By: Lauren Zakalik
Texas Alliance For Life, a pro-life group, spoke Tuesday in favor of the statute, breaking from Texas Right To Life’s position against it.
“We believe the dispute resolution process in Texas law is both good public policy and is unconstitutional,” said Joe Pojman from Texas Alliance For Life.
By: ANDREW GREENSTEIN
But Joe Pojman, executive director of Texas Alliance for Life, says the appellate court should uphold the law.
“We believe the proper place to improve the dispute resolution process is in the legislature,” says Pojman. “And we don’t think that the court should short-circuit that process by being an activist court.”
Fort Worth, TX — Today the Second Court of Appeals will consider an appeal of a lower court’s decision regarding the medical interventions provided by the doctors and nurses at Cook Children’s Medical Center to a terminally ill baby, Tinslee Lewis. The court was asked to order the interventions to be provided indefinitely against the advice of the medical team and to declare a provision of Texas law that resolves disputes between the family and doctors to be unconstitutional. However, the lower court did neither.
Compelling testimony in the lower court revealed that the interventions prolonging Tinslee Lewis’ death are causing her continual pain and suffering and require her to be sedated and paralyzed.
Texas Alliance for Life and several other pro-life, disability rights, and health care organizations filed an amicus curiae (friend-of-the-court) brief defending the law, and representatives of Texas Alliance for Life will be present in the courtroom.
That brief is here.
“We believe the dispute resolution process in Texas law is both good public policy and is constitutional,” said Joe Pojman, Ph.D., Texas Alliance for Life’s executive director. “The Texas law is among the best in the nation. It balances patients’ rights to make end of life decisions with the rights of physicians to not indefinitely order painful, medically inappropriate interventions to terminally ill patients that only prolong their deaths with no proportional benefit.”
First passed unanimously by the Legislature and signed into law by then-Governor George W. Bush in 1999, the Texas Advance Directives Act has been amended three times, all of which were supported by Texas Alliance for Life: 2003, 2015, and 2017. “We believe the proper place to improve the dispute resolution process is in the Legislature with input from stakeholders and the public. We don’t think the court should short circuit the legislative process through judicial activism,” added Pojman.
While the plaintiffs’ attorneys claim that the Texas law fails to guarantee “due process” protection from the State, we point out that just the opposite is true.
First, the dispute resolution process in Texas law, Sec. 166.046 of the Health & Safety Code, compares very well with other states’ dispute resolutions laws. Twenty-two states provide safe harbor for physicians as does Texas, but Texas provides more due process to protect patients’ end of life decision-making autonomy.
A list of the 22 states is provided here.
Second, a doctor treating a patient according to his or her best medical and ethical judgement is not the State or a state actor. “A doctor following the dispute resolution process in Texas law is no more a state actor than a taxi driver following the laws of the road,” said Pojman.
The case is on expedited appeal, but it is not known when a decision will be handed down.
Joe Pojman with Texas Alliance for Life says Tinslee is terminally ill and doctor’s have done the best they can to save her but keeping her on life support is just hurting her more.
“We think the law is very clear.. Doctor’s should not have to order nurses to perform medical interventions that harm patients even when the family, with all good intentions, thinks that’s the best thing,” said Pojman. “Family are not doctors,” he said.
In the brief, the hospital states, continuing treatment goes against physician’s ethical or moral beliefs.
“The most humane and medically ethical position is to remove those interventions which is causing this baby pain and suffering day by day,” Pojman said. “Continuing to do medical interventions and forcing that baby to stay alive is harming Tinslee,” he said.
By: Cassidy Morrison
Other state anti-abortion groups, such as the Texas Alliance for Life, believe, as do Tinslee’s doctors, that the girl is in constant pain and will never recover. Texas Alliance for Life has avoided intervening on Lewis’s behalf, and Dr. Joe Pojman, the group’s executive director, said the hospital is justified ethically in following Texas law, which says an ethics committee of physicians may remove a patient like Tinslee from life-sustaining machines after 10 days if they conclude that her health will not improve.
“The ethics committee at Cook Children’s Medical Center in Fort Worth, the facility that has wonderfully kept Tinslee alive since birth, agreed with the doctors’ assessment that the best course of action was to discontinue life-sustaining intervention causing her undue harm,” Pojman wrote in the Federalist.
The groups, both dedicated to opposing abortion, euthanasia, and assisted suicide, disagree on the constitutionality of the 10-day rule. The Texas Alliance for Life supports a Jan. 2 court decision allowing Tinslee’s doctors at Cook Children’s to remove Tinslee from life support. While also seeking out other hospitals for Tinslee, Lewis is working with Texas Right to Life to appeal the decision on the grounds that the 10-day rule denies patients due process.
Texas Right to Life argues, despite physicians testifying otherwise, that Tinslee’s condition is not fatal and that the 10-day rule “allows a hospital committee to pull the plug on the child against her mother’s will for any reason.” The group called a press conference with Lewis on Jan. 6 to advocate for Lewis’s right to make health decisions for her daughter.
“Just like any parent, I want the best for my daughter. I definitely respect Tinslee’s physicians’ abilities and their opinions, but I have not had a voice in her current care plan,” Lewis said.
The Texas Alliance for Life, on the other hand, said the rule allows parents and doctors to work together to decide whether keeping a patient on life support is prolonging his or her suffering with no hope of recovery.
“We regret that there is a pretty stark difference between Texas Right to Life regarding the dispute resolution process,” Dr. Joe Pojman told the Washington Examiner. “We believe it’s the best part of the law because it allows doctors and families to decide what the best options are to provide for the terminally ill patient and gives the family time to find an alternative provider.”
By: Joe Pojman
Many people are tuning in to the story of a beautiful baby girl named Tinslee Lewis who has severe heart and lung disease and whose medical team has been fighting for her life since her premature birth at 32 weeks. Doctors say her illness is terminal, and prolonged medical intervention is causing pain and suffering with no hope for improvement.
The ethics committee at Cook Children’s Medical Center in Fort Worth, the facility that has wonderfully kept Tinslee alive since birth, agreed with the doctors’ assessment that the best course of action was to discontinue life-sustaining intervention causing her undue harm. Lewis’s family then sued Cook Children’s in state court seeking two things: First, that the judge order the hospital’s medical team to indefinitely continue the interventions keeping Tinslee alive, and second, that the judge declare the dispute resolution process in Texas law unconstitutional.
The hearing took place before Christmas in December, and staff from Texas Alliance for Life, which I founded, attended. It was a long day of extensive testimony from Tinslee’s mom, one of her five attending physicians, a nurse, and others. In-depth details of Tinslee’s condition were shared.
She is terminally ill, suffering from a severe case of Ebstein’s anomaly, a rare congenital heart condition, chronic lung disease of infancy, and pulmonary hypertension. She requires 24-7, one-on-one nursing care. Changing a diaper, even moving her slightly, can cause her to have a near-death “crash,” which happens daily.
Doctors have performed seven surgeries, three of which were open heart. She has multiple tubes, including a breathing tube. According to the physician who testified, Tinslee is expected to die within five months even with all available interventions. Since the hearing, the hospital released an update stating Tinslee is currently also suffering from severe sepsis, a dangerous response to infection.
The ethical question this case revolves around is: What do we do when there are disagreements between doctors and families in these rare end-of-life scenarios? What is the proper pro-life position? Should doctors follow the wishes of a family even when it means inflicting medical torture on a dying patient?
The Texas legislature unanimously passed and then-Gov. George W. Bush signed into law the Texas Advanced Directives Act 20 years ago to address these cases. It was the culmination of a year of drafting by a workgroup including National Right to Life, Texas Right to Life, Texas Alliance for Life, the Texas Catholic Conference of Bishops, and numerous organizations representing medical providers, all of whom supported it. All continue to support it, except for Texas Right to Life.
The Texas law respects the autonomy of the family to make medical decisions but also does not force doctors to keep patients alive using methods that are harmful to the patient, such as in the case here, with no hope of healing. The law has a dispute resolution process that encourages doctors and patients to talk. If they can’t resolve the issue, the doctor makes a decision.
The hospital ethics committee reviews that decision at a meeting the family can attend. The committee does not decide to keep or remove interventions. Rather, the ethics committee judges whether the interventions in question are “medically appropriate.” We believe it is a good process, among the best end-of-life laws in the country.
The goal of the law is to resolve disputes by transferring the patient. Unlike numerous states that allow doctors to override the family’s wishes after a mere “reasonable attempt” to find another doctor or no attempt at all, the Texas law requires the attending physician and the hospital to attempt to find another provider and continue the medical interventions for at least ten days.
In Tinslee’s case, Cook Children’s has done an extensive job. Over the last four months, they have contacted more than 20 of the nation’s best children’s hospitals, seeking to transfer Tinslee to a doctor willing and capable of performing the interventions her family desires. None has agreed to take over her care.
In the district court, Texas Alliance for Life, along with several other key organizations, including Texans for Life, Texas Catholic Conference of Bishops, Coalition of Texans with Disabilities, and several health-care providers, filed a friend of the court brief in the state court. This brief made two key points: first, the Texas Advanced Directives Act is good public policy, and second, it is constitutional.
After three weeks of deliberation, the district court judge ordered that interventions could be removed after seven days, without commenting on the constitutionality of the law. After hearing the facts of Tinslee’s condition, we don’t see how the judge could have ruled any other way.
Cases like Tinslee’s are not easy for anybody. The physicians have done everything they can do, and no one else is willing to take the case. Further interventions are prolonging her death and causing her further pain and suffering without the hope of improving her condition.
Our view, consistent with the law, is that the intent of withholding the intensive medical interventions is not to cause the patient to die. The goal is never death. The goal of removing the interventions is to prevent the pain and suffering resulting from interventions that lack any proportionate benefit, allowing the patient’s terminal condition to bring about a natural, peaceful death, with as much dignity as possible, which we believe to be the truest pro-life position.