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March 22, 2005

Bush Flip-Flopped on Schiavo-like Cases

By Byron LaMasters

Funny how rally-the-base political opportunism forced Bush back to D.C. to sign a law in contradiction to a Texas law that he signed in 1999:

The federal law President Bush signed to prolong Terri Schiavo's life in Florida appears to conflict with a Texas law he signed as governor, attorneys familiar with the legislation said Monday.

The 1999 Advance Directives Act in Texas allows for a patient's surrogate to make end-of-life decisions and spells out how to proceed if a hospital or other health provider disagrees with a decision to maintain or halt life-sustaining treatment.

If a doctor refuses to honor a decision, the case goes before a medical committee. If the committee agrees with the doctor, the guardian or surrogate has 10 days to agree or seek treatment elsewhere.

Thomas Mayo, an associate law professor at Southern Methodist University who helped draft the Texas law, said that if the Schiavo case had happened in Texas, her husband would have been her surrogate decision-maker. Because both he and her doctors were in agreement, life support would have been discontinued.

Bush signed this law as Governor of Texas in 1999, but now he's against such a law for Terri Shiavo's family. The Bush campaign came up with a word for that in their campaign last year. Flip-flopping.

Posted by Byron LaMasters at March 22, 2005 12:11 PM | TrackBack


Except that Bush was improving an already bad situation when he signed that bill.

In August 1996 the Journal of the American Medical Association published an article describing procedures then in effect in Houston hospitals. Under these procedures, if a doctor wished to deny a patient lifesaving medical treatment and the patient or the patient's surrogate instead steadfastly expressed a desire for life, the doctor would submit the case to the hospital ethics committee. The patient or surrogate would be given 72 hours notice of the committee meeting would be allowed to plead for the patient's life at it. During that short 72 hour period, the patient or surrogate, while preparing to argue for life, could also try to find another health care provider willing to give the lifesaving treatment, food or fluids.

If the ethics committee decided for death, under these procedures there was no appeal. There was no provision that the food, fluids, or lifesaving treatment be provided after the decision while the patient or family tried to find another hospital willing to keep the patient alive.

So under these procedures, the hospitals in Houston were denying life-saving treatment, food and fluids against the wishes of patients and their families, when the hospital ethics committees said their quality of life was too poor. Patients and families were being given only 72 hours after being notified of the proposed denial to find another health care provider.

In 1997 there was an advance directives bill going through the Texas legislature that would have given specific legal sanction to such involuntary denial of life-saving treatment. An effort in the Texas legislature to amend the bill to require treatment pending transfer to a health care provider willing to provide the life-saving treatment had been defeated. When that bill reached Governor George Bush’s desk, he vetoed it, and said he was vetoing it precisely because it authorized hospitals to deny lifesaving medical treatment, food, and fluids against the will of the patients.

But even without that bill, these procedures were still going on. So there was an effort in the next sitting of the legislature, in 1999, to pass protective legislation. Unfortunately, the votes just weren’t there to require lifesaving treatment, food, or fluids be provided by unwilling hospitals. So there were negotiations that resulted in a bill that gave partial protection. That 1999 bill:

first, formalized more protections for in-hospital review
second, gave patients 10 days of treatment while seeking transfer, and
third, authorized court proceedings to extend the 10 days for reasonable additional periods to accomplish transfer.

Now this was not what patient advocates wanted and it wasn’t what Governor Bush wanted. However, it was an important advance over the existing situation of no legal requirement of treatment pending transfer, for any period of time. The votes were not there in the Texas legislature to accomplish a more protective bill. So Governor Bush signed it because it was an improvement over the existing law.

Posted by: Drew at March 22, 2005 12:50 PM

Yeah, if Gov. Bush really wanted, he could have tried that famous persuasion to get a law with more teeth in it. It still doesn't change that fact that he and the Texas Legislature apparently had no problem in allowing hospitals to deny care for financial reasons. Had that 6 month old baby in TX had health insurance, how many want to be that he'd still be alive? But his mother was a poor woman with no insurance and no ability to pay the bills, so her child is dead. This Texas law that Bush signed only have a few days for families to find someone else to take their loved one. But at the bottom of it lies an assumption that if you can't pay, you don't deserve treatment.

Posted by: Jason Cecil at March 22, 2005 02:37 PM

You know...when its time to go, its time to go...you can't hang on forever...

Posted by: hemphead at March 22, 2005 02:57 PM

My favorite HOT reporter Anderson Cooper had a story about this! No offense, but it was more entertaining to watch him report this than you... but then again I'm bias its Anderson.

Posted by: Julian Garza at March 22, 2005 06:20 PM
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