Doctors vs. Parents: Who Decides Right to Life?

"There's a conflict of interest here because there's an economic incentive to misuse the law," says Painter. "In my opinion, what they were trying to do was literally bury the malpractice."

"The assumption, I think, has always been that you have to assume doctors are acting in good faith," says Burke Balch, director of the National Right to Life's Robert Powell Center for Medical Ethics in Washington, D.C. "Yet, human nature is such that people do engage in cover-ups and people do make mistakes. There can be simple bad actors and flat-out malpractice that this (law) provides an opportunity to cover up. And human nature being what it is, that's what tends to happen."

Dr. Robert Fine points out that hospitals cannot initiate the Advance Directive law, only doctors can. And the physician who does invoke the law cannot sit on the ethics committee. In addition, Fine does not believe doctors and hospitals are in cahoots, because in most facilities throughout Texas, hospitals do not employ doctors, rather physicians work as independent agents.

"In my judgment," Fine says, "there's no way for a doctor to use this, to, let's say, hide a mistake. As a matter of fact, if a doctor wants to 'hide a mistake,' the last thing they're going to do is call in an independent committee."

State Representative Garnet Coleman, (D-Houston), who helped author the 1999 act, tends to agree with Fine. When asked if he thinks the law is sometimes used to bury malpractice, he says, "I would hope not, and that's why we have autopsies. I don't think that the law either encourages it and I don't think that it discourages it. As long as you've had an autopsy, then you would find out what was the cause of death and whether there was a medical error."

Texas ethicist William Winslade has a slightly more humanistic take.

"I'm sympathetic to doctors who don't want to provide life-support or treatment to people with incurable diseases," he says. But "in a case where the person's condition was the result of alleged medical error, I think that the hospital would be prudent and it would be morally appropriate for the hospital to prolong the process and not simply invoke the process because they can."
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Imagine being conscious and aware, fully able to understand what people are saying, yet virtually unable to walk, talk, eat or go to the bathroom on the toilet.

This is the world of Sabrina Martin.

Her short-term memory is not what it used to be, say her parents, but Sabrina can remember practically everything up until her second surgery two years ago. For a while she was able to speak, but recently she has regressed and has difficulty finding her voice.

"Because she is in this locked-in syndrome," Sabrina's physician, Dr. Sharon Kawai, says during a taped interview with Painter, "she knows what she was able to do before and that she's not able to do now."

Lopez and Murray say they must be careful around their daughter not to talk about the hospital and their efforts to save Sabrina because she gets visibly upset and it can take an entire day to calm her down. And then there's the nightmares.

"She would wake up screaming, 'I don't want to die,'" says Lopez. "And we would sit up with her and rock her back to sleep. It was like she was stuck in that traumatic moment when all that craziness was happening at the hospital."

Shortly after transferring to Texas Children's Hospital, Sabrina began to improve so dramatically that doctors recommended she not go home but rather be moved to a rehabilitation facility in San Antonio. There, at Kindred Hospital, Sabrina emerged from her coma. Doctors were able to remove her breathing tube and Sabrina began getting better, even advancing to the point where she was able to help her younger sister do math homework by counting on her fingers. Doctors now say Sabrina should have a full life expectancy.

"The people at Memorial Hermann said this would never happen," says Lopez.

Today, Sabrina must wear a diaper and primarily eats through her feeding tube, but she can swallow some soft foods like mashed potatoes and drinks from a bottle. She is wheelchair-bound, but can partially stand when lifted out of her seat. Occasionally she'll whisper, but mostly she nods her head and makes noises to express herself.

Still, it's a long way from being a "vegetable," say Lopez and Murray. And to them it's a blessing.

"It's all small improvements," says Lopez, "but to us they're major."

Starting this summer, Sabrina will begin attending Special Education classes at Klein Intermediate in hopes of doing well and continuing on with school in the fall.