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Self Determination In Texas? Hah! Don't Mess With Texas' Advance Directive

The Texas Medical Association (TMA) may be caught between a rock -- Gov. Rick Perry and his legislative posse -- and a hard place: its members, regarding advanced directives for pregnant women in Texas.
Self Determination In Texas? Hah! Don't Mess With Texas' Advance Directive
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Docs Say Texas' Pregnancy Clause in Advanced Directive is 'Unjust' and Unethical

The Texas Medical Association (TMA) may be caught between a rock -- Gov. Rick Perry and his legislative posse -- and a hard place: its members, regarding advanced directives for pregnant women in Texas.

"I'm concerned about the position of the TMA," Robert Luedecke, MD, an anesthesiologist in San Antonio, Texas, told MedPage Today after reading a statement made by Robert Tenery, MD, during an interview with MedPage Today on the Marlise Munoz case.

Tenery had said since Munoz had not updated her Advanced Directive upon learning she was pregnant, it was unusable under the circumstances.

Luedecke said he believes that the Texas law is "unjust." He also believes the majority of TMA members would take offense at it.

"The opinion of most Texas physicians would be that patients, their families, and their doctors are the ones that should be making medical decisions. To have a law that interferes, further complicates things, and I don't see that it is of any benefit at all," Luedecke said.

Luedecke suggested that the TMA is in a tight spot with the Texas legislature, and probably selected a physician who would support the law to avoid conflict.

In a press release about the upcoming 2013 Texas legislative session, the then president of the TMA, Michael E. Speer, MD, said, "It's time to put patients before politics."

That didn't keep Gov. Perry from tangling with the TMA. In September, he refused to expand Medicaid coverage to Texas' residents, roughly 25% of which are uninsured, against the wishes of the majority of the TMA's house of delegates. And he also recalled the legislative body to pass abortion restrictions after the infamous Wendy Davis filibuster.

The TMA did not take an official position on abortion at the time; however, the current president, Stephen L. Brotherton, MD, of Fort Worth, Texas, did write a letter to the House State Affairs Committee stating, "This [abortion] bill includes determinations that should be made by the medical community and science, not by the legislature."

And when pressed for comment on the Munoz case, the TMA -- the largest state medical society in the US -- referred MedPage Today to the Texas Catholic Conference and the Texas Hospital Association (THA) spokesperson, Lance Lunsford.

After TMA offered those suggestions, former TMA president, Tenery, contacted MedPage Today explaining that the organization asked him to provide comment, but Brotherton, now denies Tenery was a TMA spokesperson. Brotherton told Luedecke in an email that MedPage Today was "mistaken."

"I could see why the TMA is dodging," Luedecke said.

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