title: The Texas Advanced Directive Law: Unfinished Business.
abstract: The Texas Advance Directive Act allows physicians and hospitals to overrule patient or family requests for futile care. Purposefully not defining futility, the law leaves its determination in specific cases to an institutional process. While the law has received several criticisms, it does seem to work constructively in the cases that come to the review process. We introduce a new criticism: While the law has been justified by an appeal to professional values such as avoiding harm to patients, avoiding the provision of unseemly care, and good stewardship of medical resources, it is applied incompletely. It allows physicians and institutional committees to refuse "futile" treatments desired by patients and families while at the same time providing no way of regulating physicians who recommend or even push "futile" treatments in similar cases. In this sense, the TADA is incomplete on its own terms.
authors.affiliation: a Case Western Reserve University.
authors.forename: Michael
authors.initials: M
authors.lastname: Kapottos
authors.forename: Stuart
authors.initials: S
authors.lastname: Youngner
mesh_terms: D016223:Advance Directives / Q000941:ethics / Q000331:legislation & jurisprudence*; D016887:Cardiopulmonary Resuscitation / Q000941:ethics*; D003657:Decision Making / Q000941:ethics*; D028741:Ethics Committees, Clinical; D006801:Humans; D033183:Interdisciplinary Communication; D007883:Legislation, Medical / Q000941:ethics; D018447:Medical Futility / Q000941:ethics / Q000331:legislation & jurisprudence; D010820:Physicians / Q000941:ethics* / Q000331:legislation & jurisprudence; D013781:Texas
keywords: end-of-life issues; ethics committees; futility