As governor, Bush signed right-to-die law

WASHINGTON — The federal law that President Bush signed early yesterday in an effort to prolong Terri Schiavo's life appears to contradict a right-to-die law that he signed as Texas governor, prompting cries of hypocrisy from congressional Democrats and some bioethicists.

In 1999, then-Gov. Bush signed the Advance Directives Act, which lets a patient's surrogate make life-ending decisions on his or her behalf. The measure also allows Texas hospitals to disconnect patients from life-sustaining systems if a physician, in consultation with a hospital bioethics committee, concludes that the patient's condition is hopeless.

Bioethicists familiar with the Texas law said yesterday that if the Schiavo case had occurred in Texas, her husband would be the legal decision-maker and, because he and her doctors agreed that she had no hope of recovery, her feeding tube would be disconnected.

"The Texas law signed in 1999 allowed next of kin to decide what the patient wanted, if competent," said John Robertson, a University of Texas bioethicist.

While Congress and the White House were considering legislation recently in the Schiavo case, the Texas law faced its first high-profile test. With the permission of a judge, a Houston hospital cut off life support for a badly deformed 6-month-old baby last week against his mother's wishes after doctors determined that continuing life support would be futile. The baby died almost immediately.

"The mother down in Texas must be reading the Schiavo case and scratching her head," said Dr. Howard Brody, the director of Michigan State University's Center for Ethics and Humanities in the Life Sciences. "This does appear to be a contradiction."

Bush's apparent shift on right-to-die decisions wasn't lost on Democrats. During heated debate on the Schiavo case, Rep. Debbie Wasserman Schultz, D-Fla., accused Bush of hypocrisy.

"It appears that President Bush felt, as governor, that there was a point which, when doctors felt there was no further hope for the patient, that it is appropriate for an end-of-life decision to be made, even over the objection of family members," she said. "There is an obvious conflict here between the president's feelings on this matter now as compared to when he was governor of Texas."

The White House said yesterday that Bush's position is consistent, and that the Texas bill focused on expanding the rights of the critically ill and their families to prevent hospitals and doctors from denying life-saving treatment.

Bush spokesman Scott McClellan told reporters that Bush vetoed 1997 legislation that would have put into law Texas hospital policies that gave families virtually no protections and as little as 72 hours to find alternative care after a hospital decided to stop treatment.

Under the 1999 law, another White House official said, Bush expanded that time to 10 days and authorized family members to seek extensions in court, but acknowledged that if the challenges fell short, "under the legislation, the hospital still could authorize the end of life."

In Texas, Bush's position also had the backing of the Texas Right-to-Life Association, whose national headquarters, along with other Christian conservatives that make up a key part of the Republican base, has taken up the fight to prolong Schiavo's life as a cause célèbre.

Burke Balch, director of the Powell Center for Medical Ethics at National Right-to-Life in Washington, said he represented the Texas chapter in more than two dozen negotiating sessions over the 1999 bill. He acknowledged that the legislation could allow a hospital to move to end a patient's life over the family's wishes but denied that was inconsistent with Bush's positions now, or his own group's as well.

"Does this mean that we or Governor Bush are hypocrites because we supported that law? The answer is, it was the best we could achieve at the time, better than the existing state of the law. ... But when we have the ability to change the law to be more protective, certainly we would do that," Balch said.