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Remember how people were afraid that based on the Affordable Care Act, “death panels” would be making life and death decisions for their patients? The fact is that at least in hospitals, these panels have existed since the 1970s, in the form of ethics committees. I must say after researching these committees, I’m even more confused and ambivalent about their roles and decisions.
Listening to talk radio in my car, I learned about this issue and how it became a hot topic in Texas. One of the most publicized cases was the case of David Chris Dunn, 46 years old and a former deputy sheriff for Harris County, Texas. He was transferred to Houston Methodist on October 12, 2015. He had a mass on his pancreas which affected his other organs and was in renal failure. The family was told he would die that night, but he didn’t. Over time the medical team met to discuss Dunn’s condition; he wasn’t improving.
One day, J. Richard Cheney, the chairman of the hospital Bioethics Committee entered the room. Dunn’s mother, Evelyn Kelly, woke up to learn that the committee had decided to remove all of Dunn’s life-support machines. Kelly refused to let them take these steps. The committee met again, approved of the doctor’s decision to end medical care. The only option Evelyn Kelly had was to try to get her son transferred to another hospital. She was not surprised to discover that no one would take him.
Meanwhile, Kelly contacted an organization called Texas Right to Life:
Within a few hours, longtime Houston lawyer and former state representative Joe Nixon was in Dunn’s hospital room shaking hands with Kelly.
‘I really thought he’d be unconscious, a vegetable, the way they usually are,’ Nixon says now. When he saw that Dunn’s eyes were open, Nixon started asking him questions. One of the lawyers pulled out a phone and began to film.
‘Chris? Look at me! Is it okay if I hired some lawyers?’ Kelly said insistently, leaning over the hospital bed and waving her hands. Dunn gave a slight nod.
‘Chris, do you want to stay alive? Do you want me to fight for your life?’ Nixon asked using his full courtroom voice.
Dunn pulled his palms together, as if in prayer, and nodded his head.
Joe Nixon filed for a temporary restraining order to stop the hospital from withdrawing life-sustaining treatment and to give the family more time, and a judge approved it. Chris Dunn died on December 23 before the hospital withdrew care. Evelyn Kelly is suing the hospital on behalf of her son’s estate.
Diana Wray, the writer from the Houston Press, describes the situation this way:
Chris Dunn didn’t have health insurance, and he had never filled out advance directives or even talked to his mother and siblings about what they should do if he ever got really sick.
It wouldn’t have changed anything anyway — not once his doctors decided to convene a hospital ethics committee.
In Texas it doesn’t matter what instructions you’ve previously given or what your relatives say: If you’re in critical condition, you’re dependent on machines to survive and hospital officials decide it’s time to pull the plug, you will die. And it’s completely legal.
After hearing this story, I wanted to know more about ethics committees in hospitals and whether calling them death panels is fair. I came away with more questions than I had answered. The issues of life and death are extremely complex to address. Unfortunately, little seems to have been done to clarify how, when, why and for whom these decisions can or should be made. Here is what I have learned:
- Many hospitals across the country have ethics committees of some sort.
- Membership for these committees varies widely, including but not limited to medical professionals, bioethicists, social workers, nurses, clergy, and hospital board members.
- The size of these committees varies from hospital to hospital.
- Each hospital decides the size of these committees and when they should be called.
- No national or even state rules have been established for decision-making.
- The degree to which costs are or should be a factor in making decisions varies.
The list of uncertainties is endless.
A study from the University of Maryland cited above concluded the following:
The role and legal status of ethics committees in the United States remains amorphous. Committees, for the most part, remain unregulated and disagreements exist in the field as to whether regulation is appropriate. Despite the lack of homogeneity in committee function and operation and the inconsistent quality in committee performance, a number of state legislatures have given HCECs [health care ethics committees] legal authority to make health care decisions for patients lacking health care decision making capacity and/or available surrogates.
While threats of malpractice may lead to improvements in ethics committee performance, in a number of jurisdictions ethics committees have been protected by statute from liability. In addition, suits have been rare and there are no published judicial opinions that have articulated standards for ethics committee process. As a result, committees continue to operate with minimum oversight and without legal standards.
I don’t want to point fingers at any one group, because there are many parties who have contributed to this controversial and difficult ethical conundrum. I don’t have answers since every case is different in multiple ways, but I don’t think we can put off these issues indefinitely. As medicine becomes more sophisticated, lives are prolonged for those who are critically injured or aged, we need to try to address these ethical issues of life and death.
What are your thoughts?