Response of Dr. Elizabeth Wickham to the comments by Dr. Joe Pojman to her article on SB303

Dear Joe,

Almost everybody is wary of the term euthanasia. It is a word that most Americans find disagreeable. Use of palliative care in its purest form has received approval from Pope Benedict, but the term has been sabotaged by the “third path” euthanasia movement which many people are still unaware of. As I mentioned in my original comment, they are the ones who define palliative medicine today with consequences that the Pope would not approve.

Their overriding goal is to put people into palliative care where well-trained teams of specialists (physicians, nurses, social workers and chaplains) then seek to dissuade the family away from traditional, good medical care that would still benefit the patient. To gain immunity from prosecution they advocate legislation that will normalize over-medication and early withdrawal of life sustaining procedures always thought to be ordinary care. Advance directive forms have long been a major tool.

In more direct response to your comment that “Nowhere in SB 303 is there anything akin to POLST.”


One of the ways the “third path” euthanasia movement is able to avoid scrutiny and tracking is by shifting terminology. In the 1970s it was called the Do Not Resuscitate form. Then the out-of-hospital DNR form. Now the POLST paradigm which is being implemented state by state.

Kaiser Permanente explains that POLST will take the place of the older “out of hospital” DNR form. Charles Sabatino (an authority) writes in the AARP report “Improving Advanced Illness Care: The Evolution of State POLST programs” that the POLST paradigm is an extension of Out-of-hospital do-not-resuscitate (DNR) orders, similar but more comprehensive. The Illinois Health Care Association education message for the nurses is that POLST is Illinois ‘ new IDPH Uniform DNR Advance Directive.

Across the country the DNR is transitioning quickly into the POLST paradigm.

The new TX Futile Care bill currently under consideration (CSSB 303, Section 10) expands the scope of out-of-hospital DNRs. The Committee Substitute adds to existing law that if the person is incompetent now but previously requested that “ all treatment other than comfort treatment be discontinued or withheld” the physician may rely on that directive to be the person’s out-of-hospital DNR and place that in the person’s medical record. The directive for comfort treatment only is one of the hallmarks of the POLST paradigm.

In addition, the new Section 4 in the Committee Substitute, not present in the original bill, leaves wide open the use of the POLST paradigm in future care deliberations by hospital ethics committees. It authorizes the attending physician (who may be one of an assortment of physicians over the course of the patient’s hospital stay) to “consult with a physician who previously treated the patient if the previous physician had a conversation with the patient on end-of-life issues at a time when the patient was competent and capable of communication; and documented the conversation…in the patient’s medical records”. This conversation and documentation is precisely what advocates of the POLST paradigm have been promoting all across our country.

I commend your efforts to oppose POLST in Texas . In the 2006/2007 regular session of the TX legislature Senator Jane Nelson introduced SB 28. (The Committee Substitute is found at http://www.capitol.state.tx.us/tlodocs/80R/billtext/pdf/SB00028E.pdf#navpanes=0.)

Her bill introduced what was called “Transferable physician orders form” and authorized the Texas Health and Human Services Commission to design a form that must include all the specifications of the POLST paradigm. It is my understanding that the bill died in a House committee in 2007.

Fast forward to 2013. It appears that this same Senator Jane Nelson chaired the Senate committee which considered CSSB 303 and sent it to the House on April 19, 2013. Isn’t it reasonable to conclude that you should take extra care in making sure that the language of CSSB 303 does not pave the way for future introduction of the POLST paradigm into Texas?

Bill supporters say CSSB 303 adds more “balance” to the current law, implying that the balance is changed in favor of the family. But this may not be so. The bill introduces a family laison person to “help” the family in the negotiation process with the ethics committee. But the bill stipulates that this person must be familiar with end-of-life procedures in palliative and hospice care, i.e. a palliative care professional!

Unfortunately, CSSB 303 is replete with language such as “excessively burdensome”, “medically ineffective”, “diligent effort”, “cruel and inhumane”, “disproportionately harmful”, “close to inevitable death”, which gives ethics committees that operate from relativist platforms legal cover for the hastening of death.

Joe, some years ago my husband and I had the opportunity to have tea with folks from Texas Alliance for Life at a home on a beautiful lake in Texas . We learned about your good work. At that time we had just experienced in North Carolina how language can be used to repackage death as life. CSSB 303 is not free from similar problems.

The NC bill that would have criminalized physician assisted suicide was in fact, because of its safe harbor exceptions, a bill which would also have legalized euthanasia by its open-ended permission for withholding and withdrawing life sustaining procedures and by permitting administration of pain medications while misusing the principal of double effect.

We learned that some of the major players involved in promoting that NC so-called ban on physician assisted suicide were featured on the cover of Center for Practical Bioethics’ State Initiatives in End-of-Life Care Series, Issue 19, 2003. (See http://www.rwjf.org/content/dam/files/legacy-files/article-files/2/State_Initiatives_EOL19.pdf. )

Formerly known as the Midwest Bioethics Center , the Center for Practical Bioethics received funding from the Robert Wood Johnson Foundation to establish Community-State Partnership coalitions. Community-State Partnership States and State End-of-Life Care Coalitions acted as change agents to bring state-by-state health care reform that was consistent with “third path” euthanasia goals.    (See p. 9 in the link above for a map of the Statewide End-of-Life Initiatives.)

These coalitions have worked to encourage pain management, to require training in palliative care for doctors, nurses, social workers and chaplains, and to promote advance care planning including living wills, do-not-resuscitate orders, and the POLST paradigm.

To quote president and CEO Myra Christopher from the link above: “We’ve created a vibrant national infrastructure that can respond quickly and effectively to important health issues. It’s a well-oiled network that enables us to do more together than we could do alone.”

After passage of the Affordable Care Act, Myra Christopher, Tom Koutsoumpas who was on the board of Partnership for Caring (formerly known as Society for the Right to Die), and Bill Novelli (formerly of AARP), founded a large national coalition called the Coalition to Transform Advanced Care (C-TAC) which had been kept under the wraps until last year.


C-TAC is working with the Center for Medicare and Medicaid at HHS to promote their new innovation programs. They are clearly in the business of reshaping values in health care and deserve our attention as examples of the “third path” euthanasia movement.

For a report on the January, 2013 meeting of C-TAC in Washington, DC  see http://belburyreview.com/wp/c-tac-hosts-dc-conference/. For a list of C-TAC members see http://advancedcarecoalition.org/our-members/ from which they have developed an InterFaith Working group.

Prayers to the Holy Spirit and to St. Joseph,

Elizabeth (Betty) D. Wickham, PhD



About abyssum

I am a retired Roman Catholic Bishop, Bishop Emeritus of Corpus Christi, Texas
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