“The problems relating to the TEXAS SENATE BILL 303 are manifestations of the “third path” euthanasia movement which have been financed by private foundations for nearly three decades — i.e. the Robert Wood Johnson Foundation in the mid-80s forward and George Soros in the mid-90s forward to now.
The “third path” is the more subtle wing of the euthanasia movement. The introduction to LifeTree’s timeline at http://www.lifetree.org/timeline helps to compare and contrast the two wings of the euthanasia movement — the radical vs the low profile groups.
Obama’s healthcare reform bill is the culmination of three decades of low profile strategies to legalize euthanasia.
Unfortunately, the fundamental change in End Of Life care began with the seemingly innocent introduction of a new field in medicine called palliative medicine in the mid 80s. The trick was to position palliative medicine as the moral alternative to physician assisted suicide by various pieces of legislation starting in 1997 with Quill v Vacco, etc.
The true definition of palliative care is much more than simple pain and symptom management. It is a process, a philosophy, whereby carefully trained and certified palliative professionals (physicians, nurses, social workers, chaplains, etc) work within the family dynamic with the goal of bringing about a “consensus” decision to switch from curative to comfort care only. Their goal is to move palliative care “upstream” to the time of diagnosis. Hospice is a subset of palliative medicine.
MOST = Medical Orders for Scope of Treatment
POST = Physician Orders for Scope of Treatment
MOLST = Medical Orders for Life Sustaining Treatment
POLST = Physician Orders for Life Sustaining Treatment
TPOPP = Transportable Physician Orders for Patient Preferences
The POLST paradigm (POLST/MOST/POST/MOLST/TPOPP form) is one of their important tools and a means by which they are able to have the futility decisions in Texas which have caused so much publicity actually come from what one could characterize as a quiet, friendly patient- family- oriented process. POLST gives legal cover for hastening death, just as does Texas End-of-Life legislation. (And yes, the proposed revisions to Texas law contained in Senate Bill 303 contains nothing to write home about.)
POLST originated in Oregon in the mid-90s and has spread to the majority of states and some countries. (There are POLST forms in Spanish, Japanese, French etc). For more history, one can google LifeTree’s website (www.lifetree.org) for “POLST.”
We in North Carolina were presented with the POLSTparadigm some 8 years ago after the POLST paradigm had been studied using pilot programs in various parts of the state. By invitation, because LifeTree was considered a “stateholder”, we attended an organizational meeting in March, 2005 sponsored by the NC Medical Society which gave us a better understanding of the true nature of POLST. Immediately, we saw the need to warn about POLST (see our e-newsletters).
Wisconsin and Minnesota Catholic bishops have recently expressed their opposition to POLST, but other Catholic bishops sought to modify the form to make it “acceptable.” Unfortunately, no tweaking of POLST can adequately protect human life.
POLST is a form that contains a series of checked boxes to direct medical treatment in advance of actual health circumstances. The categories include use of antibiotics, intravenous fluids, transportation to the hospital, ventilators, etc.. Upon signatures (neither the patient nor the doctor must sign in some states) POLST immediately becomes doctor’s orders and is easily noticed on bright colored (usually hot pink) paper.
What actually happens is that POLST is filled out by a patient (or a patient’s representative) with the help of a POLST facilitator (NOT THE PATIENT’S PHYSICIAN). Contrary to the reports that POLST is patient-centered, POLST actually removes the doctor-patient relationship and replaces it with a FACILITATOR-patient (or FACILITATOR- patient representative) relationship. In some states, POLST actually trumps a health care power of attorney!
Both the radicals and the low profilers support POLST. Their eventual goal is to require electronically recorded POLST forms for everybody. Many nursing homes now require that POLST forms be filled out as part of the admission process.
Here is a notice of an upcoming FACILITATOR education training session in New Hampshire . http://www.exeterhospital.com/gedownload!/05292013%20POLST%20Trng%20PClary.pdf?item_id=207819082&version_id=207819083.
Does the following sentence not give away their true intentions?
“Without an emphasis on the importance of American College of Physicians’ discussions and qualified facilitators, implementation of the POLST form runs the risk of repeating the failures of past standard Advance Directives efforts that have focused only on form completion.”
So the Texas Senate Bill 303 will become obsolete if the Right-to-Die groups get their way. POLST will be part of every person’s electronic healthcare records filled out with the help of a carefully-trained facilitator.”
Elizabeth (Betty) D. Wickham, PhD
JOE POJMAN WROTE:
“SB 303 is supported by a broad coalition of pro-life organizations and health care providers, including:
Texas Alliance for Life * Texas CAtholic confernece of Roman Catholic Bishops. * Catholic Health Association of Texas * Texas Baptist Christian Life Commission.”
The list of organizations opposed to SB 303 were never invited to meetings about reforms to the current law, nor were the disability rights community, who are most impacted by the law and proposed reforms. Aside from the four companies listed above, the rest of the supporters of SB 303 are hospitals and medical providers with a financial conflict of interest in making decisions about a patient’s death.
The organizations opposed to SB 303 are as follows: Cathie Adams (President, Texas Eagle Forum), Beverly Aplikowski (Chairman, Human Life Alliance),Burke J. Balch, JD (Executive Director, Robert Powell Center for Medical Ethics), Judie Brown (President, American Life League), Julie Grimstad, LPN (Chair, The Pro-life Healthcare Alliance, a committee of Human Life Alliance), David E. Hargroder, MD (Chairman, John Paul II Bioethics Commission), Margaret Hotze (President & Founder, Life Advocates), Elizabeth R. Keeler, MD (Assistant Professor, MD Anderson Cancer Center),Mary Catharine Maxian, MD (Anesthesiologist, Houston,Past Chair of Healthcare Professionals for Life), Ron Panzer, LPN (President, Hospice Patients Alliance), Allen E. Parker, JD (President, The Justice Foundation), Alex Schadenberg, (International Chair, Euthanasia Prevention Coalition), Bobby Schindler (Executive Director, Terri Schiavo Life & Hope Network), Andy Schlafly, JD (General Counsel, Association of American Physicians & Surgeons), Carol Tobias (President, National Right to Life), Dave Welch (Executive Director, US Pastor Council).
JOE POJMAN WROTE:
“I encourage you read the committee substitute, CSSB 303. You will find a very good bill with substantial improvements for families and patients compared to current law.”
In the committee substitute, I find that more power is abrogated to the hospital and less to the family and patient. The four criteria under which treatment may be withdrawn from terminal and irreversible people are quite broad and left to the facility to interpret and apply. The term “medically ineffective” is broad and encourages value judgments on the quality of a person’s life, rather than a medical decision.
JOE POJMAN WROTE:
“For example, CSSB 303 prevents secret DNR orders.”
CSSB 303 only requires notice of a DNAR, not patient consent. If the family happens to learn of the DNAR notice, the family must request in writing a meeting of the ethics committee, clearly a conflict of interest, but the ethics committee is not required to revoke the DNAR. So the patient and family are still subject to secret DNAR orders. The bill does not specify logistics of the notification except that the hospital should try (again subjective) to notify the surrogate (no logistics on the notice) if the patient is incompetent.
JOE POJMAN WROTE:
“SB 303 prevents the denial of food and water, except in extreme circumstances when it would harm or hasten the death of the patient.”
CSSB 303 empowers the ethics committee to deny food and water based on its own subjective judgments. Perhaps this is an error in the bill, but a careful reading of CSSB 303 does allow the committee to withdraw all treatment, including food and water under these criteria: (1) hasten the patient’s death; (2) seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment; (3) result in substantial irremediable physical pain or discomfort not outweighed by the benefit of the provision of the treatment; or (4) be medically ineffective in prolonging the patient’s life.
JOE POJMAN WROTE:
“SB 303 requires 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.'”
While this is an important safeguard, there are no enforcement mechanisms in this provision in CSSB 303. This is a statement of intent in the bill, and not a requirement. CSSB 303 offers a lot more process while removing patient protections.
Correction to Sixth Paragraph: Why is this same standard and logic NOT applied to end-of-life issues? In the beginning-of-life scenario, we defer – rightly – to the woman, esp. when she is erring on the side of life. It is philosophically inconsistent to do otherwise in the end-of-life scenario.
I disagree with Dr. Pojman and agree with this post. This is at the very least a first step toward POLST. Abortion did not happen all at once. It started slowly, first with birth control only for married persons. Then it continued from there. Such is – not will be – but IS the case for end-of-life issues. The pro-life movement needs to be aware of this and not hasten the slide down the slippery slope. This post is a warning about just that.
Indeed, in section 7(a-3) the current bill has this language that sounds very much like palliative treatment, which is the beginning of this slippery slope that Dr. Wickham addresses: “This section does not authorize withholding or withdrawing pain management medication, medical procedures considered necessary to provide comfort care, or any other medical care provided to alleviate a patient’s pain.”
SB 303, specifically Section 7, gives many exceptions for withdrawing life-sustaining treatment (defined as including “artificially administered nutrition and hydration”) even for “nonterminal condition[s]” (which is what Terri Schiavo had) that are based on very subjective standards requiring judgments from the doctor about future events that he cannot possibly know. These subjective judgments are going to be prone to any bias toward prematurely ending a patient’s life that that doctor may have; e.g., “reasonable medical judgment”, “seriously exacerbate”, “result in irremediable physical pain or discomfort not outweighed by the benefit of the treatment”, etc. All of that is highly subjective and can be based, not on what the patient is experiencing, but what the doctor believes he or she is experiencing. The various ways in which this can be interpreted to hasten – unnecessarily – a patient’s death are legion. (As one who spends her days parsing language and interpreting the law, the loopholes here are just too great and too many. I also note that twice there is mention of legal immunity. One must always ask why special treatment is carved out for someone. Indeed, tort reform in Texas, esp. in the area of medical malpractice, has been nothing, if not, quite effective at reducing all lawsuits, including those that are meritorious. This extra layer of protection seems unnecessary and a bit of “overkill.”)
In the final analysis, there is no recourse for the family after the few administrative hurdles are crossed. Fourteen days is only four more than the 10 currently allowed for the family to find an alternative care facility. Why is the pro-life movement so opposed to a longer time – such as until an alternative facility is found?
This law is far from clear, despite what those in the Texas pro-life movement would have us believe. Just *any* revision is not what is called for here, it needs to be REAL revision that REALLY gives families and their loved ones protection.
We often see cases where a doctor has given a serious diagnosis with a dire prognosis to a pregnant woman and has advised her to abort. We in the pro-life movement laud and support that woman who rejects that advice regardless of the outcome of that child’s life. We proudly parade around pictures of that child who lives longer than expected or even a full life. We are quick to point out how often these doctors those diagnoses in utero turn out to have been completely wrong. Why is this same standard and logic applied to end-of-life issues? In the beginning-of-life scenario, we defer – rightly – to the woman, esp. when she is erring on the side of life. It is philosophically inconsistent to do otherwise in the end-of-life scenario.
Ultimately, the family members of, or, if able, the patient himself, ought to be given final say. There can be no true “balance” between family and doctors – as supporters have claimed this bill provides – when there is disagreement between the health care provider and the family. We should err on the side of life.
Finally, I note that the language being used by supporters of this bill is far more like the “death with dignity” crowd than the pro-life movement. It is chilling. We saw this in another context last year where the pro-life movement began using language from the pro-abortion crowd, referring to contraception as healthcare. When you lose control of the language, you are well on your way to losing the battle and even the soul of the movement. When representatives of the Texas Catholic Conference are making statements like: “The Texas Catholic Conference advocates advance directives reform legislation that recognizes the dignity of a natural death. Human intervention that would deliberately cause, hasten, or unnecessarily prolong the patient’s death violates the dignity of the human person.” This is very close to just saying, “We favor death with dignity.” This is a concept we in the pro-life movement have heretofore rejected. I am sorry to see that change.
I respect a lot of what the pro-life movement has accomplished, including you personally, Dr. Pojman, as you and I have had several great chats over the years. I agree with the desire to make substantive positive change to the Futile Care Law, as you know. However, this is simply not it. The way this bill can be interpreted – and it is extremely foreseeable – will allow for less protection, not more, for patients.
Regardless of who has endorsed it, it is a very flawed bill and a missed opportunity (there are/were alternative bills). Appeals to authority notwithstanding (a logical fallacy anyway), it would be wiser to wait for better amendments, that are consistent with the pro-life philosophy, than further muddy the waters. We should not confuse our duties as pro-lifers with being lobbyists for doctors who may or may not be pro-life (remember, abortionists are doctors, too).
Kassi Dee Patrick Marks, JD
Dr. Wickham, I very much disagree with your analysis of SB 303. Nowhere in SB 303 is there anything akin to POLST, as that concept is rejected by Texas Alliance for Life and other supporters of SB 303. Quite the opposite, POLST is not recognized in current Texas law or in SB 303. Raising POLST is a red herring distraction from the actual bill.
SB 303 is supported by a broad coalition of pro-life organizations and health care providers, including:
* Texas Alliance for Life
* Texas CAtholic confernece of Roman Catholic Bishops.
* Catholic Health Association of Texas
* Texas Baptist Christian Life Commission.
I encourage you read the committee substitute, CSSB 303. You will find a very good bill with substantial improvements for families and patients compared to current law.
For example, CSSB 303 prevents secret DNR orders. SB 303 prevents the denial of food and water, except in extreme circumstances when it would harm or hasten the death of the patient. SB 303 requires 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.”
We urge citizens to contact and ask their state elected officials to support SB 303. http://www.texasallianceforlife.org/Issues.aspx?str=ReformTADA.
Joe Pojman, Ph.D.
Texas Alliance for Life