Texas disability medical futility case to be heard in court.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Michael Hickson

I have good news. The US Court of Appeals for the Fifth Circuit has agreed to hear the disability discrimination "medical futility" case of Michael Hickson who died on June 11, 2020 after being denied basic care by St. David’s South Austin Medical Center.

Thaddeus Pope published the following comment on his medical futility blog on March 8, 2026:

The U.S. Court of Appeals for the Fifth Circuit has ruled that a disability discrimination case may proceed where Texas providers withheld life-sustaining treatment based on determinations that the patient's inability to walk or talk meant that he had a low quality of life.

"We hold that a plaintiff asserts a cognizable claim for disability discrimination based on adverse medical treatment decisions—or decisions not to treat—when allegations show that the treatment was based 'solely,' in the pejorative sense, on the individual’s disability."

The family of Michael Hickson may now proceed on this and some other claims in the U.S. District Court for the Western District of Texas.

This ruling, combined with new DHHS regulations targeting medical futility determinations, raises significant red flags for hospitals withdrawing life-sustaining treatment over patient or family objections.

The disability rights group - ADAPT - published a powerful video by Melissa Fridie Hickson concerning the death of her husband Michael, who was also the father of her 5 children.

The Michael Hickson case is particularly egregious since the doctors unilaterally decided to deny Hickson treatment, they denied him basic care based on "quality of life." The legal decision stated:

(“St. David’s Healthcare”) stopped giving food and fluids to Michael Hickson, a loving husband and father of five who was hospitalized for illnesses that he had previously overcome. The doctors told Michael’s wife that his inability to walk or talk meant he had a low quality of life. Michael passed away.

Link to previous articles about Michael Hickson.

• The deadly quality of life ethic (Read).
• ADAPT of Texas Demands Investigation into Michael Hickson's death (Read).
• ADAPT of Texas protests Hospital killing of Michael Hickson (Read).

Texas woman arrested for assisting her ex-husband's suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Caitlin McCormack reported for the New York Post on February 18 that Sarah Regmund was arrested in the suicide death of her ex-husband Joseph Cheffo. The report indicated that Regmund assisted the suicide of Cheffo by following and participating in how-to instructions from the Final Exit Network.

The Final Exit Network (FEN) provides information, advice and sometimes trained people to assist a suicide.

According to McCormack:

Joseph Cheffo was found dead in his home in Odessa, Texas on Feb. 13. Even though assisted suicide is illegal in the Lone Star State, his ex-wife and primary caretaker, Sarah Regmund, allegedly helped suffocate him with how-to instructions from the Final Exit Network, the Odessa American reported.

I will not describe the assisted suicide death, but McCormack reported:

During an interview with police, Regmund explained that she had been in touch with the Final Exit Network, whose founder authored the book found near Cheffo’s bed. She claimed that the nonprofit’s representatives showed Cheffo how to kill himself the same day he died, according to the Odessa American.

McCormack stated that it was not clear whether or not FEN members were present at the death. Regmund admitted to following the FEN instructions, to setting up the suicide, and waiting two hours before reporting the death.

The Euthanasia Prevention Coalition will follow this case.

FEN have been involved in many known assisted suicide deaths.

In 2015, the Final Exit Network or FEN was found guilty, by a jury, of assisted suicide in the suicide of Doreen Dunn (57) in 2007, who was depressed but not terminally ill. The group was sentenced on August 24, 2015. FEN appealed to the Minnesota Court of Appeals, the Minnesota Supreme Court and the U.S. Supreme Court to no avail. They argued the Minnesota assisted suicide statute violated the free speech protections of the U.S. Constitution. 

After exhausting their appeals of the 2015 jury verdict, FEN filed a federal lawsuit in the Minnesota District Court in 2018 seeking to have the Minnesota assisted suicide law ruled unconstitutional on free speech grounds. The District Court dismissed the case in 2019 because it was simply a repeat of the state appellate case they had lost. Once a decision is final, you don’t get “overs” under the legal doctrine of collateral estoppel.

In May 2021 FEN filed a federal lawsuit with the Minnesota District Court seeking to invalidate the assisted suicide statute on free speech grounds. The legal arguments were the same as those in the 2018 suit that was dismissed, but the facts are different. The case appears to have died in 2023.

John Celmer

FEN has been prosecuted in several assisted suicide deaths. In Georgia, FEN assisted the suicide of John Celmer, who was depressed after recovering from cancer. Susan Celmer, John's widow, testified against the Final Exit Network.

FEN assists the suicide of people at the most vulnerable time of their life. Larry Egbert, the former medical director for the Final Exit Network, lost his medical license in Maryland for assisting suicides.

The deadly Quality of Life ethic

This article was published by First Things on July 6, 2020

Wesley Smith

By Wesley J Smith

Something evil happened recently in Austin. Michael Hickson, a forty-six-year-old African-American man with quadriplegia and a serious brain injury, was refused treatment at St. David’s Hospital South Austin while ill with COVID-19. The hospital withheld his tube-supplied food and water despite the objections of his wife, Melissa—and even though Michael might have survived the illness with the medical care generally provided COVID patients. Michael died on June 11 because his doctors did not believe he had a sufficient “quality of life” to justify curative treatment, and that because of his disabilities, saving his life was “futile.”

Michael Hickson

Here’s the backstory: In 2017, Michael experienced brain injury after cardiac arrest. He was quadriplegic and had seizures. But he was conscious and, according to Melissa, able to do math calculations and answer trivia questions. Wasn’t his life as precious as everybody else’s? Not according to Michael's doctors. When Michael became sick with coronavirus, his doctor informed Melissa that treatment would not improve the quality of his life (meaning, he would remain quadriplegic and cognitively disabled if he survived), so the medical team “and the state,” through a court-appointed guardian, had decided all treatment except hospice comfort care should end.

Melissa was unable legally to save her husband’s life by insisting that he receive proper care. Having been appointed Michael’s temporary guardian, she was in a legal struggle with Michael’s sister over his custody, a dispute that predated Michael’s hospitalization. Family Eldercare, a nonprofit agency, had been appointed interim guardian until a final decision could be made about permanent guardianship. Doctors convinced Family Eldercare to approve Michael’s transfer to hospice care even though he was breathing on his own. Michael died of pneumonia after six days on hospice, the withdrawal of artificial nutrition and hydration having no doubt weakened his body’s ability to fight disease. Even without pneumonia, Michael would have soon died of dehydration.

Please note that this wasn’t a case of triage, a sad necessity required by a lack of resources in a time of pandemic emergency. Nor was it a situation of doctor said/wife said. Melissa recorded her conversation with the unnamed physician and posted it on YouTube so we can all hear for ourselves what families in these circumstances too often experience when dealing with the healthcare needs of disabled and elderly patients.

Here’s the substance of the conversation from the YouTube transcript, with my commentary.

Doctor: At this point, the decision is, do we want to be extremely aggressive with his care or do we feel like this will be futile? And the big question of futility is one that we always question. The issue is: Will this help him improve the quality of life, will this help him improve anything, will it ultimately change the outcome? And the thought is the answer is no to all of those.

Melissa: What would make you say no to all of those?

Doctor: As of right now the quality of life, he doesn’t have much of one.

Melissa: What do you mean? Because he was paralyzed with a brain injury, he doesn’t have a quality of life?

Doctor: Correct

The doctor did not base his decision on the seriousness of Michael’s illness, but on his continuing disability. This is a classic example of applying the invidious “quality of life” ethic, which deems people with disabilities, the elderly, the chronically ill, and the dying to have a lower moral worth than the healthy, able-bodied, and young; this ethic sometimes translates into denying the weak and vulnerable medical care that others would receive readily.

Back to the conversation:

Melissa: Who gets to make that decision whether somebody’s quality of life, if they have a disability that their quality of life is not good?

Doctor: Well, it’s definitely not me. I don’t make that decision. However, will it affect his quality, will it improve his quality of life, and the answer is no.

Melissa: Why wouldn’t it? Being able to live isn’t improving the quality of life?

Doctor: There’s no improvement with being intubated, with a bunch of lines and tubes in your body and being on a ventilator for more than two weeks. Each of our people here have COVID and they are in respiratory failure. They’ve been here for more than two weeks.

A bit later, the doctor says that the decision is not Melissa’s to make.

Melissa: So the fact that you are killing someone doesn’t make sense in your mind?

Doctor: We don’t think it’s killing. Because I don’t know when or if he will die. But at this point I don’t think it would be humane or compassionate to put a breathing tube in this man and do the lines and the tubes and all that stuff because I don’t think it will benefit him.

Melissa: And I totally agree with you on the intubation part of it. I don’t want him intubated. But I also don’t think you should just sit him somewhere to be comfortable until he finally just drifts away. That to me is futile too. That’s saying you’re not trying to save someone’s life. You’re just watching them go. The ship is sailing. I mean that just doesn’t make any sense to me to not try. I don’t get that part. I don’t like that part.

Melissa is not asking for intubation. She is not asking for “everything possible” to be done. Rather, she wants proper care for Michael, which would presumably have included medicines and tube-supplied food and water.

The doctor becomes increasingly tired of the conversation:

Doctor: But what I’m going to tell you is that this is the decision between the medical community and the state.

Melissa: And the state. Forget about his wife and his family and his five kids.

Doctor: I have nothing to do with that.

The recording ends there.

What can we learn from this? First, people should sign advance directives naming legal surrogates who will make medical decisions for them in the event of incapacity. Michael had apparently not done that. Had Melissa been Michael’s legal surrogate, it is very possible he would be alive today, because she would not have consented to his transfer from acute care to hospice.

Second, the quality of life ethic is deadly. When doctors fail to recognize life itself as a good, and only deem as “good” those lives they perceive to be of sufficient quality, the weak and vulnerable are put at material risk.

Finally, our societal attitudes need adjusting. Rather than upholding a quality of life ethic, we should insist that society generally—and medicine specifically—adhere to the sanctity/equality of life ethic, according to which everyone is considered equally valuable and worthy of living and care. This ethic would not force people to accept medical treatment they do not want. But it would keep the most weak and vulnerable among us, people like Michael Hickson, from being pushed out of the lifeboat by doctors who can’t imagine why anyone with quadriplegia and cognitive incapacities should go on living.

Wesley J. Smith is a senior fellow at the Discovery Institute. His latest book is Culture of Death: The Age of “Do Harm” Medicine.

ADAPT of Texas Demands Investigation into Michael Hickson’s Death

Not Dead Yet (NDY) Press Release

Michael Hickson

ADAPT of Texas has issued an Independence Day announcement that disability advocates are holding a vigil at St. David’s South Austin Medical Center to support the family of Michael Hickson, a 46-year old Black man with disabilities who died after being denied COVID-19 treatment. Not Dead Yet applauds ADAPT of Texas’ demand for “A full and immediate investigation of the death of Michael Hickson by state and federal officials including the role of the medical community,” and a meeting with Charles Laird, CEO of the St. David’s facility.

Mr. Hickson’s wife and widow, Melissa Hickson, has recorded a compelling video concerning the hospital’s denial of care for her husband based on negative quality of life judgments about his disability.

Mrs. Hickson has also provided other recordings of her husband’s recovery and statements made to her by a St. David’s doctor expressing blatant and unlawful discrimination. Links to these recordings are includes in an earlier NDY article.

ADAPT’s July 4th Press Advisory and Statement of Demands follow below.

*****PRESS ADVISORY ******

SUBJECT:  Disability Independence and Life Itself Challenged because of COVID 19 rationing. Michael Hickson’s death Outrages ADAPT of Texas

For information:

Nicky – 512 736 4814

Sophia – 512 924 8449

Attached are the demands of ADAPT of Texas.

Currently Texas has no guidance on the rationing of healthcare.

People with disabilities are NOT DISPOSABLE.

Our chant: LIFE WORTHY OF LIFE

1100 South IH 35 * Austin, Texas 78704 * www.adaptoftexas.org

Recently a quadriplegic Michael Hickson died under circumstances that may have resulted from rationing services because of his disability and being tested positive with COVID 19.

This has outraged the ADAPT of Texas Community.

WE DEMAND:

1. A full and immediate investigation into the death of Michael Hickson by state and federal officials including the role of the medical community;

2. Charles Laird, CEO of St. David’s South Austin Medical Center meet with members of the ADAPT of Texas Community. 

July 4, 2020

LIFE WORTHY OF LIFE

PEOPLE WITH DISABILITIES ARE NOT DISPOSIBLE

ADAPT of Texas Protests Hospital Killing of Michael Hickson, A Black Disabled Man

This article was published by Not Dead Yet on June 29, 2020

ADAPT of Texas members protested on June 28th in front of St. David’s Hospital in Austin where they refused treatment and starved to death Michael Hickson, a black disabled man who died on June 11th, 2020.

ADAPT of Texas reported that Michael Hickson was a quadriplegic with a brain injury who was refused treatment for COVID 19 that he acquired in a local nursing home.

A pro-life media outlet reported on Mr. Hickson’s story, including a video of his recovery as he progressed over time, and an audio recording of a doctor explaining the hospital’s decision not to treat him for COVID-19.

. . . Hickson became a quadriplegic in May 2017 after going into sudden cardiac arrest while driving his wife Melissa to work. He received CPR but suffered an anoxic brain injury from the loss of oxygen to his brain. Since that time, he has been conscious and alert, responding to jokes, laughing, shaking his head, singing, and puckering his lips when his wife asked for a kiss over FaceTime. See the video below:

Then in 2020, he contracted COVID-19 from a staff member in his nursing home and developed pneumonia. He was hospitalized at St. David’s South Austin Medical Center, but doctors there refused to treat him, allowing him to die.

In a recorded conversation between the doctor and Melissa, she was told that he would not receive treatment due to his disability:

Doctor: So as of right now, his quality of life — he doesn’t have much of one.

Melissa: What do you mean? Because he’s paralyzed with a brain injury he doesn’t have quality of life?

Doctor: Correct.

A five-minute recording of the conversation is here:

The doctor seems to invoke the infamous Texas futility law, aka the “10-day-rule”, which allows doctors to involuntarily withdraw life-sustaining treatment after giving ten days notice. But it’s not clear how long Mr. Hickson was in the hospital. There’s no indication that even the minimal requirements of the futility law were met. Even if they used a hospital “ethics” committee, it’s highly unlikely that it included any disability rights advocates. (A problem we can all work to address – nothing about us without us!)

There’s also no indication that Austin hospitals had entered a period of shortages that would have triggered COVID-19 triage policies. Even if resource shortages existed in early June, the reasons given for withholding treatment are blatantly and illegally discriminatory under recent federal HHS Office of Civil Rights COVID triage rulings. The latest OCR settlement with the state of Tennessee makes it crystal clear that the Texas hospital’s decision leading to Mr. Hickson’s death violated federal standards.

Based on the information we have, it seems that the hospital used COVID triage and Texas futility policies in combination to try to “justify” a killing that neither policy could do alone. NDY questions the relative lack of media interest in this outrageous killing of a Black disabled man, and the hospital’s cold and cavalier dismissal of his life as unworthy of care. But for the video and audio recordings, this injustice would likely have remained hidden. Our hearts go out to his family for their terrible loss.

Texas bill is model legislation to prevent Death by Dehydration.

By Dr Jacqueline Harvey

Governor Abbott signed
HB 3074 into law.

On Friday, June 12, 2015, Texas Governor Greg Abbott overturned 16 years of legal forced dehydration and starvation in Texas by signing House Bill 3074. The Euthanasia Prevention Coalition (EPC) was present for the historic moment and presented a commendation to Representative Drew Springer on his skillful passage of this landmark legislation, and EPC briefly explained the significance of this bi-partisan, unanimously-supported, model disability rights bill. HB 3074 is a critical first step in EPC’s national and worldwide efforts to restore the rights of persons with disabilities to receive nutrition and hydration (ANH). Therefore this vital win in Texas is anticipated to save lives not just within the Lone Star State but throughout the United States and even globally as EPC prepares to explore this issue with standing at the United Nations.

Rep. Drew Springer
receives EPC award.

Under Rep. Springer’s leadership, HB 3074 moved Texas from the one state to allow healthcare providers to remove food and water in any circumstance to joining five other states that explicitly protect patients in need of ANH. The Texas law was an anomaly in that it allowed the medical community authority to remove ANH in any circumstance. In contrast, five states have passed laws to ensure that food and water is not forcibly withheld by a healthcare provider to kill a patient. Now that HB 3074 is signed into law, Texas no longer ranks as the worst state for patients in need of ANH but ranks among the best.

EPC believes that HB 3074 is model legislation. Representative Springer brokered an unprecedented compromise that cleared a 12-year stalemate on this issue. HB 3074 began in committee with opposition, but Springer was able to find language agreeable to all parties and foster unity to enable the bill to be passed in all committees and chambers of both House and Senate with no opposition.

Landmark Bill to Stop Forced Dehydration Passes Texas House, Heads to Senate

By Dr Jacqueline Harvey

The Texas House of Representatives has passed House Bill 3074, which is groundbreaking legislation that would end the forced withdrawal of feeding tubes by medical facilities. HB 3074 by Representative Drew Springer proudly endorsed by Euthanasia Prevention Coalition (EPC) will stop involuntary euthanasia by dehydration and is expected to be taken up quickly by the Senate early next week. Once signed into law, HB 3074 will be the first successful reform to the Texas Advanced Directives Act since 2003.

HB 3074 was passed on second reading in the Texas House of Representatives on Thursday, May 14 in under three minutes by a simple voice vote due to overwhelming support from legislators. Representative Springer’s bill boasts four joint authors and 80 co-authors - well over half of the 150 House representatives. But moreover, HB 3074 is the first end-of-life bill in 12 years that has garnered universal agreement among patient advocates, disability rights, prolife and religious organizations.

While these groups take different approaches to reforming broader aspects of Texas end-of-life law and have filed bills on those issues since 2003, Representative Springer found common ground in that all groups wish to protect patients from forced starvation and dehydration and could therefore support a bill like HB 3074 that accomplishes that singular but vital goal. In an inspiring gesture of statesmanship, Representative Patricia Harless chose to delay consideration of her end-of-life bill, House Bill 2351 (which was supported by many groups) until after HB 3074 (which was supported by all). This sacrifice ultimately cost HB 2351 the opportunity to a floor hearing and vote to allowed HB 3074 to pass just before the deadline.

The EPC wishes to congratulate and thank Representative Springer and Representative Harless, State Affairs Committee Chairman Byron Cook for their leadership and success passing HB 3074 to the Senate. Congratulations and thanks as well as the Texas Catholic Conference, Texas Alliance for Life and Texans for Life for leading the advocacy effort. EPC pledges its continued support. 

Dr. Jacqueline C. Harvey (Ph.D.) is a former faculty member at the University of North Texas, as well as the University of Michigan-Dearborn. Harvey, in conjunction with the EPC - International, has authored definitive works on the Texas Advance Directive Act.

Feeding Tubes and Futility in Texas.

We Can End the End-of-Life Impasse in the Texas Legislature.

Dr Jacqueline Harvey

By Jacqueline C. Harvey, Ph.D . 

After five consecutive sessions of bitter battles over end-of-life bills, the Texas Legislature is finally poised to pass the first reform to the Texas Advance Directives Act (TADA) in twelve years. An issue that created uncanny adversaries out of natural allies and equally odd bedfellows has finally found common ground in H.B. 3074: an act that simply prohibits doctor-imposed euthanasia by starvation and dehydration. Since H.B. 3074 includes only those provisions and language that all major organizations are on record as having deemed acceptable in previous legislative sessions, there is finally hope of ending the end-of-life impasse in the Texas Capitol.

Many people are surprised to learn that Texas law allows physicians to forcibly remove a feeding tube against the will of the patient and their family. In fact, there is a greater legal penalty for failing to feed or water an animal than for a hospital to deny a human being food and water through a tube. This is because there is no penalty whatsoever for a healthcare provider who wishes to deny artificially administered nutrition and hydration (ANH). According to Texas Health and Safety Code, “every living dumb creature” is legally entitled to access to suitable food and water. Denying an animal food and water, such as a case this January in San Antonio, is punishable by civil fines up to $10,000 and criminal penalties up to two years in jail per offense. Yet Texas law allows health care providers to forcibly deny food and water from human beings - what they would not be able to legally do to their pet cat. And healthcare providers are immune from civil and criminal penalties deny of food and water to human beings as long as they follow the current statutory process which is sorely lacking in safeguards. Therefore while it is surprising that Texas is the only state law that explicitly mentions food and water delivered artificially for the purpose of completely permitting its forced denial (six other states mention ANH explicitly for the opposite purpose, to limit or prohibit its refusal), it is not at all surprising that the issue of protecting a patient’s right to food and water is perhaps the one point of consensus across all major stakeholders.

H.B. 3074 is the first TADA reform bill to include only this provision that is agreed upon across all major players in previous legislative sessions. Texas Alliance for Life and Texas Right to Life have each previously sponsored broad and ambitious bills to either preserve but reform the current law (Texas Alliance for Life’s position) or overturn it altogether as Texas Right to Life aims to do. Prior to H.B. 3074, bills filed by major advocacy organizations have often included ANH, but also a host of other provisions that were so contentious and unacceptable to other organizations each bill ultimately died, and this mutually-agreed-upon and vital reform always died along with it. The 2011 and 2013 sessions present a prime example where both organizations filed complicated, contentious opposing bills, both of which would have protected a patient’s right to food and water but each bill also included provisions that other groups saw as contrary to their goals. Both bills were ultimately defeated and neither group was able to achieve protections for patients at risk of forced starvation and dehydration- a mutual goal that could have been met through a third, narrow bill like H.B. 3074. H.B. 3074 focuses on what unites the organizations involved rather than what divides them.

H.B. 3074 is progress that is pre-negotiated and pre-approved. It is not a fertile springboard for negotiations on an area of mutual agreement. Rather it is the culmination of years of previous negotiations on bill that all came too late, either due to the complex nature of rival bills, the controversy involved or even both. On the contrary, H.B. 3074 is not just simple and an area of agreement, moreover, it is has already been negotiated. since Texas Alliance for Life and Texas Right to Life (along with their allies) were able to agree on language in 2007 with C.S.S.B. 439. 

The language from C.S.S.B. 439 is strikingly similar to H.B. 3074 which states, “except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would: 

1. hasten the patient's death; 
2. seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment; 
3. result in substantial irremediable physical pain, suffering, or discomfort not outweighed by the benefit of the provision of the treatment; 
4. be medically ineffective; or 
5. be contrary to the patient's clearly stated desire not to receive artificially administered nutrition or hydration.”