A third party to speak for the terminally ill

Doctors and nurses in cases involving medically futile treatment often clash with a patient’s loved ones over whether to continue that treatment. An extrajudicial process, however, allows both sides to appeal to a committee of physicians, nurses, community representatives and other caregivers, a medical ethicist told an audience at pediatric grand rounds in September.

The Texas Advanced Directives Act of 1999, the first statewide attempt to resolve such disputes, has created “a legal safe harbor,” said Robert L. Fine, M.D., director of the Office of Clinical Ethics at Baylor Health Care System. When a case is deemed futile, it may go before the ethics committee, which does not always agree with the medical team. If the committee agrees with the medical team, treatment may be withdrawn unless an alternative health care provider is found within 10 days.

Most cases are settled within the 10-day process. “In many cases the family is relieved,” said Fine, who helped write the Texas law. “They didn’t let go. It lifted the burden.” Doctors are relieved, too. “Sometimes the highest level of care is to withdraw medically inappropriate treatment.”