Texas hospitals' experience with the Texas Advance Directives Act

Objective. The Texas Advance Directives Act (TADA) provides legal immunity for physicians who discontinue life-sustaining treatment judged to be medically inappropriate. The process includes review and affirmation of physicians' judgments by an ethics or medical committee. This study was undertaken to determine awareness of and experience with the medical appropriateness review process at Texas Hospital Association (THA) member hospitals from 1999 to 2004. Design: Cross-sectional, descriptive, 20-item written survey instrument. Setting. University cancer center. Subjects: Subjects were 409 hospital members of THA in 2004. Interventions: Mailed surveys. Measurements and Main Results. Participants returned 197 of 409 surveys usable for analysis (48.2%). Eighty-one percent of respondents (n = 159) were aware of all the provisions of the TADA. Thirty percent of respondents (n = 58) stated that their hospitals' TADA policy or procedure had been used to review specific patient cases. However, only 46 hospitals indicated a specific number of cases reviewed. Six of these 46 surveys were judged to be too inconsistent to be usable. The 40 remaining hospitals reviewed a total of 256 cases. For 70% of the 256 reported cases (n = 178), review committees agreed with physicians that the treatments in question were medically inappropriate. Conclusions. A minority of THA hospitals have used their policies or procedures to review specific patient cases. Most cases were resolved before the end of the mandated 10-day waiting period because patients died, patients or representatives agreed to forgo the treatment in question, or patients were transferred. Discontinuation of life-sustaining treatment against patient or patient representative wishes occurred in only a small number of cases.