Ethics. Research. Community.

Cook Children’s Ethics Committee Member Concedes TADA Flaws

Late last month, Stuart Pickell write an op-ed in the Forth Worth Star-Telegram on the ongoing Tinslee Lewis case. Dr. Pickell is chairman of the Tarrant County Academy of Medicine Ethics Consortium and a member of Cook Children’s Medical Center’s ethics committee.

While defending the dispute resolution provisions in the Texas Advance Directives Act, Dr. Pickell actually concedes much of what the case is really about. 

First, Dr. Pickell explicitly acknowledges: "The Texas Advance Directives Act is imperfect." That is fine. Many other defenders of TADA concede as much. This is not a big or surprising concession. Many pieces of legislation are imperfect. The legal question is whether the statute is unconstitutional.


Second, Dr. Pickell writes: "the typical ethics committee consists of an interdisciplinary team of healthcare workers." Yes, but the statute provides no rules or constraints on the size or composition of the committee. While many committees may be inter-professional and diverse, many are not.

Third, Dr. Pickell writes: "The members are often employees of the institution but the panels also usually include community members who have no official relationship with the facility." Yes, the statute does not require community members. And Dr. Pickell acknowledges (using the word "usually") that some committees have none. Therefore, many committees are comprised entirely of insiders with a real or apparent conflict of interest.

Fourth, Dr. Pickell writes: "Texas’ law leverages the expertise of healthcare and ethics professionals." That may sometimes be true. But the statute does not require the involvement of either. The committee could be comprised entirely of utilization managers. 

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