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Texas death panels moving right along

Via Texas Right to Life come these two entries giving the story of a man named Willie who had not only his ventilator support but also his food and fluids withdrawn, despite having insurance and family financial support and against both his own wishes and his family's wishes, and subsequently died.

It is unfortunate that the story is unclear on a few points. Specifically, when it refers to Willie's receiving sedation, what was the purpose of this? (There is a reference to surgery, but it looks like perhaps he never received the surgery.) How long was Willie without food and fluids, and, if it was only for twenty-four hours or less (which seems possible based on the stories), what is the family's evidence that withholding food and fluids significantly hastened Willie's death? He had previously been ventilator dependent (or so I infer) but appears to have been breathing on his own after his vent support was removed. Still, it is entirely possible that he was not able to get enough oxygen that way and died pretty much entirely for that reason.

Texas hospitals' policy of kicking you out after a death panel rules that you should no longer receive life support and after a ten-day wait has been known now for some years. Please, liberal commentators: Do not waste my time blah-blahing about how this was a "Republican policy" and how G.W. Bush signed it. The real story is that previously Texas hospitals were kicking people out with only a day or three's warning, and what got pushed through was a ten-day waiting period to give a chance to try to find a transferring institution. This hasn't worked out well, because apparently the hospitals and hospices are either in cahoots with one another or else share a remarkable unanimity of perspective and hence will almost never actually accept transfers during the ten-day waiting period, but the ten-day wait was an improvement over what had been going on.

Anyway, there have been several high-profile cases in connection with this policy (which at the moment I'm not going to go and look up). One thing they have shared in common is that the patients have all died very, very shortly, if not immediately, after having ventilator support withdrawn. Since ventilator support has a stronger claim to be an "extraordinary means" than the mere provision of food and water, the hospitals thus minimized their bad press by presenting these as truly extreme cases where actual life support (that often abused word) was withdrawn.

I have, however, always suspected that a parallel movement was going on. Namely, that food and fluids were in fact withdrawn and that, if the patient proved able to breathe on his own after all and even lived for days thereafter, he would simply be dehydrated to death. While, if my interpretation of TRTL's releases is accurate, Willie does not seem to have lived for days, the firm withdrawal of food and fluids against family wishes in Willie's case does go to confirm what I've always thought. It's just that until now there hasn't been (as far as I know) a high-profile case like this in the Texas system. And (again, if I'm understanding the story correctly) we're still waiting for one in which the patient lives for a sufficient number of days after withdrawal of food and fluids for it to be undeniable that this was a significant contributing cause of death.

But it looks like the TX hospitals aren't going to be fazed if and when that happens.

Here are some salient features of Willie's case that should give us all pause:

--Willie's family was unanimous about his receiving life-preserving care.
--Willie himself had clearly stated that he wanted to live and didn't want his family to give up on him.
--Willie had insurance, and his family was willing to pay extra costs.
--The hospital insisted, apparently purely for ideological and "futile care" reasons, on withdrawing not only ventilator support but also food and fluids.
--No other TX institution would accept Willie as a transfer patient within the ten-day window of time.

The hospital is said to be located in north Houston, but the family has withheld the name of the hospital (fear of lawsuit?).

I guess not everything is better in Texas. (See this interesting summary document on variations in state laws in this area.)

Comments (19)

How would (could) the family's release of the hospital name create a cause for lawsuit? Does a hospital have some kind of "right to privacy"?

I could see the family hiring an ambulance from New Orleans (or closer, but in LA) to come over, get Willie, and transport him hither.

That was just a guess. Maybe they're just trying to be nice. I don't know. Would a Louisiana hospital have been more likely to have accepted the patient?

One thing I notice is that they seem to have trusted a social worker to find a transferring hospital within the 10-day window and then later decided that their trust was misplaced and that the social worker had essentially been de-advertising the case when "asking" other hospitals if they would take Willie. So they only got in touch with TRTL at the end of the 10-day window.

It would be handy to have social media buttons for each post here at W4.

This wouldn't happen if more people truly believed in God and the afterlife. There wouldn't be the futile struggle to hang on in an artificial (machine-provided) state, but an honest acceptance that time has come and with hope towards eternal life in Heaven.

My experience with hospice in Texas is it's all sweetness and light until you're signed up- or, less imprecisely, signed over to them. Then it's 'we can't hydrate, lawsy mussy no, our hands are simply tied' even as my mother in law is sobbing that she's not read to die yet and while my wife desperately wanders the bureaucratic maze getting her mom out of hospice's clutches before they kill her.

So, uh, and I really hate to say this, but we moved her over to California, and she's still alive and both the university hospital staff and the hospice people in San Diego have been night & day better than what we got from the top-ranked, well-regarded university hospital and 'Catholic' hospital system (that she worked for!!) in Austin. Those murderous quacks.

(So if you turn out to have pancreatic cancer in Texas, either move straight to Houston and live in convenient walking/wheelchair distance to the truly excellent M D Anderson complex, or get the hell out of the Lone Star State.)

{Sorry for ranting/threadjacking.}

There wouldn't be the futile struggle to hang on in an artificial (machine-provided) state, but an honest acceptance that time has come and with hope towards eternal life in Heaven.

I agree. It's time we see pacemakers and dialysis machines for what they are: gateway devices to atheism.

Mike T, I take it you're being facetious.

Harry S., excuse me, but feeding and hydrating patients is not some kind of weird artificial thing. It's basic care. Yes, even if the person is sedated and it has to be done by a Terrible Tube. And actually, that isn't up for debate in this particular thread.

David, I appreciate your insights very much. I've very often wondered whether one could find out ahead of time if a hospice would feed and hydrate. Your story raises the ominous possibility that there might be some difficulty doing that!

Mike T, I take it you're being facetious.

Extremely.

The hospice group that my mother talked with and received information from was not like this at all. They guaranteed, in writing, that they would never recommend removing food/water or overdosing on morphine. When my mom decided not to make use of their services, because Daddy was in a rest home where his needs were met and she trusted the people, one of the women from the hospice group still came several times a week just to visit Daddy and talk with my mother to see how she was doing,

I don't recall if this was a group local to Marble Falls or if it was out of another town that has a fabulous Alzheimer's care facility (it was too far away for Mother to visit every day, so we chose not to place Daddy there). Anyway, I was certainly favorably impressed.

And my daddy died with *genuine* dignity -- the nurses and aides kept him comfortable without doing anything to hasten his death, they placed him in a private room when they knew he couldn't live many more hours, and my mom sat with him all that last day, singing and reading the Scriptures and praying. Both he and she were treated beautifully.

I have, however, always suspected that a parallel movement was going on. Namely, that food and fluids were in fact withdrawn and that, if the patient proved able to breathe on his own after all and even lived for days thereafter, he would simply be dehydrated to death.
Sorry, but this is murder. I really don't believe this is going on in Texas hospitals, no not EVEN in Texas. If you have proof for this, I'd like to see it.

Lydia, I don't mean anything by this, and I really don't mean to disrespect you, but what do you think about government FEMA camps?

Don't threadjack. You liberals. You're amazing. The ultimate ADHD-ers. "Squirrel!!!"

And are you totally ignorant on this issue? Evidently so. People who cannot eat and drink on their own are dehydrated to death all over the country, week after week, year after year. Have you never heard of Terri Schiavo? Those who supported her killing _themselves_ made a big song and dance about the prevalence of cutting off nutrition and hydration until death in this country. So, hey, it's just normal medical practice and what were all the pro-lifers making such a fuss about in this particular case? The _only_ question raised by what you quote from my post is whether it's being done a) specifically in Texas hospitals b) against the wishes of families, and c) under the 10-days-and-you're-out rule.

Threadjack? ONE dissenting post, and I'm threadjacking?

I've noticed you haven't put up any links, let alone neutral ones.

Another question: would there be any evidence that would convince you that there's not large-scale murder going on in American hospitals?

Listen, this is the case:
You believe that American, Texan doctors are willing letting patients die, by not giving them fluids and food.
I do not believe that, for now.

However, what WOULD convince me of your views, is reports from the AMA, Governor Perry, the CDC, or any official, large, neutral and credible organization that this is going on. Preferable with video testimony. Do you have that? And being an independent and all, NOT a liberal, I don't really trust Fox, no.

Um, Jack, they _did_ remove Willie's food and fluids. That's linked in the main post. He just happened to die swiftly.

And I don't quite know what you mean by not providing links. Surely I don't have to _link_ to the debate surrounding the Terri Schiavo case? How about Nancy Cruzan? Or many others. Do your own research. It's not like this is obscure stuff. The removal of nutrition and hydration from unconscious patients or patients otherwise not able to eat and drink on their own is so mainstream that it's a check-off item on living wills!

This is _widely known_. It's just that the fiction is that this is "what the patient would have wished." Usually it's done with the family's consent. In Willie's case, it wasn't. That's what makes the case remarkable. Not its being done at all.

Lydia, what you have is two links to articles by the same person reporting the story with no supporting links or enough details to independently confirm. To simply declare this as settled fact on that alone, as you seem to be doing, is absurd.

What is so remarkable about this case is that it is claimed it was done against the requests of the (I assume) the entire family *and* the insurance company. If that is true, then I would be very concerned as well. And so I would love to see some confirmation.

And just to be clear: this case, as described, is quite different from Terry Shiavo or Nancy Cruzan, where members of the family requested life support to be removed.

...this case, as described, is quite different from Terry Shiavo or Nancy Cruzan, where members of the family requested life support to be removed.

Yes, it's always comforting to know that a murder was carried out a family's request.

Peter X, nobody claims that the insurance company _requested_ something. The claim is that insurance would, in the normal course of events, have _covered_ Willie's continued care.

The Texas hospitals' propensity for moving patients out after a ten-day warning and a "futile care" determination is well-known. This case _seems_ remarkable because it's against the family's wishes, but in actual fact there've been quite a few other cases where this has been done in Texas hospitals against family wishes, so that isn't new. You can look that up yourself, Peter. My impression is that in those cases there was also a payment problem, but the determination is never _explicitly_ made on the basis of payment but rather because of the determination of a "futile care" committee. Given that that is the case, it's only logical that it would be carried out against a patient who has insurance as well. This is allegedly being done because the hospital has determined that anything else would be "inappropriate," not because of an inability to pay.

If you want to disbelieve the story, Peter, go ahead. Have fun. I suggest that you do a little research on the Texas 10-day policy though. This is by no means the first case where "life support" has been cut off against family wishes in Texas hospitals where a transfer can't be obtained. Many others have been even higher profile. It's just the first one of these Texas 10-day cases I've heard of where nutrition and hydration has been made an issue.

I entirely agree with Bill Luse's implication: Dehydrating someone to death doesn't become okay because the family agrees.

But Peter X, your comment is unintentionally helpful to me. You represent the usual liberal mainstream. Commentator Jack, above, apparently thinks I'm making up the entire thing about nutrition and hydration being cut off, even with family support. Either he's just pretending or he's been living in a cave for the past twenty-odd years on this issue. Your comment, Peter X, is the far more common type of comment and makes clear what I was trying to tell Jack: Cutting off nutrition and hydration is _not_ new. It's just usually done with the agreement of some member of one's family or other.

Peter X:

Here is an article not from a particularly right-to-life perspective on the way that the Texas 10-day rule plays out.

http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=642233

It discusses, for example, the Sun Hudson case in which doctors decided that continued ventilator support was "medically inappropriate" and removed it against family wishes.

These are the kind of cases I was discussing in the main post. This is now legal and standard practice in some states (see the document I linked on varying state laws) and has come up in Texas before, and it isn't primarily a matter of ability to pay (at least not openly), nor is it subject to the wishes of the family.

As I said in the main post, the previous cases I've been aware of have all involved death nearly immediately after extubation. Willie lived a little longer, so the issue of food and fluids became a live one in his family's mind.

You yourself evidently know that removing food and fluids until death with the consent of the family, thinking of such things as "treatment" and "life support," is mainstream.

What we now see on the Texas side is that removing "life support" _against_ family wishes on the basis of a determination of "medical inappropriateness" is also becoming mainstream, at least in some locations.

The possibility for these two medico-legal trends to intersect is a completely live one. Indeed, there is no reason why they should not intersect.

To be clear, I meant that there is no legal reason why the two trends--dehydrating to death, and removing medical care against family wishes--should not intersect. Of course there are moral reasons!

so, did you report these people to the police? This seems like neglicence or even murder two, to me.

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