Tinslee came into the world in February of 2019 a prematurely born baby suffering from Ebstein’s anomaly, a rare and often terminal heart disease that has required constant intensive care at Cook Children’s Medical Center in Fort Worth.
After an unsuccessful surgery, doctors at the hospital decided to unhook Tinslee’s ventilator under the 10-Day Rule of the Texas Advance Directives Act, a law that allows doctors to refuse care without liability after invoking a review before their hospital’s ethics committee.
An eleventh-hour temporary court order kept Tinslee on life support for a time before a district court judge initially ruled in favor of the hospital. The Lewis family appealed and found favor at a higher Texas appeals court in July of 2020, which reversed the first decision and ruled that Tinslee could remain on life support. This decision withstood appeals to the Texas Supreme Court and, as of yesterday, to the U.S. Supreme Court as well.
America’s highest court denied the hospital’s request for a writ of certiorari, allowing the lower court’s opinion in favor of Lewis to stand.
The conflict rests on the question of whether the law sees the doctors that decide to pull the plug as state actors instead of private actors. In their petition to the U.S. Supreme Court for a writ of certiorari, the hospital called the Texas Advance Directives Act a necessary protection for the conscience of doctors.
“Under the Act, the Legislature created a safe harbor for doctors and hospitals facing the most difficult, sensitive situations in patient care — those where patients demand a course of treatment (often in end-of-life settings) contrary to the doctors’ moral, ethical, and medical judgment.”
The appeals court that sided with the Lewis family in the current standing opinion held that Tinslee’s doctors are state actors and that the hospital’s choice to cut the child’s life support violated due process.
“The decision rendered thereby constitutes ‘state action’ within the meaning of the Fourteenth Amendment of the United States Constitution and 42 U.S.C.A § 1983,” the opinion reads.
“As a state actor, then, CCMC had to comply with the procedural and substantive dictates of due process before affirming and thereby effectuating such a treatment decision,” the opinion continues. “Because Mother pleaded… that the committee review process set forth in Section 166.046 and followed by CCMC fails to comply with the dictates of procedural due process… the trial court erred by denying Mother temporary injunctive relief, and we reverse the trial court’s order denying it.”
“Section 166.046” refers to a piece of Texas Health and Safety Code, which requires hospital ethics committees to review a doctor’s refusal to treat a patient. Section 1983, a federal rather than state law, holds people “acting under color of state law” liable for any infringements of constitutional rights. In other words, an action that may be legal under Texas law can still face a challenge in court if it violates a person’s federal rights.
A full list of the case’s briefs from both sides at the Supreme Court may be viewed here.
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