Whether private doctors who discontinue private care for a private patient at a private hospital are state actors for invoking a state law's internal-review process

QUESTION PRESENTED This case raises an important question under the state-action doctrine in a constitutional challenge to the Texas Advance Directives Act. 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. When such a conflict arises, the Act permits doctors to invoke an optional internal-review process before the hospital’s ethics committee (consisting entirely of private actors); that committee solicits input from all stakeholders, and issues a neutral decision on the appropriate course of action. Any doctor or hospital complying with this optional process may refuse to provide care and is protected from civil or criminal liability; any patient disagreeing with the committee is free to reject the decision and pursue care elsewhere. Aside from insulating doctors and hospitals, the process does not otherwise grant or deny any rights or powers, and the Act does not influence, control, or dictate the appropriate manner of care, a decision left entirely to private actors. In the decision below, the court of appeals invalidated the Act under Section 1983, and held that private doctors who discontinue private care for a private patient at a private hospital are state actors—simply for invoking the Act’s internal-review process. The question presented is: Whether, despite the lack of any state involvement, participation, coercion, input, or control of any kind, a private hospital is nevertheless a state actor because state law creates a safe harbor for those who conduct a private internal review to determine private medical care in a private facility. (I)