Mediaal futility: the advanced texas directives act
...w the case. 2. The family will be notified no less than 48 hours before the meeting and attendance is encouraged. A written summary of the proceedings will be provided. 3. If, after the review, the committee determines that ongoing treatment is futile the family may oppose the decision. The medical center staff will assist the family in finding a physician and facility to provide treatment. 4. The patient will continue to be given treatment until transfer to another institution or until 10 days has passed from the written ruling of the committee that treatment other than comfort care is inappropriate. 5. If within the 10 days, a provider cannot be found, the medical center may cease all treatment other than comfort (Fine). The Texas Advanced Directives Act proposes the use of community. A wide collaboration involving an array of institutions to allow both considerations of diverse values, as well as fairness. Halevy states, “We need a defensible ethical basis for futility policies. There is balance between the respect for patient autonomy and the respect for the institutional and professional integrity which must be achieved” (574). With the Texas Advanced Directives Act, all of this can be achieved. It has been proven that poor communications between the patients and physicians hinders appropriate decision-making. The Texas Advanced Directives Act has served as a communication venue between the families and medical staff. It has aided in the conclusions many families have drawn when discussing a terminally ill loved one. By implementing this policy, families can now express their views to the Hospital Ethics Committee (HEC) and know that their loved one is being treated fairly. This helps to relieve the guilt felt by discontinuing care and no family thus far has taken any of their cases to the courts. An example of this positive outcome was seen in an incident involving an eighty year old woman suffering from cardiac arrest and severe anoxia. All brain function except stem activity had ceased, and her multi organ system had failed. The patient’s niece insisted upon a life support measure including dialysis. The medical staff disagreed and the Hospital Ethics Committee concluded dialysis and ventilation were both medically futile. Several other relatives agreed with the decision, for they did not want to see this woman endure the rest of her life in this vegetative state. Life support was then discontinued one day later. These family members thanked the staff of the intensive care unit for the care and concern for their aunt’s comfort and welfare (Heitman & Gremillion). From the above case, it appears that the policy has opened the lines of communication dealing with end of life issues. The family involved first protested the physician’s decision, yet they felt empowered by the ability to plead the case to a governing committee (in this case the Hospital Ethics Committee). The empowerment led the family to the conclusion that everything possible was done and that the right decision to withdraw treatment was made. The American population has witnessed an eightfold increase in the number of individuals over the age of 65 in the last century. According to The American Medical Association, “the elderly are the heaviest users of health care and services, and represent one third of the nation’s total health care expenditures.” Life extending health care is not unlimited, so therefore we as a country need to ration the amount of money we spend on health care. Sadly, over 27% of health care expenditures are spent during the last year of life on hospital care that is futile or of marginal utility (Tomlinson 29). This higher spending does not produce reduced mortality rates or improved quality of life, so there is no need to continue it. If the Texas Advanced Directives Act were to be legalized in all states the nation could stop spending money on foolish tactics which will not improve anyone’s life. Actions such as ventilation and dialysis may keep a person alive in a persistent vegetative state, but to the unconscious patient this is not a benefit. America has formed a habit of confusing the terms “effective” and “beneficial.” We need to realize that although some health care is giving a person “life” technically, they are not benefiting from this. The most important aspect of life is quality not quantity. For years hospitals have felt obligated to extend a life by spending billions of dollars to preserve a permanently unconscious being. The Texas Advanced Directives Act makes it clear that it is acceptable to end treatment of a patient that is medically futile. 67 billion dollars should fund things which would benefit the living, not the unconscious. This large amount of funding could be given to programs such as education and environment, places where you will see a direct positive outcome. It has been both professional practice and personal experience which convinces me that the need for medical futility legislation does exist. Too often patients needlessly suffer and linger during their last days, placing an emotional burden on both families and medical staff. Medical futility can be easily implemented if it were simply brought to people’s attention through legislation, education, and open discussion. The issue of medical futility needs to be addressed on a nationwide level and the policy of the Texas Advanced Directives Act should be executed by all states in order to achieve a more positive outcome concerning the end of life care for all Americans. Educators should initiate curricula changes to ensure that health professionals on all levels are equipped with the necessary skills to care for a dying patient. This could be achieved on either an institutional level or be mandated by program accreditation agencies. Textbooks, as well as continuing education would also need modifying in order to meet the requirements for effective end o...