempted definitions have appeared since then, for the most part writers about futility have found it more profitable to stop trying to define futility and instead move in a different direction, that of figuring out how to resolve disputes where patient families want more treatment which clinicians think is futile. This is, for example, the approach taken by the Texas Advance Directives Act (1999), which was the first futility legislation in North America and is often seen as an appropriate template. The idea embodied in this influential legislation is that our energies should be focused on creating a process which we can use to resolve difficult cases, and which everyone finds legitimate, rather than in trying to find a definition which everyone finds legitimate.