Point: The Texas Advance Directives Act Effectively and Ethically Resolves Disputes About Medical Futility

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 963-967 ◽  
Author(s):  
Robert L. Fine
2016 ◽  
Vol 16 (1) ◽  
pp. 22 ◽  
Author(s):  
Thaddeus Mason Pope

<em>Increasingly, clinicians and commentators have been calling for the establishment of special adjudicatory dispute resolution mechanisms to resolve intractable medical futility disputes. As a leading model to follow, policymakers both around the United States and around the world have been looking to the conflict resolution provisions in the 1999 Texas Advance Directives Act (‘TADA’). In this article, I provide a complete and thorough review of the purpose, history, and operation of TADA. I conclude that TADA is a commendable attempt to balance the competing goals of efficiency and fairness in the resolution of these time-sensitive life-and-death conflicts. But TADA is too lopsided. It is far more efficient than it is fair. TADA should be amended to better comport with fundamental notions of procedural due process.</em>


Author(s):  
Robert C. Macauley

The 1990s were termed the “futility decade” because of greater interest in cases where the patient demands treatment that the physician is reluctant to provide. In many ways this was the converse of the “right to die” movement of the 1970s and 1980s, except it did not lead to resolution because of definitional and practical barriers. The concept of nonbeneficial treatment—a more acceptable term—has recently received additional attention in the context of soaring health care costs. Some states have proposed clear and definitive mechanisms for adjudicating such disputes (such as the Texas Advance Directives Act). Each institution should have its own policy that can be modeled after a recent consensus statement on the topic.


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