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Life preserver


A controversial new state law seeks to prevent health care providers from denying care to the elderly, disabled or dying.

Brendan Hoover August 14th, 2013

Is terminal illness to be treated aggressively, no matter the risk or chance of success? Should someone confronting the end of his or her life opt instead for comfort, seeking the quality of life that palliative care or hospice might offer?

Annette Prince
Credit: Mark Hancock

Physicians and patients have long agonized over such issues.

“The patient has the right to make decisions about their body and about their health care,” said Dr. Phillip Rettig, pediatrics professor at the University of Oklahoma College of Medicine and co-chair of the OU Health Sciences Center Ethics Committee. “But it has to be done within the framework of what is appropriate medical care.”

A new state law set to take effect Nov. 1 has sparked debate between pro-life activists and health care providers.

Under the Nondiscrimination in Treatment Act, patients who are elderly, disabled or terminally ill cannot be denied a “life-preserving” treatment if they or their health care proxies desire it.

House Bill 1403 states that treatment of a patient cannot be denied on the basis that extending the life of a patient in question is of “lower value” than extending the life of a patient who is not elderly, disabled or terminally ill. Moreover, treatment cannot be denied on the basis of disagreement with how patients or their proxies value the tradeoff between an extended life and risk of disability.

Idaho last year passed a similar law, banning physician-assisted suicide and prohibiting denial of care to the elderly, disabled or terminally ill.


Alarming trend
State Rep. Dennis Johnson, R-Duncan, who sponsored HB 1403, said the measure addresses a civil rights issue. He said the law, which Gov. Mary Fallin signed in April, spotlights a growing problem nationwide in which doctors are going against the wishes of their patients.

“We don’t want to see that trend grow in Oklahoma, so we are trying to get ahead of the problem,” he said.

Johnson cited an Oklahoma case in which an elderly woman went to court to keep her ailing husband on a ventilator.

Such rationing of care to terminally ill patients is tantamount to involuntary euthanasia, according to Tony Lauinger, who was one of HB 1403’s chief proponents and is chairman of Oklahomans for Life.

“There is a philosophy out there that the goal of our society ought to be to make death more efficient,” he said. “We believe the individual patient’s right to live is more important.”

State Rep. Dennis Johnson

 

Discourages dialogue
Not everyone is so taken with the law. Oklahoma ranks near the bottom nationally in palliative care treatment, and HB 1403 is written vaguely, in terms that will discourage end-of-life dialogue between physicians and patients, according to Annette Prince, director of the Oklahoma Palliative Care Resource Center.

“My fear is that physicians will be even more reluctant to be honest when curative treatment is futile,” she said.

Prince said research has shown that terminally ill patients who choose to forgo aggressive treatment in order to enjoy more comfort through palliative care may actually live longer.

“Needless suffering should be outlawed by our state leaders if they are intent on practicing medicine without a license,” she said.

The law may make physicians think twice about forcefully stating what care is most appropriate for an individual patient, said Rettig, who has cared for hundreds of patients facing end-of-life issues during his 30 years in medicine.

“Each patient is unique, and I think doctors will stop treating each patient and their situation and values uniquely,” he said. “I think it’s going to put a damper on appropriate medical care.”


Legal issues
Rettig contends the law is based on a false premise that patients are denied care in a discriminatory fashion, but Lauinger believes opponents are misunderstanding its language.

HB 1403, said Lauinger, does not require futile care.

“If a surgery is going to result in the death of the patient,” he said, “then obviously that surgery is not required under this bill.”

People on both sides of the argument invoke the case of Terri Shiavo, the Florida woman who remained in a persistent vegetative state for 15 years while family members battled in court over whether to prolong her life. She died in 2005 after a judge ordered that her feeding tube be disconnected.

“We’re concerned we could see multiple Terri Shiavo cases in Oklahoma if people use the recourse of going to court whenever they think a doctor is denying something that could be done when the doctor feels it shouldn’t be done,” Rettig said.

Shiavo’s husband insisted on her feeding tube being removed not because she was dying but because she was not dying, Lauinger said.

Tony Lauinger

Rettig and Prince will discuss legal and ethical challenges to quality health care during the seventh annual Palliative Care and Bioethics Conference in Oklahoma City on Oct. 24.

Hosted by the Oklahoma Palliative Care Resource Center, it will be at the Samis Education Center Auditorium of The Children’s Hospital at OU Medical Center, 1200 Children’s Ave.

The conference is free and open to the public, but registration is required. To do so, email ok-palliative@ouhsc.edu.


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