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Governor George W. Bush's Involvement with Texas Futile Care Law


By Elizabeth Graham, Texas Right to Life Director

Congressional efforts to save and protect the life of Terri Shiavo have drawn some attention to President Bush’s support of the Texas Advance Directive law passed during his tenure as Governor. Some claim that Bush has been inconsistent by both supporting the Texas Advance Directive Act in 1999 and now intervening in the Shiavo case; yet his position is very consistent. In Texas in 1999, due to his leadership, the Advance Directive law restricted the practice of euthanasia; beforehand there were no safeguards in place for patients. Some explanation may clear this confusion.

In August of 1996, the Journal of the American Medical Association published an article outlining how hospitals and doctors could follow certain steps to withdraw treatment and unplug machines that provide lifesaving treatment in the spirit of institutional autonomy. Several Houston hospitals were ready to implement this protocol, effectively preparing to euthanize patients whose lives were deemed futile or perhaps whose insurance was spent. These hospitals and other medical institutions wanted license to continue doing so and sought legal permission through passing a bill in the Texas legislature.

At the end of the 1997 legislative session, then-Governor Bush called some prolife leaders in Texas to express his disappointment that no prolife laws were passed due to an anti-life Lieutenant Governor presiding over the State Senate and an anti-life Speaker presiding over the State House. One of the leaders phoned was Dr. Joseph Graham, President of Texas Right to Life. During the conversation, Dr. Graham directed Governor Bush’s attention to a bill on the Governor’s desk (Senate Bill 414) awaiting his signature; the bill would have legalized involuntary euthanasia, that is, allowed for doctors and hospitals to unplug machines and withdraw lifesaving treatment from patients with little notice or discussion with the patient or the family of the patient—the same careless treatment advocated in the JAMA article. At Dr. Graham’s request, Governor Bush vetoed that bill despite tremendous pressure from the medical community and hospital associations.

These medical groups sought an explanation from then-Governor Bush for his veto. To his credit, Governor Bush instructed them to begin negotiating with Texas Right to Life in order to craft a bill upon which all could agree. The 2-year negotiations began with the goal of a bill draft prepared for the 1999 legislative session. Burke Balch, JD, director of the Robert Powell Center for Medical Ethics, which is a branch of National Right to Life, represented Texas Right to Life in these meetings. As the nation’s premiere expert on medical ethics and end of life issues, Burke traveled to Texas over 20 times to participate in this unlikely coalition.

Both Burke and Texas Right to Life were appalled at the blatant, unashamed, and callous disregard for those nearing the end of life or those simply severely injured or brain damaged. The health care providers advocating for involuntary euthanasia were those who also swore on Hippocrates’ name: “I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion.” The reluctance to provide nutrition and hydration to patients was shocking, and yet the prolifers were billed as the extremists simply because we advocated that people should be fed.

We fought tooth and nail for a longer grace period, but 10 days was the best we could achieve. Prior to this law, NO protections or grace periods were in place to protect patients from biased ethics committees in hospitals (often employees of these facilities) who moved forward to withdraw lifesaving treatment and euthanize. The Advance Directive Act mandates that hospitals and doctors provide 10 days notice of their intention to do so. During the 10 day grace period, the health care facilities are to assist patients or their surrogates in finding a facility willing to receive the patient and continue the treatment. Granted these transfers are very difficult to secure, but prior to the law, NO protections or grace period were afforded. The law works both ways also. If a doctor disagrees with the wishes of a patient or the surrogates and wants to continue lifesaving treatment, the 10 days allows time to dialogue and hopefully reach an agreement before any action is taken. In either case, treatment is still administered during the grace period.

Many inquiries have been made to Texas Right to Life about why we would advocate that a person be removed from life-sustaining measures after 10 days. Texas Right to Life does not advocate that a person be denied or removed from treatment; however, the 10 day grace period was a tremendous improvement in the protection of innocent human life. Then-Governor Bush recognized then and now that the sanctity of innocent human life must be restored, and the 1999 Texas Advance Directive law is a result of his commitment to such restoration.

Elizabeth Graham

Director, Texas Right to Life


(Special thanks to Carrie K. Hutchens for contacting Texas Right to Life for clarification on this issue, in light of controversy surrounding Emilio Gonzales, the Texas Futile Care Law and the involvement of then-Governor George W. Bush. Graham sent Hutchens this previously issued statement.)



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