5/27/2013 AUSTIN, TX — The 140-day regular session ended on May 27 without passing SB 303, a bill to help families protect loved ones near the end of life from secret DNR orders and denial of lifesaving care including food and water.
Authored by Sen. Bob Deuell (R-Greenville), the full Senate passed SB 303 on a decisive 24-6 vote. Pro-life Rep. Susan King (R-Abilene) was the House sponsor of SB 303. However, the House Committee on Public Health failed to take a vote on SB 303, and the bill never made it to the House floor. SB 303 would have changed current law to:
- Prevent secret DNAR orders (“Do Not Attempt Resuscitation”),
- Prevent DNAR orders for non-terminally ill competent patents without consent,
- Prevent the denial of food and water, except in extreme circumstances,
- Require doctors and hospitals to treat all patients “equally without regard to permanent physical or mental disabilities, age, gender, religion, ethnic background, or financial or insurance status,” and
- Preserve conscience protections so physicians are not required to provide futile or harmful procedures indefinitely.
SB 303 was strongly supported by a broad coalition of pro-life and provider organizations including Texas Alliance for Life, the Texas Catholic Conference of Bishops, the Texas Baptist Christian Life Commission, and the Coalition of Texans with Disabilities.
A great deal of false and misleading information about SB 303 was spread by several groups, especially by one Houston based group in particular. In response, the Texas Catholic Conference of Bishops issued a strongly-worded letter to set the record straight. Also, Cardinal Daniel DiNardo and all of the Diocesan Catholic Bishops of Texas signed a letter that strongly endorsed SB 303.
The Texas Advance Directives Act (TADA) was unanimously passed in 1999 and signed by then-Gov. George W. Bush. It was supported by pro-life organizations including Texas Alliance for Life, Texas Right to Life, and National Right to Life. The previous law gave almost total discretion to physicians to cut off life-sustaining treatments, even food and water, with almost no accountability.
Compared to the previous law, the TADA is a vast improvement for protecting patient’s right to life. The TADA sets up a dispute resolution process when patient near the end of life or the patient’s family disagrees with a doctor about how much life-sustaining care is appropriate. A physician’s decision to withhold or withdraw life-sustaining treatments had to reviewed by a hospital ethics committee. If the committee disagrees with the physician, treatment has to continue. If the committee agrees with the doctor, the hospital must assist the patient and family find an alternative, willing physician either inside or outside the hospital.
In the years since, the dispute resolution process has been applied very infrequently,for example, only 21 times out of more than 1.3 million hospital admittance since 2011, according to a Texas Hospital Association survey. Nevertheless, several cases have come to light that highlight the need for reform, including possible cases when a “Do Not Attempt Resuscitation” (DNAR) order made without even informing the patient or his/her family. The entire process can take as little as 12 days, and some families report finding another doctor is difficult. Also, under the TADA, patients do not have the right to artificially-administered food and water.
SB 303 by Sen. Bob Deuell (R-Greenville) reforms the TADA to better protect vulnerable patients from involuntary denial of life-sustaining treatments.
This bill also preserves conscience protections so physicians are not required to provide harmful, unethical, and ineffective procedures indefinitely, especially procedures that are excessively burdensome for the patient to endure and may be futile. When there is a disagreement between a doctor and the patient that cannot be resolved SB 303 makes transfers easier and more compassionate to the patient and family.
- SB 303 bans “secret” Do-Not-Attempt-Resuscitation (DNAR) orders.
- It is not clear how often that is going on, but under this bill it would not happen.
- The patient or family must be notified before a DNAR order can be applied, except in extreme circumstances.
- If the physician and surrogate disagree, the disagreement goes through the dispute resolution process, and the DNAR order cannot be applied during that process.
SB 303 requires artificially-administered nutrition and hydration in all cases when the patient or family wants it, except in extreme circumstances.
- SB 303 increases patient protections in the dispute resolution process.
- It substantially narrows the class of patients to whom the dispute resolution process can be applied.
- The totally time for the dispute resolution process goes from 12 days to 28 days.
- A liaison is provided to the family.
- The family can attend the ethics committee hearing.
- Medical records are provided free of charge in a timely manner.
- SB 303 requires annual reporting of ethics committee meetings.
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