AN ACT
1-1 relating to certain advance directives for medical treatment;
1-2 providing administrative penalties.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 ARTICLE 1. ADVANCE DIRECTIVES
1-5 SECTION 1.01. Subtitle H, Title 2, Health and Safety Code,
1-6 is amended by adding a chapter heading for Chapter 166 to read as
1-7 follows:
1-8 CHAPTER 166. ADVANCE DIRECTIVES
1-9 SECTION 1.02. Subtitle H, Title 2, Health and Safety Code,
1-10 is amended by adding Subchapter A, Chapter 166, to read as follows:
1-11 SUBCHAPTER A. GENERAL PROVISIONS
1-12 Sec. 166.001. SHORT TITLE. This chapter may be cited as the
1-13 Advance Directives Act.
1-14 Sec. 166.002. DEFINITIONS. In this chapter:
1-15 (1) "Advance directive" means:
1-16 (A) a directive, as that term is defined by
1-17 Section 166.031;
1-18 (B) an out-of-hospital DNR order, as that term
1-19 is defined by Section 166.081; or
1-20 (C) a medical power of attorney under Subchapter
1-21 D.
1-22 (2) "Artificial nutrition and hydration" means the
1-23 provision of nutrients or fluids by a tube inserted in a vein,
1-24 under the skin in the subcutaneous tissues, or in the stomach
2-1 (gastrointestinal tract).
2-2 (3) "Attending physician" means a physician selected
2-3 by or assigned to a patient who has primary responsibility for a
2-4 patient's treatment and care.
2-5 (4) "Competent" means possessing the ability, based on
2-6 reasonable medical judgment, to understand and appreciate the
2-7 nature and consequences of a treatment decision, including the
2-8 significant benefits and harms of and reasonable alternatives to a
2-9 proposed treatment decision.
2-10 (5) "Declarant" means a person who has executed or
2-11 issued a directive under this chapter.
2-12 (6) "Ethics or medical committee" means a committee
2-13 established under Sections 161.031-161.033.
2-14 (7) "Health care or treatment decision" means consent,
2-15 refusal to consent, or withdrawal of consent to health care,
2-16 treatment, service, or a procedure to maintain, diagnose, or treat
2-17 an individual's physical or mental condition.
2-18 (8) "Incompetent" means lacking the ability, based on
2-19 reasonable medical judgment, to understand and appreciate the
2-20 nature and consequences of a treatment decision, including the
2-21 significant benefits and harms of and reasonable alternatives to a
2-22 proposed treatment decision.
2-23 (9) "Irreversible condition" means a condition,
2-24 injury, or illness:
2-25 (A) that may be treated but is never cured or
2-26 eliminated;
3-1 (B) that leaves a person unable to care for or
3-2 make decisions for the person's own self; and
3-3 (C) that, without life-sustaining treatment
3-4 provided in accordance with the prevailing standard of medical
3-5 care, is fatal.
3-6 (10) "Life-sustaining treatment" means treatment that,
3-7 based on reasonable medical judgment, sustains the life of a
3-8 patient and without which the patient will die. The term includes
3-9 both life-sustaining medications and artificial life support, such
3-10 as mechanical breathing machines, kidney dialysis treatment, and
3-11 artificial nutrition and hydration. The term does not include the
3-12 administration of pain management medication or the performance of
3-13 a medical procedure considered to be necessary to provide comfort
3-14 care, or any other medical care provided to alleviate a patient's
3-15 pain.
3-16 (11) "Medical power of attorney" means a document
3-17 delegating to an agent authority to make health care decisions
3-18 executed or issued under Subchapter D.
3-19 (12) "Physician" means:
3-20 (A) a physician licensed by the Texas State
3-21 Board of Medical Examiners; or
3-22 (B) a properly credentialed physician who holds
3-23 a commission in the uniformed services of the United States and who
3-24 is serving on active duty in this state.
3-25 (13) "Terminal condition" means an incurable condition
3-26 caused by injury, disease, or illness that according to reasonable
4-1 medical judgment will produce death within six months, even with
4-2 available life-sustaining treatment provided in accordance with the
4-3 prevailing standard of medical care. A patient who has been
4-4 admitted to a program under which the person receives hospice
4-5 services provided by a home and community support services agency
4-6 licensed under Chapter 142 is presumed to have a terminal condition
4-7 for purposes of this chapter.
4-8 (14) "Witness" means a person who may serve as a
4-9 witness under Section 166.003.
4-10 Sec. 166.003. WITNESSES. In any circumstance in which this
4-11 chapter requires the execution of an advance directive or the
4-12 issuance of a nonwritten advance directive to be witnessed:
4-13 (1) each witness must be a competent adult; and
4-14 (2) at least one of the witnesses must be a person who
4-15 is not:
4-16 (A) a person designated by the declarant to make
4-17 a treatment decision;
4-18 (B) a person related to the declarant by blood
4-19 or marriage;
4-20 (C) a person entitled to any part of the
4-21 declarant's estate after the declarant's death under a will or
4-22 codicil executed by the declarant or by operation of law;
4-23 (D) the attending physician;
4-24 (E) an employee of the attending physician;
4-25 (F) an employee of a health care facility in
4-26 which the declarant is a patient if the employee is providing
5-1 direct patient care to the declarant or is an officer, director,
5-2 partner, or business office employee of the health care facility or
5-3 of any parent organization of the health care facility; or
5-4 (G) a person who, at the time the written
5-5 advance directive is executed or, if the directive is a nonwritten
5-6 directive issued under this chapter, at the time the nonwritten
5-7 directive is issued, has a claim against any part of the
5-8 declarant's estate after the declarant's death.
5-9 Sec. 166.004. STATEMENT RELATING TO ADVANCE DIRECTIVE.
5-10 (a) In this section, "health care provider" means:
5-11 (1) a hospital;
5-12 (2) an institution licensed under Chapter 242,
5-13 including a skilled nursing facility;
5-14 (3) a home and community support services agency;
5-15 (4) a personal care facility; and
5-16 (5) a special care facility.
5-17 (b) A health care provider shall maintain written policies
5-18 regarding the implementation of advance directives. The policies
5-19 must include a clear and precise statement of any procedure the
5-20 health care provider is unwilling or unable to provide or withhold
5-21 in accordance with an advance directive.
5-22 (c) Except as provided by Subsection (g), the health care
5-23 provider shall provide written notice to an individual of the
5-24 written policies described by Subsection (b). The notice must be
5-25 provided at the earlier of:
5-26 (1) the time the individual is admitted to receive
6-1 services from the health care provider; or
6-2 (2) the time the health care provider begins providing
6-3 care to the individual.
6-4 (d) If, at the time notice is to be provided under
6-5 Subsection (c), the individual is incompetent or otherwise
6-6 incapacitated and unable to receive the notice required by this
6-7 section, the provider shall provide the required written notice, in
6-8 the following order of preference, to:
6-9 (1) the individual's legal guardian;
6-10 (2) a person responsible for the health care decisions
6-11 of the individual;
6-12 (3) the individual's spouse;
6-13 (4) the individual's adult child;
6-14 (5) the individual's parent; or
6-15 (6) the person admitting the individual.
6-16 (e) If Subsection (d) applies and except as provided by
6-17 Subsection (f), if a health care provider is unable, after diligent
6-18 search, to locate an individual listed by Subsection (d), the
6-19 health care provider is not required to provide the notice.
6-20 (f) If an individual who was incompetent or otherwise
6-21 incapacitated and unable to receive the notice required by this
6-22 section at the time notice was to be provided under Subsection (c)
6-23 later becomes able to receive the notice, the health care provider
6-24 shall provide the written notice at the time the individual becomes
6-25 able to receive the notice.
6-26 (g) This section does not apply to outpatient hospital
7-1 services, including emergency services.
7-2 Sec. 166.005. ENFORCEABILITY OF ADVANCE DIRECTIVES EXECUTED
7-3 IN ANOTHER JURISDICTION. An advance directive or similar
7-4 instrument validly executed in another state or jurisdiction shall
7-5 be given the same effect as an advance directive validly executed
7-6 under the law of this state. This section does not authorize the
7-7 administration, withholding, or withdrawal of health care otherwise
7-8 prohibited by the laws of this state.
7-9 Sec. 166.006. EFFECT OF ADVANCE DIRECTIVE ON INSURANCE
7-10 POLICY AND PREMIUMS. (a) The fact that a person has executed or
7-11 issued an advance directive does not:
7-12 (1) restrict, inhibit, or impair in any manner the
7-13 sale, procurement, or issuance of a life insurance policy to that
7-14 person; or
7-15 (2) modify the terms of an existing life insurance
7-16 policy.
7-17 (b) Notwithstanding the terms of any life insurance policy,
7-18 the fact that life-sustaining treatment is withheld or withdrawn
7-19 from an insured qualified patient under this chapter does not
7-20 legally impair or invalidate that person's life insurance policy
7-21 and may not be a factor for the purpose of determining, under the
7-22 life insurance policy, whether benefits are payable or the cause of
7-23 death.
7-24 (c) The fact that a person has executed or issued or failed
7-25 to execute or issue an advance directive may not be considered in
7-26 any way in establishing insurance premiums.
8-1 Sec. 166.007. EXECUTION OF ADVANCE DIRECTIVE MAY NOT BE
8-2 REQUIRED. A physician, health facility, health care provider,
8-3 insurer, or health care service plan may not require a person to
8-4 execute or issue an advance directive as a condition for obtaining
8-5 insurance for health care services or receiving health care
8-6 services.
8-7 Sec. 166.008. CONFLICT BETWEEN ADVANCE DIRECTIVES. To the
8-8 extent that a treatment decision or an advance directive validly
8-9 executed or issued under this chapter conflicts with another
8-10 treatment decision or an advance directive executed or issued under
8-11 this chapter, the treatment decision made or instrument executed
8-12 later in time controls.
8-13 Sec. 166.009. CERTAIN LIFE-SUSTAINING TREATMENT NOT
8-14 REQUIRED. This chapter may not be construed to require the
8-15 provision of life-sustaining treatment that cannot be provided to a
8-16 patient without denying the same treatment to another patient.
8-17 SECTION 1.03. Chapter 672, Health and Safety Code, is
8-18 transferred to Subtitle H, Title 2, Health and Safety Code, is
8-19 redesignated as Subchapter B, Chapter 166, Health and Safety Code,
8-20 and is amended to read as follows:
8-21 SUBCHAPTER B. DIRECTIVE TO PHYSICIANS [CHAPTER 672. NATURAL]
8-22 [DEATH ACT]
8-23 [Sec. 672.001. SHORT TITLE. This chapter may be cited as
8-24 the Natural Death Act.]
8-25 Sec. 166.031 [672.002]. DEFINITIONS. In this subchapter
8-26 [chapter]:
9-1 (1) ["Attending physician" means the physician who has
9-2 primary responsibility for a patient's treatment and care.]
9-3 [(2) "Competent" means possessing the ability, based
9-4 on reasonable medical judgment, to understand and appreciate the
9-5 nature and consequences of a treatment decision, including the
9-6 significant benefits and harms of and reasonable alternatives to a
9-7 proposed treatment decision.]
9-8 [(3) "Declarant" means a person who has executed or
9-9 issued a directive under this chapter.]
9-10 [(4)] "Directive" means an instruction made under
9-11 Section 166.032, 166.034, or 166.035 [672.003, 672.005, or 672.006]
9-12 to administer, withhold, or withdraw life-sustaining treatment
9-13 [procedures] in the event of a terminal or irreversible condition.
9-14 (2) [(5) "Incompetent" means lacking the ability,
9-15 based on reasonable medical judgment, to understand and appreciate
9-16 the nature and consequences of a treatment decision, including the
9-17 significant benefits and harms of and reasonable alternatives to a
9-18 proposed treatment decision.]
9-19 [(6) "Life-sustaining procedure" means a medical
9-20 procedure or intervention that uses mechanical or other artificial
9-21 means to sustain, restore, or supplant a vital function, and only
9-22 artificially postpones the moment of death of a patient in a
9-23 terminal condition whose death is imminent or will result within a
9-24 relatively short time without the application of the procedure.
9-25 The term does not include the administration of medication or the
9-26 performance of a medical procedure considered to be necessary to
10-1 provide comfort or care or to alleviate pain.]
10-2 [(7) "Physician" means a physician licensed by the
10-3 Texas State Board of Medical Examiners or a properly credentialed
10-4 physician who holds a commission in the uniformed services of the
10-5 United States and who is serving on active duty in this state.]
10-6 [(8)] "Qualified patient" means a patient with a
10-7 terminal or irreversible condition that has been diagnosed and
10-8 certified in writing by the attending physician [and one other
10-9 physician who have personally examined the patient].
10-10 [(9) "Terminal condition" means an incurable or
10-11 irreversible condition caused by injury, disease, or illness that
10-12 would produce death without the application of life-sustaining
10-13 procedures, according to reasonable medical judgment, and in which
10-14 the application of life-sustaining procedures serves only to
10-15 postpone the moment of the patient's death.]
10-16 Sec. 166.032 [672.003]. WRITTEN DIRECTIVE BY COMPETENT
10-17 ADULT; NOTICE TO PHYSICIAN. (a) A competent adult may at any time
10-18 execute a written directive.
10-19 (b) The declarant must sign the directive in the presence of
10-20 two witnesses who qualify under Section 166.003, at least one of
10-21 whom must be a witness who qualifies under Section 166.003(2). The
10-22 [and those] witnesses must sign the directive.
10-23 (c) [A witness may not be:]
10-24 [(1) a person designated by the declarant to make a
10-25 treatment decision;]
10-26 [(2) a person related to the declarant by blood or
11-1 marriage;]
11-2 [(3) a person entitled to any part of the declarant's
11-3 estate after the declarant's death under a will or codicil executed
11-4 by the declarant or by operation of law;]
11-5 [(4) the attending physician;]
11-6 [(5) an employee of the attending physician;]
11-7 [(6) an employee of a health care facility in which
11-8 the declarant is a patient if the employee is providing direct
11-9 patient care to the declarant or is an officer, director, partner,
11-10 or business office employee of the health care facility or of any
11-11 parent organization of the health care facility; or]
11-12 [(7) a person who, at the time the written directive
11-13 is executed or if the directive is a nonwritten directive issued
11-14 under Section 672.005, at the time the nonwritten directive is
11-15 issued, has a claim against any part of the declarant's estate
11-16 after the declarant's death.]
11-17 [(d)] A declarant may include in a directive directions
11-18 other than those provided by Section 166.033 [672.004] and may
11-19 designate in a directive a person to make a treatment decision for
11-20 the declarant in the event the declarant becomes [comatose,]
11-21 incompetent[,] or otherwise mentally or physically incapable of
11-22 communication.
11-23 (d) [(e)] A declarant shall notify the attending physician
11-24 of the existence of a written directive. If the declarant is
11-25 [comatose,] incompetent[,] or otherwise mentally or physically
11-26 incapable of communication, another person may notify the attending
12-1 physician of the existence of the written directive. The attending
12-2 physician shall make the directive a part of the declarant's
12-3 medical record.
12-4 Sec. 166.033 [672.004]. FORM OF WRITTEN DIRECTIVE. A
12-5 written directive may be in the following form:
12-6 DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
12-7 Instructions for completing this document:
12-8 This is an important legal document known as an Advance
12-9 Directive. It is designed to help you communicate your wishes
12-10 about medical treatment at some time in the future when you are
12-11 unable to make your wishes known because of illness or injury.
12-12 These wishes are usually based on personal values. In particular,
12-13 you may want to consider what burdens or hardships of treatment you
12-14 would be willing to accept for a particular amount of benefit
12-15 obtained if you were seriously ill.
12-16 You are encouraged to discuss your values and wishes with
12-17 your family or chosen spokesperson, as well as your physician.
12-18 Your physician, other health care provider, or medical institution
12-19 may provide you with various resources to assist you in completing
12-20 your advance directive. Brief definitions are listed below and may
12-21 aid you in your discussions and advance planning. Initial the
12-22 treatment choices that best reflect your personal preferences.
12-23 Provide a copy of your directive to your physician, usual hospital,
12-24 and family or spokesperson. Consider a periodic review of this
12-25 document. By periodic review, you can best assure that the
12-26 directive reflects your preferences.
13-1 In addition to this advance directive, Texas law provides for
13-2 two other types of directives that can be important during a
13-3 serious illness. These are the Medical Power of Attorney and the
13-4 Out-of-Hospital Do-Not-Resuscitate Order. You may wish to discuss
13-5 these with your physician, family, hospital representative, or
13-6 other advisers. You may also wish to complete a directive related
13-7 to the donation of organs and tissues.
13-8 DIRECTIVE
13-9 I, ______________, recognize that the best health care is
13-10 based upon a partnership of trust and communication with my
13-11 physician. My physician and I will make health care decisions
13-12 together as long as I am of sound mind and able to make my wishes
13-13 known. If there comes a time that I am unable to make medical
13-14 decisions about myself because of illness or injury, I direct that
13-15 the following treatment preferences be honored:
13-16 If, in the judgment of my physician, I am suffering with a
13-17 terminal condition from which I am expected to die within six
13-18 months, even with available life-sustaining treatment provided in
13-19 accordance with prevailing standards of medical care:
13-20 ____ I request that all treatments other than those needed to keep
13-21 me comfortable be discontinued or withheld and my physician
13-22 allow me to die as gently as possible; OR
13-23 ____ I request that I be kept alive in this terminal condition
13-24 using available life-sustaining treatment. (THIS SELECTION
13-25 DOES NOT APPLY TO HOSPICE CARE.)
13-26 If, in the judgment of my physician, I am suffering with an
14-1 irreversible condition so that I cannot care for myself or make
14-2 decisions for myself and am expected to die without life-sustaining
14-3 treatment provided in accordance with prevailing standards of care:
14-4 ____ I request that all treatments other than those needed to keep
14-5 me comfortable be discontinued or withheld and my physician
14-6 allow me to die as gently as possible; OR
14-7 ____ I request that I be kept alive in this irreversible condition
14-8 using available life-sustaining treatment. (THIS SELECTION
14-9 DOES NOT APPLY TO HOSPICE CARE.)
14-10 Additional requests: (After discussion with your physician,
14-11 you may wish to consider listing particular treatments in this
14-12 space that you do or do not want in specific circumstances, such as
14-13 artificial nutrition and fluids, intravenous antibiotics, etc. Be
14-14 sure to state whether you do or do not want the particular
14-15 treatment.)
14-16 ___________________________________________________________________
14-17 ___________________________________________________________________
14-18 ___________________________________________________________________
14-19 After signing this directive, if my representative or I elect
14-20 hospice care, I understand and agree that only those treatments
14-21 needed to keep me comfortable would be provided and I would not be
14-22 given available life-sustaining treatments.
14-23 If I do not have a Medical Power of Attorney, and I am unable
14-24 to make my wishes known, I designate the following person(s) to
14-25 make treatment decisions with my physician compatible with my
14-26 personal values:
15-1 1._____________________
15-2 2._____________________
15-3 (If a Medical Power of Attorney has been executed, then an agent
15-4 already has been named and you should not list additional names in
15-5 this document.)
15-6 If the above persons are not available, or if I have not
15-7 designated a spokesperson, I understand that a spokesperson will be
15-8 chosen for me following standards specified in the laws of Texas.
15-9 If, in the judgment of my physician, my death is imminent within
15-10 minutes to hours, even with the use of all available medical
15-11 treatment provided within the prevailing standard of care, I
15-12 acknowledge that all treatments may be withheld or removed except
15-13 those needed to maintain my comfort. I understand that under Texas
15-14 law this directive has no effect if I have been diagnosed as
15-15 pregnant. This directive will remain in effect until I revoke it.
15-16 No other person may do so.
15-17 Signed__________________________________ Date______________________
15-18 City, County, State of Residence __________________________________
15-19 Two competent adult witnesses must sign below, acknowledging
15-20 the signature of the declarant. The witness designated as Witness
15-21 1 may not be a person designated to make a treatment decision for
15-22 the patient and may not be related to the patient by blood or
15-23 marriage. This witness may not be entitled to any part of the
15-24 estate and may not have a claim against the estate of the patient.
15-25 This witness may not be the attending physician or an employee of
15-26 the attending physician. If this witness is an employee of a
16-1 health care facility in which the patient is being cared for, this
16-2 witness may not be involved in providing direct patient care to the
16-3 patient. This witness may not be an officer, director, partner, or
16-4 business office employee of a health care facility in which the
16-5 patient is being cared for or of any parent organization of the
16-6 health care facility.
16-7 Witness 1________________________Witness 2_________________________
16-8 Definitions:
16-9 "Artificial nutrition and hydration" means the provision of
16-10 nutrients or fluids by a tube inserted in a vein, under the skin in
16-11 the subcutaneous tissues, or in the stomach (gastrointestinal
16-12 tract).
16-13 "Irreversible condition" means a condition, injury, or
16-14 illness:
16-15 (1) that may be treated, but is never cured or
16-16 eliminated;
16-17 (2) that leaves a person unable to care for or make
16-18 decisions for the person's own self; and
16-19 (3) that, without life-sustaining treatment provided
16-20 in accordance with the prevailing standard of medical care, is
16-21 fatal.
16-22 Explanation: Many serious illnesses such as cancer, failure
16-23 of major organs (kidney, heart, liver, or lung), and serious brain
16-24 disease such as Alzheimer's dementia may be considered irreversible
16-25 early on. There is no cure, but the patient may be kept alive for
16-26 prolonged periods of time if the patient receives life-sustaining
17-1 treatments. Late in the course of the same illness, the disease
17-2 may be considered terminal when, even with treatment, the patient
17-3 is expected to die. You may wish to consider which burdens of
17-4 treatment you would be willing to accept in an effort to achieve a
17-5 particular outcome. This is a very personal decision that you may
17-6 wish to discuss with your physician, family, or other important
17-7 persons in your life.
17-8 "Life-sustaining treatment" means treatment that, based on
17-9 reasonable medical judgment, sustains the life of a patient and
17-10 without which the patient will die. The term includes both
17-11 life-sustaining medications and artificial life support such as
17-12 mechanical breathing machines, kidney dialysis treatment, and
17-13 artificial hydration and nutrition. The term does not include the
17-14 administration of pain management medication, the performance of a
17-15 medical procedure necessary to provide comfort care, or any other
17-16 medical care provided to alleviate a patient's pain.
17-17 "Terminal condition" means an incurable condition caused by
17-18 injury, disease, or illness that according to reasonable medical
17-19 judgment will produce death within six months, even with available
17-20 life-sustaining treatment provided in accordance with the
17-21 prevailing standard of medical care.
17-22 Explanation: Many serious illnesses may be considered
17-23 irreversible early in the course of the illness, but they may not
17-24 be considered terminal until the disease is fairly advanced. In
17-25 thinking about terminal illness and its treatment, you again may
17-26 wish to consider the relative benefits and burdens of treatment and
18-1 discuss your wishes with your physician, family, or other important
18-2 persons in your life.
18-3 ["DIRECTIVE TO PHYSICIANS]
18-4 ["Directive made this __________ day of __________ (month,
18-5 year).]
18-6 ["I ________________________, being of sound mind, wilfully
18-7 and voluntarily make known my desire that my life shall not be
18-8 artificially prolonged under the circumstances set forth in this
18-9 directive.]
18-10 ["1. If at any time I should have an incurable or
18-11 irreversible condition caused by injury, disease, or illness
18-12 certified to be a terminal condition by two physicians, and if the
18-13 application of life-sustaining procedures would serve only to
18-14 artificially postpone the moment of my death, and if my attending
18-15 physician determines that my death is imminent or will result
18-16 within a relatively short time without the application of
18-17 life-sustaining procedures, I direct that those procedures be
18-18 withheld or withdrawn, and that I be permitted to die
18-19 naturally.]
18-20 ["2. In the absence of my ability to give directions
18-21 regarding the use of those life-sustaining procedures, it is my
18-22 intention that this directive be honored by my family and
18-23 physicians as the final expression of my legal right to refuse
18-24 medical or surgical treatment and accept the consequences from that
18-25 refusal.]
18-26 ["3. If I have been diagnosed as pregnant and that diagnosis
19-1 is known to my physician, this directive has no effect during my
19-2 pregnancy.]
19-3 ["4. This directive is in effect until it is revoked.]
19-4 ["5. I understand the full import of this directive and I am
19-5 emotionally and mentally competent to make this directive.]
19-6 ["6. I understand that I may revoke this directive at any
19-7 time.]
19-8 ["Signed _____________________________]
19-9 [(City, County, and State of Residence)]
19-10 [I am not a person designated by the declarant to make a
19-11 treatment decision. I am not related to the declarant by blood or
19-12 marriage. I would not be entitled to any portion of the
19-13 declarant's estate on the declarant's death. I am not the
19-14 attending physician of the declarant or an employee of the
19-15 attending physician. I have no claim against any portion of the
19-16 declarant's estate on the declarant's death. Furthermore, if I am
19-17 an employee of a health care facility in which the declarant is a
19-18 patient, I am not involved in providing direct patient care to the
19-19 declarant and am not an officer, director, partner, or business
19-20 office employee of the health care facility or of any parent
19-21 organization of the health care facility.]
19-22 ["Witness________________________________]
19-23 ["Witness_______________________________"]
19-24 Sec. 166.034 [672.005]. ISSUANCE OF NONWRITTEN DIRECTIVE BY
19-25 COMPETENT ADULT QUALIFIED PATIENT. (a) A competent qualified
19-26 patient who is an adult may issue a directive by a nonwritten means
20-1 of communication.
20-2 (b) A declarant must issue the nonwritten directive in the
20-3 presence of the attending physician and two witnesses who qualify
20-4 under Section 166.003, at least one of whom must be a witness who
20-5 qualifies under Section 166.003(2). [The witnesses must possess
20-6 the same qualifications as are required by Section 672.003(c).]
20-7 (c) The physician shall make the fact of the existence of
20-8 the directive a part of the declarant's medical record, and the
20-9 names of the witnesses shall be entered [sign the entry] in the
20-10 medical record.
20-11 Sec. 166.035 [672.006]. EXECUTION OF DIRECTIVE ON BEHALF OF
20-12 PATIENT YOUNGER THAN 18 YEARS OF AGE. The following persons may
20-13 execute a directive on behalf of a qualified patient who is younger
20-14 than 18 years of age:
20-15 (1) the patient's spouse, if the spouse is an adult;
20-16 (2) the patient's parents; or
20-17 (3) the patient's legal guardian.
20-18 Sec. 166.036. NOTARIZED DOCUMENT NOT REQUIRED; REQUIREMENT
20-19 OF SPECIFIC FORM PROHIBITED. (a) A written directive executed
20-20 under Section 166.033 or 166.035 is effective without regard to
20-21 whether the document has been notarized.
20-22 (b) A physician, health care facility, or health care
20-23 professional may not require that:
20-24 (1) a directive be notarized; or
20-25 (2) a person use a form provided by the physician,
20-26 health care facility, or health care professional.
21-1 Sec. 166.037 [672.007]. PATIENT DESIRE SUPERSEDES DIRECTIVE.
21-2 The desire of a [competent] qualified patient, including a
21-3 [competent] qualified patient younger than 18 years of age,
21-4 supersedes the effect of a directive.
21-5 Sec. 166.038 [672.008]. PROCEDURE WHEN DECLARANT IS
21-6 INCOMPETENT OR INCAPABLE OF COMMUNICATION. (a) This section
21-7 applies when an adult qualified patient has executed or issued a
21-8 directive and is [comatose,] incompetent[,] or otherwise mentally
21-9 or physically incapable of communication.
21-10 (b) If the adult qualified patient has designated a person
21-11 to make a treatment decision as authorized by Section 166.032(c)
21-12 [672.003(d)], the attending physician and the designated person may
21-13 make a treatment decision in accordance with the declarant's
21-14 directions [to withhold or withdraw life-sustaining procedures from
21-15 the patient].
21-16 (c) If the adult qualified patient has not designated a
21-17 person to make a treatment decision, the attending physician shall
21-18 comply with the directive unless the physician believes that the
21-19 directive does not reflect the patient's present desire.
21-20 Sec. 166.039 [672.009]. PROCEDURE WHEN PERSON HAS NOT
21-21 EXECUTED OR ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF
21-22 COMMUNICATION. (a) If an adult qualified patient has not executed
21-23 or issued a directive and is [comatose,] incompetent[,] or
21-24 otherwise mentally or physically incapable of communication, the
21-25 attending physician and the patient's legal guardian or an agent
21-26 under a medical power of attorney may make a treatment decision
22-1 that may include a decision to withhold or withdraw life-sustaining
22-2 treatment [procedures] from the patient.
22-3 (b) If the patient does not have a legal guardian or an
22-4 agent under a medical power of attorney, the attending physician
22-5 and one person, if available, from one [at least two persons, if
22-6 available,] of the following categories, in the following priority,
22-7 may make a treatment decision that may include a decision to
22-8 withhold or withdraw life-sustaining treatment [procedures]:
22-9 (1) the patient's spouse;
22-10 (2) [a majority of] the patient's reasonably available
22-11 adult children;
22-12 (3) the patient's parents; or
22-13 (4) the patient's nearest living relative.
22-14 (c) A treatment decision made under Subsection (a) or (b)
22-15 must be based on knowledge of what the patient would desire, if
22-16 known.
22-17 (d) A treatment decision made under Subsection (b) must be
22-18 documented in the patient's medical record and signed by the
22-19 attending physician.
22-20 (e) If the patient does not have a legal guardian and a
22-21 person listed in Subsection (b) is not available, a treatment
22-22 decision made under Subsection (b) must be concurred in [witnessed]
22-23 by another physician who is not involved in the treatment of the
22-24 patient or who is a representative of an ethics or medical
22-25 committee of the health care facility in which the person is a
22-26 patient.
23-1 (f) The fact that an adult qualified patient has not
23-2 executed or issued a directive does not create a presumption that
23-3 the patient does not want a treatment decision to be made to
23-4 withhold or withdraw life-sustaining treatment [procedures].
23-5 (g) A person listed in Subsection (b) who wishes to
23-6 challenge a treatment decision made under this section must apply
23-7 for temporary guardianship under Section 875, Texas Probate Code.
23-8 The court may waive applicable fees in that proceeding.
23-9 Sec. 166.040 [672.010]. PATIENT CERTIFICATION AND
23-10 PREREQUISITES FOR COMPLYING WITH DIRECTIVE. (a) An attending
23-11 physician who has been notified of the existence of a directive
23-12 shall provide for the declarant's certification as a qualified
23-13 patient on diagnosis of a terminal or irreversible condition.
23-14 (b) Before withholding or withdrawing life-sustaining
23-15 treatment [procedures] from a qualified patient under this
23-16 subchapter [chapter], the attending physician must[:]
23-17 [(1) determine that the patient's death is imminent or
23-18 will result within a relatively short time without application of
23-19 those procedures;]
23-20 [(2) note that determination in the patient's medical
23-21 record; and]
23-22 [(3)] determine that the steps proposed to be taken
23-23 are in accord with this subchapter [chapter] and the patient's
23-24 existing desires.
23-25 Sec. 166.041 [672.011]. DURATION OF DIRECTIVE. A directive
23-26 is effective until it is revoked as prescribed by Section 166.042
24-1 [672.012].
24-2 Sec. 166.042 [672.012]. REVOCATION OF DIRECTIVE. (a) A
24-3 declarant may revoke a directive at any time without regard to the
24-4 declarant's mental state or competency. A directive may be revoked
24-5 by:
24-6 (1) the declarant or someone in the declarant's
24-7 presence and at the declarant's direction canceling, defacing,
24-8 obliterating, burning, tearing, or otherwise destroying the
24-9 directive;
24-10 (2) the declarant signing and dating a written
24-11 revocation that expresses the declarant's intent to revoke the
24-12 directive; or
24-13 (3) the declarant orally stating the declarant's
24-14 intent to revoke the directive.
24-15 (b) A written revocation executed as prescribed by
24-16 Subsection (a)(2) takes effect only when the declarant or a person
24-17 acting on behalf of the declarant notifies the attending physician
24-18 of its existence or mails the revocation to the attending
24-19 physician. The attending physician or the physician's designee
24-20 shall record in the patient's medical record the time and date when
24-21 the physician received notice of the written revocation and shall
24-22 enter the word "VOID" on each page of the copy of the directive in
24-23 the patient's medical record.
24-24 (c) An oral revocation issued as prescribed by Subsection
24-25 (a)(3) takes effect only when the declarant or a person acting on
24-26 behalf of the declarant notifies the attending physician of the
25-1 revocation. The attending physician or the physician's designee
25-2 shall record in the patient's medical record the time, date, and
25-3 place of the revocation, and, if different, the time, date, and
25-4 place that the physician received notice of the revocation. The
25-5 attending physician or the physician's designees shall also enter
25-6 the word "VOID" on each page of the copy of the directive in the
25-7 patient's medical record.
25-8 (d) Except as otherwise provided by this subchapter
25-9 [chapter], a person is not civilly or criminally liable for failure
25-10 to act on a revocation made under this section unless the person
25-11 has actual knowledge of the revocation.
25-12 Sec. 166.043 [672.013]. REEXECUTION OF DIRECTIVE. A
25-13 declarant may at any time reexecute a directive in accordance with
25-14 the procedures prescribed by Section 166.032 [672.003], including
25-15 reexecution after the declarant is diagnosed as having a terminal
25-16 or irreversible condition.
25-17 [Sec. 672.014. EFFECT OF DIRECTIVE ON INSURANCE POLICY AND
25-18 PREMIUMS. (a) The fact that a person has executed or issued a
25-19 directive under this chapter does not:]
25-20 [(1) restrict, inhibit, or impair in any manner the
25-21 sale, procurement, or issuance of a life insurance policy to that
25-22 person; or]
25-23 [(2) modify the terms of an existing life insurance
25-24 policy.]
25-25 [(b) Notwithstanding the terms of any life insurance policy,
25-26 the fact that life-sustaining procedures are withheld or withdrawn
26-1 from an insured qualified patient under this chapter does not
26-2 legally impair or invalidate that person's life insurance policy.]
26-3 [(c) A physician, health facility, health provider, insurer,
26-4 or health care service plan may not require a person to execute or
26-5 issue a directive as a condition for obtaining insurance for health
26-6 care services or receiving health care services.]
26-7 [(d) The fact that a person has executed or issued or failed
26-8 to execute or issue a directive under this chapter may not be
26-9 considered in any way in establishing insurance premiums.]
26-10 Sec. 166.044 [672.015]. LIMITATION OF LIABILITY FOR
26-11 WITHHOLDING OR WITHDRAWING LIFE-SUSTAINING PROCEDURES. (a) A
26-12 physician or health care facility that causes life-sustaining
26-13 treatment [procedures] to be withheld or withdrawn from a qualified
26-14 patient in accordance with this subchapter [chapter] is not civilly
26-15 liable for that action unless the physician or health care facility
26-16 fails to exercise reasonable care when applying the patient's
26-17 advance directive [negligent].
26-18 (b) A health professional, acting under the direction of a
26-19 physician, who participates in withholding or withdrawing
26-20 life-sustaining treatment [procedures] from a qualified patient in
26-21 accordance with this subchapter [chapter] is not civilly liable for
26-22 that action unless the health professional fails to exercise
26-23 reasonable care when applying the patient's advance directive
26-24 [negligent].
26-25 (c) A physician, or a health professional acting under the
26-26 direction of a physician, who participates in withholding or
27-1 withdrawing life-sustaining treatment [procedures] from a qualified
27-2 patient in accordance with this subchapter [chapter] is not
27-3 criminally liable or guilty of unprofessional conduct as a result
27-4 of that action unless the physician or health professional fails to
27-5 exercise reasonable care when applying the patient's advance
27-6 directive [negligent].
27-7 (d) The standard of care that a physician, health care
27-8 facility, or health care professional shall exercise under this
27-9 section is that degree of care that a physician, health care
27-10 facility, or health care professional, as applicable, of ordinary
27-11 prudence and skill would have exercised under the same or similar
27-12 circumstances in the same or a similar community.
27-13 Sec. 166.045 [672.016]. [LIMITATION OF] LIABILITY FOR
27-14 FAILURE TO EFFECTUATE DIRECTIVE. (a) A physician, health care
27-15 facility, or health care professional who has no knowledge of a
27-16 directive is not civilly or criminally liable for failing to act in
27-17 accordance with the directive.
27-18 (b) A physician, or a health professional acting under the
27-19 direction of a physician, is subject to review and disciplinary
27-20 action by the appropriate licensing board [not civilly or
27-21 criminally liable] for failing to effectuate a qualified patient's
27-22 directive in violation of this subchapter or other laws of this
27-23 state. This subsection does not limit remedies available under
27-24 other laws of this state.
27-25 (c) If an attending physician refuses to comply with a
27-26 directive or treatment decision and does not wish to follow the
28-1 procedure established under Section 166.046, life-sustaining
28-2 treatment shall be provided to the patient, but only until a
28-3 reasonable opportunity has been afforded for the [physician shall
28-4 make a reasonable effort to] transfer of the patient to another
28-5 physician or health care facility willing to comply with the
28-6 directive or treatment decision.
28-7 (d) A physician, health professional acting under the
28-8 direction of a physician, or health care facility is not civilly or
28-9 criminally liable or subject to review or disciplinary action by
28-10 the person's appropriate licensing board if the person has complied
28-11 with the procedures outlined in Section 166.046.
28-12 Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE.
28-13 (a) If an attending physician refuses to honor a patient's advance
28-14 directive or a treatment decision under Section 166.039, the
28-15 physician's refusal shall be reviewed by an ethics or medical
28-16 committee. The attending physician may not be a member of that
28-17 committee. The patient shall be given life-sustaining treatment
28-18 during the review.
28-19 (b) The patient or the person responsible for the health
28-20 care decisions of the individual who has made the decision
28-21 regarding the directive or treatment decision:
28-22 (1) shall be informed of the committee review process
28-23 not less than 48 hours before the meeting called to discuss the
28-24 patient's directive, unless the time period is waived by mutual
28-25 agreement; and
28-26 (2) is entitled to:
29-1 (A) attend the meeting; and
29-2 (B) receive a written explanation of the
29-3 decision reached during the review process.
29-4 (c) The written explanation required by Subsection (b)(2)(B)
29-5 must be included in the patient's medical record.
29-6 (d) If the attending physician, the patient, or the person
29-7 responsible for the health care decisions of the individual does
29-8 not agree with the decision reached during the review process under
29-9 Subsection (b), the physician shall make a reasonable effort to
29-10 transfer the patient to a physician who is willing to comply with
29-11 the directive. If the patient is a patient in a health care
29-12 facility, the facility's personnel shall assist the physician in
29-13 arranging the patient's transfer to:
29-14 (1) another physician;
29-15 (2) an alternative care setting within that facility;
29-16 or
29-17 (3) another facility.
29-18 (e) If the patient is requesting life-sustaining treatment
29-19 that the attending physician and the review process have decided is
29-20 inappropriate treatment, the patient shall be given available
29-21 life-sustaining treatment pending transfer under Subsection (d).
29-22 The patient is responsible for any costs incurred in transferring
29-23 the patient to another facility. The physician and the health care
29-24 facility are not obligated to provide life-sustaining treatment
29-25 after the 10th day after the written decision required under
29-26 Subsection (b) is provided to the patient or the person responsible
30-1 for the health care decisions of the patient unless ordered to do
30-2 so under Subsection (g).
30-3 (f) Life-sustaining treatment under this section may not be
30-4 entered in the patient's medical record as medically unnecessary
30-5 treatment until the time period provided under Subsection (e) has
30-6 expired.
30-7 (g) At the request of the patient or the person responsible
30-8 for the health care decisions of the patient, the appropriate
30-9 district or county court shall extend the time period provided
30-10 under Subsection (e) only if the court finds, by a preponderance of
30-11 the evidence, that there is a reasonable expectation that a
30-12 physician or health care facility that will honor the patient's
30-13 directive will be found if the time extension is granted.
30-14 (h) This section may not be construed to impose an
30-15 obligation on a facility or a home and community support services
30-16 agency licensed under Chapter 142 or similar organization that is
30-17 beyond the scope of the services or resources of the facility or
30-18 agency. This section does not apply to hospice services provided
30-19 by a home and community support services agency licensed under
30-20 Chapter 142.
30-21 Sec. 166.047 [672.017]. HONORING DIRECTIVE DOES NOT
30-22 CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not commit an
30-23 offense under Section 22.08, Penal Code, by withholding or
30-24 withdrawing life-sustaining treatment [procedures] from a qualified
30-25 patient in accordance with this subchapter [chapter].
30-26 Sec. 166.048 [672.018]. CRIMINAL PENALTY; PROSECUTION.
31-1 (a) A person commits an offense if the person intentionally
31-2 conceals, cancels, defaces, obliterates, or damages another
31-3 person's directive without that person's consent. An offense under
31-4 this subsection is a Class A misdemeanor.
31-5 (b) A person is subject to prosecution for criminal homicide
31-6 under Chapter 19, Penal Code, if the person, with the intent to
31-7 cause life-sustaining treatment [procedures] to be withheld or
31-8 withdrawn from another person contrary to the other person's
31-9 desires, falsifies or forges a directive or intentionally conceals
31-10 or withholds personal knowledge of a revocation and thereby
31-11 directly causes life-sustaining treatment [procedures] to be
31-12 withheld or withdrawn from the other person with the result that
31-13 the other person's death is hastened.
31-14 Sec. 166.049 [672.019]. PREGNANT PATIENTS. A person may not
31-15 withdraw or withhold life-sustaining treatment [procedures] under
31-16 this subchapter [chapter] from a pregnant patient.
31-17 Sec. 166.050 [672.020]. MERCY KILLING NOT CONDONED. This
31-18 subchapter [chapter] does not condone, authorize, or approve mercy
31-19 killing or permit an affirmative or deliberate act or omission to
31-20 end life except to permit the natural process of dying as provided
31-21 by this subchapter [chapter].
31-22 Sec. 166.051 [672.021]. LEGAL RIGHT OR RESPONSIBILITY NOT
31-23 AFFECTED. This subchapter [chapter] does not impair or supersede
31-24 any legal right or responsibility a person may have to effect the
31-25 withholding or withdrawal of life-sustaining treatment [procedures]
31-26 in a lawful manner, provided that if an attending physician or
32-1 health care facility is unwilling to honor a patient's advance
32-2 directive or a treatment decision to provide life-sustaining
32-3 treatment, life-sustaining treatment is required to be provided the
32-4 patient, but only until a reasonable opportunity has been afforded
32-5 for transfer of the patient to another physician or health care
32-6 facility willing to comply with the advance directive or treatment
32-7 decision.
32-8 SECTION 1.04. Chapter 674, Health and Safety Code, is
32-9 transferred to Subtitle H, Title 2, Health and Safety Code, is
32-10 redesignated as Subchapter C, Chapter 166, Health and Safety Code,
32-11 and is amended to read as follows:
32-12 SUBCHAPTER C [CHAPTER 674]. OUT-OF-HOSPITAL
32-13 DO-NOT-RESUSCITATE ORDERS
32-14 Sec. 166.081 [674.001]. DEFINITIONS. In this subchapter
32-15 [chapter]:
32-16 (1) ["Attending physician" means the physician who has
32-17 primary responsibility for a person's treatment and care.]
32-18 [(2) "Board" means the Texas Board of Health.]
32-19 [(3)] "Cardiopulmonary resuscitation" means any
32-20 medical intervention used to restore circulatory or respiratory
32-21 function that has ceased [includes a component of cardiopulmonary
32-22 resuscitation].
32-23 (2) [(4) "Competent" means possessing the ability,
32-24 based on reasonable medical judgment, to understand and appreciate
32-25 the nature and consequences of a treatment decision, including the
32-26 significant benefits and harms of, and reasonable alternatives to,
33-1 a proposed treatment decision.]
33-2 [(5) "Declarant" means a person who has executed or
33-3 issued an out-of-hospital do-not-resuscitate order under this
33-4 chapter.]
33-5 [(6) "Department" means the Texas Department of
33-6 Health.]
33-7 [(7)] "DNR identification device" means an
33-8 identification device specified by the board under Section 166.101
33-9 [674.023] that is worn for the purpose of identifying a person who
33-10 has executed or issued an out-of-hospital DNR order or on whose
33-11 behalf an out-of-hospital DNR order has been executed or issued
33-12 under this subchapter [chapter].
33-13 (3) [(8) "Durable power of attorney for health care"
33-14 means a document delegating to an agent the authority to make
33-15 health care decisions for a person in accordance with Chapter 135,
33-16 Civil Practice and Remedies Code.]
33-17 [(9)] "Emergency medical services" has the meaning
33-18 assigned by Section 773.003.
33-19 (4) [(10)] "Emergency medical services personnel" has
33-20 the meaning assigned by Section 773.003.
33-21 (5) [(11)] "Health care professionals" means
33-22 physicians, physician assistants, nurses, and emergency medical
33-23 services personnel and, unless the context requires otherwise,
33-24 includes hospital emergency personnel.
33-25 (6) [(12) "Incompetent" means lacking the ability,
33-26 based on reasonable medical judgment, to understand and appreciate
34-1 the nature and consequences of a treatment decision, including the
34-2 significant benefits and harms of, and reasonable alternatives to,
34-3 a proposed treatment decision.]
34-4 [(13) "Life-sustaining procedure" means a medical
34-5 procedure, treatment, or intervention that uses mechanical or other
34-6 artificial means to sustain, restore, or supplant a spontaneous
34-7 vital function and, when applied to a person in a terminal
34-8 condition, serves only to prolong the process of dying. The term
34-9 does not include the administration of medication or the
34-10 performance of a medical procedure considered to be necessary to
34-11 provide comfort or care or to alleviate pain or the provision of
34-12 water or nutrition.]
34-13 [(14)] "Out-of-hospital DNR order":
34-14 (A) means a legally binding out-of-hospital
34-15 do-not-resuscitate order, in the form specified by the board under
34-16 Section 166.083 [674.003], prepared and signed by the attending
34-17 physician of a person [who has been diagnosed as having a terminal
34-18 condition], that documents the instructions of a person or the
34-19 person's legally authorized representative and directs health care
34-20 professionals acting in an out-of-hospital setting not to initiate
34-21 or continue the following life-sustaining treatment [procedures]:
34-22 (i) cardiopulmonary resuscitation;
34-23 (ii) [endotracheal intubation or other
34-24 means of] advanced airway management;
34-25 (iii) artificial ventilation;
34-26 (iv) defibrillation;
35-1 (v) transcutaneous cardiac pacing; and
35-2 (vi) [the administration of cardiac
35-3 resuscitation medications; and]
35-4 [(vii)] other life-sustaining treatment
35-5 [procedures] specified by the board under Section 166.101(a)
35-6 [674.023(a)]; and
35-7 (B) does not include authorization to withhold
35-8 medical interventions or therapies considered necessary to provide
35-9 comfort [or] care or to alleviate pain or to provide water or
35-10 nutrition.
35-11 (7) [(15)] "Out-of-hospital setting" means a location
35-12 [any setting outside of a licensed acute care hospital] in which
35-13 health care professionals are called for assistance, including
35-14 long-term care facilities, in-patient hospice facilities, private
35-15 homes, hospital outpatient or emergency departments, physician's
35-16 offices, and vehicles during transport.
35-17 (8) [(16) "Physician" means a physician licensed by
35-18 the Texas State Board of Medical Examiners or a properly
35-19 credentialed physician who holds a commission in the uniformed
35-20 services of the United States and who is serving on active duty in
35-21 this state.]
35-22 [(17)] "Proxy" means a person designated and
35-23 authorized by a directive executed or issued in accordance with
35-24 Subchapter B [Chapter 672] to make a treatment decision for another
35-25 person in the event the other person becomes [comatose,]
35-26 incompetent[,] or otherwise mentally or physically incapable of
36-1 communication.
36-2 (9) [(18)] "Qualified relatives" means those persons
36-3 authorized to execute or issue an out-of-hospital DNR order on
36-4 behalf of a person who is [comatose,] incompetent[,] or otherwise
36-5 mentally or physically incapable of communication under Section
36-6 166.088 [674.008].
36-7 (10) [(19)] "Statewide out-of-hospital DNR protocol"
36-8 means a set of statewide standardized procedures adopted by the
36-9 board under Section 166.101(a) [674.023] for withholding
36-10 cardiopulmonary resuscitation and certain other life-sustaining
36-11 treatment [procedures] by health care professionals acting in
36-12 out-of-hospital settings.
36-13 [(20) "Terminal condition" means an incurable or
36-14 irreversible condition caused by injury, disease, or illness that
36-15 would produce death without the application of life-sustaining
36-16 procedures, according to reasonable medical judgment, and in which
36-17 the application of life-sustaining procedures serves only to
36-18 postpone the moment of the person's death.]
36-19 Sec. 166.082 [674.002]. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE
36-20 TO PHYSICIANS. (a) A competent person [who has been diagnosed by
36-21 a physician as having a terminal condition] may at any time execute
36-22 a written out-of-hospital DNR order directing health care
36-23 professionals acting in an out-of-hospital setting to withhold
36-24 cardiopulmonary resuscitation and certain other life-sustaining
36-25 treatment [procedures] designated by the board.
36-26 (b) The declarant must sign the out-of-hospital DNR order in
37-1 the presence of two witnesses who qualify under Section 166.003, at
37-2 least one of whom must be a witness who qualifies under Section
37-3 166.003(2). The [and those] witnesses must sign the order. The
37-4 attending physician of the declarant must sign the order and shall
37-5 make the fact of the existence of the order and the reasons for
37-6 execution of the order a part of the declarant's medical record.
37-7 (c) [A witness must have the same qualifications as those
37-8 provided by Section 672.003(c).]
37-9 [(d)] If the person is incompetent but previously executed
37-10 or issued a directive to physicians in accordance with Subchapter B
37-11 [Chapter 672], the physician may rely on the directive as the
37-12 person's instructions to issue an out-of-hospital DNR order and
37-13 shall place a copy of the directive in the person's medical record.
37-14 The physician shall sign the order in lieu of the person signing
37-15 under Subsection (b).
37-16 (d) [(e)] If the person is incompetent but previously
37-17 executed or issued a directive to physicians in accordance with
37-18 Subchapter B [Chapter 672] designating a proxy, the proxy may make
37-19 any decisions required of the designating person as to an
37-20 out-of-hospital DNR order and shall sign the order in lieu of the
37-21 person signing under Subsection (b).
37-22 (e) [(f)] If the person is now incompetent but previously
37-23 executed or issued a medical [durable] power of attorney [for
37-24 health care in accordance with Chapter 135, Civil Practice and
37-25 Remedies Code,] designating an agent, the agent may make any
37-26 decisions required of the designating person as to an
38-1 out-of-hospital DNR order and shall sign the order in lieu of the
38-2 person signing under Subsection (b).
38-3 (f) [(g)] The board, on the recommendation of the
38-4 department, shall by rule adopt procedures for the disposition and
38-5 maintenance of records of an original out-of-hospital DNR order and
38-6 any copies of the order.
38-7 (g) [(h)] An out-of-hospital DNR order is effective on its
38-8 execution.
38-9 Sec. 166.083 [674.003]. FORM OF OUT-OF-HOSPITAL DNR ORDER.
38-10 (a) A written out-of-hospital DNR order shall be in the standard
38-11 form specified by board rule as recommended by the department.
38-12 (b) The standard form of an out-of-hospital DNR order
38-13 specified by the board must, at a minimum, contain the following:
38-14 (1) a distinctive single-page format that readily
38-15 identifies the document as an out-of-hospital DNR order;
38-16 (2) a title that readily identifies the document as an
38-17 out-of-hospital DNR order;
38-18 (3) the printed or typed name of the person;
38-19 (4) a statement that the physician signing the
38-20 document is the attending physician of the person[, that the
38-21 physician has diagnosed the person as having a terminal condition,]
38-22 and that the physician is directing health care professionals
38-23 acting in out-of-hospital settings, including a hospital emergency
38-24 department, not to initiate or continue certain life-sustaining
38-25 treatment [procedures] on behalf of the person, and a listing of
38-26 those procedures not to be initiated or continued;
39-1 (5) a statement that the person understands that the
39-2 person may revoke the out-of-hospital DNR order at any time by
39-3 destroying the order and removing the DNR identification device, if
39-4 any, or by communicating to health care professionals at the scene
39-5 the person's desire to revoke the out-of-hospital DNR order;
39-6 (6) places for the printed names and signatures of the
39-7 witnesses and attending physician of the person and the medical
39-8 license number of the attending physician;
39-9 (7) a separate section for execution of the document
39-10 by the legal guardian of the person, the person's proxy, an agent
39-11 of the person having a medical [durable] power of attorney [for
39-12 health care], or the attending physician attesting to the issuance
39-13 of an out-of-hospital DNR order by nonwritten means of
39-14 communication or acting in accordance with a previously executed or
39-15 previously issued directive to physicians under Section 166.082(c)
39-16 [674.002(d)] that includes the following:
39-17 (A) a statement that the legal guardian, the
39-18 proxy, the agent, the person by nonwritten means of communication,
39-19 or the physician directs that each [the] listed life-sustaining
39-20 treatment [procedures] should not be initiated or continued in
39-21 behalf of the person; and
39-22 (B) places for the printed names and signatures
39-23 of the witnesses and, as applicable, the legal guardian, proxy,
39-24 agent, or physician;
39-25 (8) a separate section for execution of the document
39-26 by at least one [two] qualified relative [relatives] of the person
40-1 when the person does not have a legal guardian, proxy, or agent
40-2 having a medical [durable] power of attorney [for health care] and
40-3 is [comatose,] incompetent[,] or otherwise mentally or physically
40-4 incapable of communication, including:
40-5 (A) a statement that the relative [relatives] of
40-6 the person is [are] qualified to make a treatment decision to
40-7 withhold cardiopulmonary resuscitation and certain other designated
40-8 life-sustaining treatment [procedures] under Section 166.088
40-9 [674.008] and, based on the known desires of the person or a
40-10 determination of the best interest of the person, directs [direct]
40-11 that each [the] listed life-sustaining treatment [procedures]
40-12 should not be initiated or continued in behalf of the person; and
40-13 (B) places for the printed names and signatures
40-14 of the witnesses and qualified relative [relatives] of the person;
40-15 (9) a place for entry of the date of execution of the
40-16 document;
40-17 (10) a statement that the document is in effect on the
40-18 date of its execution and remains in effect until the death of the
40-19 person or until the document is revoked;
40-20 (11) a statement that the document must accompany the
40-21 person during transport;
40-22 (12) a statement regarding the proper disposition of
40-23 the document or copies of the document, as the board determines
40-24 appropriate; and
40-25 (13) a statement at the bottom of the document, with
40-26 places for the signature of each person executing the document,
41-1 that the document has been properly completed.
41-2 (c) The board may, by rule and as recommended by the
41-3 department, modify the standard form of the out-of-hospital DNR
41-4 order described by Subsection (b) in order to accomplish the
41-5 purposes of this subchapter [chapter].
41-6 (d) A photocopy or other complete facsimile of the original
41-7 written out-of-hospital DNR order executed under this subchapter
41-8 may be used for any purpose for which the original written order
41-9 may be used under this subchapter.
41-10 Sec. 166.084 [674.004]. ISSUANCE OF OUT-OF-HOSPITAL DNR
41-11 ORDER BY NONWRITTEN COMMUNICATION. (a) A competent person who is
41-12 an adult may issue an out-of-hospital DNR order by nonwritten
41-13 communication.
41-14 (b) A declarant must issue the nonwritten out-of-hospital
41-15 DNR order in the presence of the attending physician and two
41-16 witnesses who qualify under Section 166.003, at least one of whom
41-17 must be a witness who qualifies under Section 166.003(2). [The
41-18 witnesses must possess the same qualifications as those provided by
41-19 Section 672.003(c).]
41-20 (c) The attending physician and witnesses shall sign the
41-21 out-of-hospital DNR order in the [that] place of the document
41-22 provided by Section 166.083(b)(7) [674.003(b)(7)] and the attending
41-23 physician shall sign the document in the place required by Section
41-24 166.083(b)(13) [674.003(b)(13)]. The physician shall make the fact
41-25 of the existence of the out-of-hospital DNR order a part of the
41-26 declarant's medical record and the names of the witnesses shall be
42-1 entered [sign that entry] in the medical record.
42-2 (d) An out-of-hospital DNR order issued in the manner
42-3 provided by this section is valid and shall be honored by
42-4 responding health care professionals as if executed in the manner
42-5 provided by Section 166.082 [674.002].
42-6 Sec. 166.085 [674.005]. EXECUTION OF OUT-OF-HOSPITAL DNR
42-7 ORDER ON BEHALF OF A MINOR. The following persons may execute an
42-8 out-of-hospital DNR order on behalf of a minor:
42-9 (1) the minor's parents;
42-10 (2) the minor's legal guardian; or
42-11 (3) the minor's managing conservator.
42-12 Sec. 166.086 [674.006]. DESIRE OF PERSON SUPERSEDES
42-13 OUT-OF-HOSPITAL DNR ORDER. The desire of a competent person,
42-14 including a competent minor, supersedes the effect of an
42-15 out-of-hospital DNR order executed or issued by or on behalf of the
42-16 person when the desire is communicated to responding health care
42-17 professionals as provided by this subchapter [chapter].
42-18 Sec. 166.087 [674.007]. PROCEDURE WHEN DECLARANT IS
42-19 INCOMPETENT OR INCAPABLE OF COMMUNICATION. (a) This section
42-20 applies when a person 18 years of age or older has executed or
42-21 issued an out-of-hospital DNR order and subsequently becomes
42-22 [comatose,] incompetent[,] or otherwise mentally or physically
42-23 incapable of communication.
42-24 (b) If the adult person has designated a person to make a
42-25 treatment decision as authorized by Section 166.032(c)
42-26 [672.003(d)], the attending physician and the designated person
43-1 shall comply with the out-of-hospital DNR order.
43-2 (c) If the adult person has not designated a person to make
43-3 a treatment decision as authorized by Section 166.032(c)
43-4 [672.003(d)], the attending physician shall comply with the
43-5 out-of-hospital DNR order unless the physician believes that the
43-6 order does not reflect the person's present desire.
43-7 Sec. 166.088 [674.008]. PROCEDURE WHEN PERSON HAS NOT
43-8 EXECUTED OR ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR
43-9 INCAPABLE OF COMMUNICATION. (a) If an adult person has not
43-10 executed or issued an out-of-hospital DNR order and is [comatose,]
43-11 incompetent[,] or otherwise mentally or physically incapable of
43-12 communication, the attending physician and the person's legal
43-13 guardian, proxy, or agent having a medical [durable] power of
43-14 attorney [for health care] may execute an out-of-hospital DNR order
43-15 on behalf of the person.
43-16 (b) If the person does not have a legal guardian, proxy, or
43-17 agent under a medical power of attorney, the attending physician
43-18 and at least one [two] qualified relative from a category listed by
43-19 Section 166.039(b), subject to the priority established under that
43-20 subsection, [relatives] may execute an out-of-hospital DNR order in
43-21 the same manner as a treatment decision made under Section
43-22 166.039(b) [672.009(b)].
43-23 (c) A decision to execute an out-of-hospital DNR order made
43-24 under Subsection (a) or (b) must be based on knowledge of what the
43-25 person would desire, if known.
43-26 (d) An out-of-hospital DNR order executed under Subsection
44-1 (b) must be made in the presence of at least two witnesses who
44-2 qualify under Section 166.003, at least one of whom must be a
44-3 witness who qualifies under Section 166.003(2) [who possess the
44-4 same qualifications that are required by Section 672.003(c)].
44-5 (e) The fact that an adult person has not executed or issued
44-6 an out-of-hospital DNR order does not create a presumption that the
44-7 person does not want a treatment decision made to withhold
44-8 cardiopulmonary resuscitation and certain other designated
44-9 life-sustaining treatment [procedures] designated by the board.
44-10 (f) If there is not a qualified relative available to act
44-11 for the person under Subsection (b), an out-of-hospital DNR order
44-12 must be concurred in by another physician who is not involved in
44-13 the treatment of the patient or who is a representative of the
44-14 ethics or medical committee of the health care facility in which
44-15 the person is a patient.
44-16 (g) A person listed in Section 166.039(b) who wishes to
44-17 challenge a decision made under this section must apply for
44-18 temporary guardianship under Section 875, Texas Probate Code. The
44-19 court may waive applicable fees in that proceeding.
44-20 Sec. 166.089 [674.009]. COMPLIANCE WITH OUT-OF-HOSPITAL DNR
44-21 ORDER. (a) When responding to a call for assistance, health care
44-22 professionals shall honor an out-of-hospital DNR order in
44-23 accordance with the statewide out-of-hospital DNR protocol and,
44-24 where applicable, locally adopted out-of-hospital DNR protocols not
44-25 in conflict with the statewide protocol if:
44-26 (1) the responding health care professionals discover
45-1 an executed or issued out-of-hospital DNR order form on their
45-2 arrival at the scene; and
45-3 (2) the responding health care professionals comply
45-4 with this section.
45-5 (b) If the person is wearing a DNR identification device,
45-6 the responding health care professionals must comply with Section
45-7 166.090 [674.010].
45-8 (c) The responding health care professionals must establish
45-9 the identity of the person as the person who executed or issued the
45-10 out-of-hospital DNR order or for whom the out-of-hospital DNR order
45-11 was executed or issued.
45-12 (d) The responding health care professionals must determine
45-13 that the out-of-hospital DNR order form appears to be valid in that
45-14 it includes:
45-15 (1) written responses in the places designated on the
45-16 form for the names, signatures, and other information required of
45-17 persons executing or issuing, or witnessing the execution or
45-18 issuance of, the order;
45-19 (2) a date in the place designated on the form for the
45-20 date the order was executed or issued; and
45-21 (3) the signature of the declarant or persons
45-22 executing or issuing the order and the attending physician in the
45-23 appropriate places designated on the form for indicating that the
45-24 order form has been properly completed.
45-25 (e) If the conditions prescribed by Subsections (a) through
45-26 (d) are not determined to apply by the responding health care
46-1 professionals at the scene, the out-of-hospital DNR order may not
46-2 be honored and life-sustaining procedures otherwise required by law
46-3 or local emergency medical services protocols shall be initiated or
46-4 continued. Health care professionals acting in out-of-hospital
46-5 settings are not required to accept or interpret an out-of-hospital
46-6 DNR order that does not meet the requirements of this subchapter
46-7 [chapter].
46-8 (f) The out-of-hospital DNR order form or a copy of the
46-9 form, when available, must accompany the person during transport.
46-10 (g) A record shall be made and maintained of the
46-11 circumstances of each emergency medical services response in which
46-12 an out-of-hospital DNR order or DNR identification device is
46-13 encountered, in accordance with the statewide out-of-hospital DNR
46-14 protocol and any applicable local out-of-hospital DNR protocol not
46-15 in conflict with the statewide protocol.
46-16 (h) An out-of-hospital DNR order executed or issued and
46-17 documented or evidenced in the manner prescribed by this subchapter
46-18 [chapter] is valid and shall be honored by responding health care
46-19 professionals unless the person or persons found at the scene:
46-20 (1) identify themselves as the declarant or as the
46-21 attending physician, legal guardian, qualified relative, or agent
46-22 of the person having a medical [durable] power of attorney [for
46-23 health care] who executed or issued the out-of-hospital DNR order
46-24 on behalf of the person; and
46-25 (2) request that cardiopulmonary resuscitation or
46-26 certain other life-sustaining treatment [procedures] designated by
47-1 the board be initiated or continued.
47-2 (i) If the policies of a health care facility preclude
47-3 compliance with the out-of-hospital DNR order of a person or an
47-4 out-of-hospital DNR order issued by an attending physician on
47-5 behalf of a person who is admitted to or a resident of the
47-6 facility, or if the facility is unwilling to accept DNR
47-7 identification devices as evidence of the existence of an
47-8 out-of-hospital DNR order, that facility shall take all reasonable
47-9 steps to notify the person or, if the person is incompetent, the
47-10 person's guardian or the person or persons having authority to make
47-11 health care treatment decisions on behalf of the person, of the
47-12 facility's policy and shall take all reasonable steps to effect the
47-13 transfer of the person to the person's home or to a facility where
47-14 the provisions of this subchapter [chapter] can be carried out.
47-15 Sec. 166.090 [674.010]. DNR IDENTIFICATION DEVICE. (a) A
47-16 person who has a valid out-of-hospital DNR order under this
47-17 subchapter [chapter] may wear a DNR identification device around
47-18 the neck or on the wrist as prescribed by board rule adopted under
47-19 Section 166.101 [674.023].
47-20 (b) The presence of a DNR identification device on the body
47-21 of a person is conclusive evidence that the person has executed or
47-22 issued a valid out-of-hospital DNR order or has a valid
47-23 out-of-hospital DNR order executed or issued on the person's
47-24 behalf. Responding health care professionals shall honor the DNR
47-25 identification device as if a valid out-of-hospital DNR order form
47-26 executed or issued by the person were found in the possession of
48-1 the person.
48-2 Sec. 166.091 [674.011]. DURATION OF OUT-OF-HOSPITAL DNR
48-3 ORDER. An out-of-hospital DNR order is effective until it is
48-4 revoked as prescribed by Section 166.092 [674.012].
48-5 Sec. 166.092 [674.012]. REVOCATION OF OUT-OF-HOSPITAL DNR
48-6 ORDER. (a) A declarant may revoke an out-of-hospital DNR order at
48-7 any time without regard to the declarant's mental state or
48-8 competency. An order may be revoked by:
48-9 (1) the declarant or someone in the declarant's
48-10 presence and at the declarant's direction destroying the order form
48-11 and removing the DNR identification device, if any;
48-12 (2) a person who identifies himself or herself as the
48-13 legal guardian, as a qualified relative, or as the agent of the
48-14 declarant having a medical [durable] power of attorney [for health
48-15 care] who executed the out-of-hospital DNR order or another person
48-16 in the person's presence and at the person's direction destroying
48-17 the order form and removing the DNR identification device, if any;
48-18 (3) the declarant communicating the declarant's intent
48-19 to revoke the order; or
48-20 (4) a person who identifies himself or herself as the
48-21 legal guardian, a qualified relative, or the agent of the declarant
48-22 having a medical [durable] power of attorney [for health care] who
48-23 executed the out-of-hospital DNR order orally stating the person's
48-24 intent to revoke the order.
48-25 (b) An oral revocation under Subsection (a)(3) or (a)(4)
48-26 takes effect only when the declarant or a person who identifies
49-1 himself or herself as the legal guardian, a qualified relative, or
49-2 the agent of the declarant having a medical [durable] power of
49-3 attorney [for health care] who executed the out-of-hospital DNR
49-4 order communicates the intent to revoke the order to the responding
49-5 health care professionals or the attending physician at the scene.
49-6 The responding health care professionals shall record the time,
49-7 date, and place of the revocation in accordance with the statewide
49-8 out-of-hospital DNR protocol and rules adopted by the board and any
49-9 applicable local out-of-hospital DNR protocol. The attending
49-10 physician or the physician's designee shall record in the person's
49-11 medical record the time, date, and place of the revocation and, if
49-12 different, the time, date, and place that the physician received
49-13 notice of the revocation. The attending physician or the
49-14 physician's designee shall also enter the word "VOID" on each page
49-15 of the copy of the order in the person's medical record.
49-16 (c) Except as otherwise provided by this subchapter
49-17 [chapter], a person is not civilly or criminally liable for failure
49-18 to act on a revocation made under this section unless the person
49-19 has actual knowledge of the revocation.
49-20 Sec. 166.093 [674.013]. REEXECUTION OF OUT-OF-HOSPITAL DNR
49-21 ORDER. A declarant may at any time reexecute or reissue an
49-22 out-of-hospital DNR order in accordance with the procedures
49-23 prescribed by Section 166.082 [674.002], including reexecution or
49-24 reissuance after the declarant is diagnosed as having a terminal or
49-25 irreversible condition.
49-26 [Sec. 674.014. CONFLICT WITH NATURAL DEATH ACT OR DURABLE
50-1 POWER OF ATTORNEY FOR HEALTH CARE. To the extent that an
50-2 out-of-hospital DNR order conflicts with a directive or treatment
50-3 decision executed or issued under Chapter 672 or a durable power of
50-4 attorney for health care executed or issued in accordance with
50-5 Chapter 135, Civil Practice and Remedies Code, the instrument
50-6 executed later in time controls.]
50-7 [Sec. 674.015. EFFECT OF OUT-OF-HOSPITAL DNR ORDER ON
50-8 INSURANCE POLICY AND PREMIUMS. (a) The fact that a person has
50-9 executed or issued an out-of-hospital DNR order under this chapter
50-10 does not:]
50-11 [(1) restrict, inhibit, or impair in any manner the
50-12 sale, procurement, or issuance of a life insurance policy to that
50-13 person; or]
50-14 [(2) modify the terms of an existing life insurance
50-15 policy.]
50-16 [(b) Notwithstanding the terms of any life insurance policy,
50-17 the fact that cardiopulmonary resuscitation or certain other
50-18 life-sustaining procedures designated by the board are withheld
50-19 from an insured person under this chapter does not legally impair
50-20 or invalidate that person's life insurance policy and may not be a
50-21 factor for the purpose of determining the payability of benefits or
50-22 the cause of death under the life insurance policy.]
50-23 [(c) A physician, health facility, health care provider,
50-24 insurer, or health care service plan may not require a person to
50-25 execute or issue an out-of-hospital DNR order as a condition for
50-26 obtaining insurance for health care services or receiving health
51-1 care services.]
51-2 [(d) The fact that a person has executed or issued or failed
51-3 to execute or issue an out-of-hospital DNR order under this chapter
51-4 may not be considered in any way in establishing insurance
51-5 premiums.]
51-6 Sec. 166.094 [674.016]. LIMITATION ON LIABILITY FOR
51-7 WITHHOLDING CARDIOPULMONARY RESUSCITATION AND CERTAIN OTHER
51-8 LIFE-SUSTAINING PROCEDURES. (a) A health care professional or
51-9 health care facility or entity that in good faith causes
51-10 cardiopulmonary resuscitation or certain other life-sustaining
51-11 treatment [procedures] designated by the board to be withheld from
51-12 a person in accordance with this subchapter [chapter] is not
51-13 civilly liable for that action.
51-14 (b) A health care professional or health care facility or
51-15 entity that in good faith participates in withholding
51-16 cardiopulmonary resuscitation or certain other life-sustaining
51-17 treatment [procedures] designated by the board from a person in
51-18 accordance with this subchapter [chapter] is not civilly liable for
51-19 that action.
51-20 (c) A health care professional or health care facility or
51-21 entity that in good faith participates in withholding
51-22 cardiopulmonary resuscitation or certain other life-sustaining
51-23 treatment [procedures] designated by the board from a person in
51-24 accordance with this subchapter [chapter] is not criminally liable
51-25 or guilty of unprofessional conduct as a result of that action.
51-26 (d) A health care professional or health care facility or
52-1 entity that in good faith causes or participates in withholding
52-2 cardiopulmonary resuscitation or certain other life-sustaining
52-3 treatment [procedures] designated by the board from a person in
52-4 accordance with this subchapter [chapter] and rules adopted under
52-5 this subchapter [chapter] is not in violation of any other
52-6 licensing or regulatory laws or rules of this state and is not
52-7 subject to any disciplinary action or sanction by any licensing or
52-8 regulatory agency of this state as a result of that action.
52-9 Sec. 166.095 [674.017]. LIMITATION ON LIABILITY FOR FAILURE
52-10 TO EFFECTUATE OUT-OF-HOSPITAL DNR ORDER. (a) A health care
52-11 professional or health care facility or entity that has no actual
52-12 knowledge of an out-of-hospital DNR order is not civilly or
52-13 criminally liable for failing to act in accordance with the order.
52-14 (b) A health care professional or health care facility or
52-15 entity is subject to review and disciplinary action by the
52-16 appropriate licensing board [not civilly or criminally liable] for
52-17 failing to effectuate an out-of-hospital DNR order. This
52-18 subsection does not limit remedies available under other laws of
52-19 this state.
52-20 (c) If an attending physician refuses to execute or comply
52-21 with an out-of-hospital DNR order, the physician shall inform the
52-22 person, the legal guardian or qualified relatives of the person, or
52-23 the agent of the person having a medical [durable] power of
52-24 attorney [for health care] and, if the person or another authorized
52-25 to act on behalf of the person so directs, shall make a reasonable
52-26 effort to transfer the person to another physician who is willing
53-1 to execute or comply with an out-of-hospital DNR order.
53-2 Sec. 166.096 [674.018]. HONORING OUT-OF-HOSPITAL DNR ORDER
53-3 DOES NOT CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not
53-4 commit an offense under Section 22.08, Penal Code, by withholding
53-5 cardiopulmonary resuscitation or certain other life-sustaining
53-6 treatment [procedures] designated by the board from a person in
53-7 accordance with this subchapter [chapter].
53-8 Sec. 166.097 [674.019]. CRIMINAL PENALTY; PROSECUTION.
53-9 (a) A person commits an offense if the person intentionally
53-10 conceals, cancels, defaces, obliterates, or damages another
53-11 person's out-of-hospital DNR order or DNR identification device
53-12 without that person's consent or the consent of the person or
53-13 persons authorized to execute or issue an out-of-hospital DNR order
53-14 on behalf of the person under this subchapter [chapter]. An
53-15 offense under this subsection is a Class A misdemeanor.
53-16 (b) A person is subject to prosecution for criminal homicide
53-17 under Chapter 19, Penal Code, if the person, with the intent to
53-18 cause cardiopulmonary resuscitation or certain other
53-19 life-sustaining treatment [procedures] designated by the board to
53-20 be withheld from another person contrary to the other person's
53-21 desires, falsifies or forges an out-of-hospital DNR order or
53-22 intentionally conceals or withholds personal knowledge of a
53-23 revocation and thereby directly causes cardiopulmonary
53-24 resuscitation and certain other life-sustaining treatment
53-25 [procedures] designated by the board to be withheld from the other
53-26 person with the result that the other person's death is hastened.
54-1 Sec. 166.098 [674.020]. PREGNANT PERSONS. A person may not
54-2 withhold cardiopulmonary resuscitation or certain other
54-3 life-sustaining treatment [procedures] designated by the board
54-4 under this subchapter [chapter] from a person known by the
54-5 responding health care professionals to be pregnant.
54-6 Sec. 166.099 [674.021]. MERCY KILLING NOT CONDONED. This
54-7 subchapter [chapter] does not condone, authorize, or approve mercy
54-8 killing or permit an affirmative or deliberate act or omission to
54-9 end life except to permit the natural process of dying as provided
54-10 by this subchapter [chapter].
54-11 Sec. 166.100 [674.022]. LEGAL RIGHT OR RESPONSIBILITY NOT
54-12 AFFECTED. This subchapter [chapter] does not impair or supersede
54-13 any legal right or responsibility a person may have under a
54-14 constitution, other statute, regulation, or court decision to
54-15 effect the withholding of cardiopulmonary resuscitation or certain
54-16 other life-sustaining treatment [procedures] designated by the
54-17 board.
54-18 Sec. 166.101 [674.023]. DUTIES OF DEPARTMENT AND BOARD.
54-19 (a) The board shall, on the recommendation of the department,
54-20 adopt all reasonable and necessary rules to carry out the purposes
54-21 of this subchapter [chapter], including rules:
54-22 (1) adopting a statewide out-of-hospital DNR order
54-23 protocol that sets out standard procedures for the withholding of
54-24 cardiopulmonary resuscitation and certain other life-sustaining
54-25 treatment [procedures] by health care professionals acting in
54-26 out-of-hospital settings;
55-1 (2) designating life-sustaining treatment [procedures]
55-2 that may be included in an out-of-hospital DNR order, including all
55-3 procedures listed in Sections 166.081(6)(A)(i) through (v) [Section
55-4 674.001(14)(A)(i) through (vi)]; and
55-5 (3) governing recordkeeping in circumstances in which
55-6 an out-of-hospital DNR order or DNR identification device is
55-7 encountered by responding health care professionals.
55-8 (b) The rules adopted by the board under Subsection (a) are
55-9 not effective until approved by the Texas State Board of Medical
55-10 Examiners.
55-11 (c) Local emergency medical services authorities may adopt
55-12 local out-of-hospital DNR order protocols if the local protocols do
55-13 not conflict with the statewide out-of-hospital DNR order protocol
55-14 adopted by the board.
55-15 (d) The board by rule shall specify a distinctive standard
55-16 design for a necklace and a bracelet DNR identification device that
55-17 signifies, when worn by a person, that the possessor has executed
55-18 or issued a valid out-of-hospital DNR order under this subchapter
55-19 [chapter] or is a person for whom a valid out-of-hospital DNR order
55-20 has been executed or issued.
55-21 (e) The department shall report to the board from time to
55-22 time regarding issues identified in emergency medical services
55-23 responses in which an out-of-hospital DNR order or DNR
55-24 identification device is encountered. The report may contain
55-25 recommendations to the board for necessary modifications to the
55-26 form of the standard out-of-hospital DNR order or the designated
56-1 life-sustaining procedures listed in the standard out-of-hospital
56-2 DNR order, the statewide out-of-hospital DNR order protocol, or the
56-3 DNR identification devices.
56-4 [Sec. 674.024. RECOGNITION OF OUT-OF-HOSPITAL DNR ORDER
56-5 EXECUTED OR ISSUED IN OTHER STATE. An out-of-hospital DNR order
56-6 executed, issued, or authorized in another state or a territory or
56-7 possession of the United States in compliance with the law of that
56-8 jurisdiction is effective for purposes of this chapter.]
56-9 SECTION 1.05. Chapter 135, Civil Practice and Remedies Code,
56-10 is transferred to Subtitle H, Title 2, Health and Safety Code, is
56-11 redesignated as Subchapter D, Chapter 166, Health and Safety Code,
56-12 and is amended to read as follows:
56-13 SUBCHAPTER D [CHAPTER 135]. MEDICAL [DURABLE]
56-14 POWER OF ATTORNEY [FOR HEALTH CARE]
56-15 Sec. 166.151 [135.001]. DEFINITIONS. In this subchapter
56-16 [chapter]:
56-17 (1) "Adult" means a person 18 years of age or older or
56-18 a person under 18 years of age who has had the disabilities of
56-19 minority removed.
56-20 (2) "Agent" means an adult to whom authority to make
56-21 health care decisions is delegated under a medical [durable] power
56-22 of attorney [for health care].
56-23 (3) ["Attending physician" means the physician,
56-24 selected by or assigned to a patient, who has primary
56-25 responsibility for the treatment and care of the patient.]
56-26 [(4) "Capacity to make health care decisions" means
57-1 the ability to understand and appreciate the nature and
57-2 consequences of a health care decision, including the significant
57-3 benefits and harms of and reasonable alternatives to any proposed
57-4 health care.]
57-5 [(5) "Durable power of attorney for health care" means
57-6 a document delegating to an agent the authority to make health care
57-7 decisions as provided by this chapter.]
57-8 [(6) "Health care decision" means consent, refusal to
57-9 consent, or withdrawal of consent to health care, treatment,
57-10 service, or procedure to maintain, diagnose, or treat an
57-11 individual's physical or mental condition.]
57-12 [(7)] "Health care provider" means an individual or
57-13 facility licensed, certified, or otherwise authorized to administer
57-14 health care, for profit or otherwise, in the ordinary course of
57-15 business or professional practice and includes a physician.
57-16 (4) [(8) "Physician" means:]
57-17 [(A) a physician licensed by the Texas State
57-18 Board of Medical Examiners; or]
57-19 [(B) a physician with proper credentials who
57-20 holds a commission in a branch of the armed services of the United
57-21 States and who is serving on active duty in this state.]
57-22 [(9)] "Principal" means an adult who has executed a
57-23 medical [durable] power of attorney [for health care].
57-24 (5) [(10)] "Residential care provider" means an
57-25 individual or facility licensed, certified, or otherwise authorized
57-26 to operate, for profit or otherwise, a residential care home.
58-1 Sec. 166.152 [135.002]. SCOPE AND DURATION OF AUTHORITY.
58-2 (a) Subject to this subchapter [chapter] or any express limitation
58-3 on the authority of the agent contained in the medical [durable]
58-4 power of attorney [for health care], the agent may make any health
58-5 care decision on the principal's behalf that the principal could
58-6 make if the principal were competent [but for the principal's lack
58-7 of capacity to make health care decisions].
58-8 (b) An agent may exercise authority only if the principal's
58-9 attending physician certifies in writing and files the
58-10 certification in the principal's medical record that, based on the
58-11 attending physician's reasonable medical judgment, the principal is
58-12 incompetent [lacks capacity to make health care decisions].
58-13 (c) Notwithstanding any other provisions of this subchapter
58-14 [chapter], treatment may not be given to or withheld from the
58-15 principal if the principal objects regardless of whether, at the
58-16 time of the objection:
58-17 (1) a medical [durable] power of attorney [for health
58-18 care] is in effect; or
58-19 (2) the principal is competent [has the capacity to
58-20 make health care decisions].
58-21 (d) The principal's attending physician shall make
58-22 reasonable efforts to inform the principal of any proposed
58-23 treatment or of any proposal to withdraw or withhold treatment
58-24 before implementing an agent's advance directive.
58-25 (e) After consultation with the attending physician and
58-26 other health care providers, the agent shall make a health care
59-1 decision:
59-2 (1) according to the agent's knowledge of the
59-3 principal's wishes, including the principal's religious and moral
59-4 beliefs; or
59-5 (2) if the agent does not know the principal's wishes,
59-6 according to the agent's assessment of the principal's best
59-7 interests.
59-8 (f) Notwithstanding any other provision of this subchapter
59-9 [chapter], an agent may not consent to:
59-10 (1) voluntary inpatient mental health services;
59-11 (2) convulsive treatment;
59-12 (3) psychosurgery;
59-13 (4) abortion; or
59-14 (5) neglect of the principal through the omission of
59-15 care primarily intended to provide for the comfort of the
59-16 principal.
59-17 (g) The power of attorney is effective indefinitely on
59-18 execution as provided by this subchapter [chapter] and delivery of
59-19 the document to the agent, unless it is revoked as provided by this
59-20 subchapter [chapter] or the principal becomes competent [regains
59-21 the capacity to make health care decisions]. If the medical
59-22 [durable] power of attorney includes an expiration date and on that
59-23 date the principal is incompetent [lacks the capacity to make
59-24 health care decisions], the power of attorney continues to be
59-25 effective until the principal becomes competent [regains the
59-26 capacity to make health care decisions] unless it is revoked as
60-1 provided by this subchapter [chapter].
60-2 Sec. 166.153 [135.003]. PERSONS WHO MAY NOT EXERCISE
60-3 AUTHORITY OF AGENT. A person may not exercise the authority of an
60-4 agent while the person serves as:
60-5 (1) the principal's health care provider;
60-6 (2) an employee of the principal's health care
60-7 provider unless the person is a relative of the principal;
60-8 (3) the principal's residential care provider; or
60-9 (4) an employee of the principal's residential care
60-10 provider unless the person is a relative of the principal.
60-11 Sec. 166.154 [135.004]. EXECUTION AND WITNESSES. (a) The
60-12 medical [durable] power of attorney [for health care] must be
60-13 signed by the principal in the presence of [at least] two [or more
60-14 subscribing] witnesses who qualify under Section 166.003, at least
60-15 one of whom must be a witness who qualifies under Section
60-16 166.003(2). The witnesses must sign the document.
60-17 (b) [A witness may not, at the time of execution, be:]
60-18 [(1) the agent;]
60-19 [(2) the principal's health or residential care
60-20 provider or the provider's employee;]
60-21 [(3) the principal's spouse or heir;]
60-22 [(4) a person entitled to any part of the estate of
60-23 the principal on the death of the principal under a will or deed in
60-24 existence or by operation of law; or]
60-25 [(5) any other person who has any claim against the
60-26 estate of the principal.]
61-1 [(c) The witnesses shall affirm that, at the time the
61-2 durable power of attorney for health care was signed, the
61-3 principal:]
61-4 [(1) appeared to be of sound mind to make a health
61-5 care decision;]
61-6 [(2) stated in the witness's presence that the
61-7 principal was aware of the nature of the durable power of attorney
61-8 for health care and that the principal was signing the document
61-9 voluntarily and free from any duress; and]
61-10 [(3) requested that the witness serve as a witness to
61-11 the principal's execution of the document.]
61-12 [(d)] If the principal is physically unable to sign, another
61-13 person may sign the medical [durable] power of attorney [for health
61-14 care] with the principal's name in the principal's presence and at
61-15 the principal's express direction.
61-16 Sec. 166.155 [135.005]. REVOCATION. (a) A medical
61-17 [durable] power of attorney [for health care] is revoked by:
61-18 (1) oral or written notification at any time by the
61-19 principal to the agent or a licensed or certified health or
61-20 residential care provider or by any other act evidencing a specific
61-21 intent to revoke the power, without regard to whether the principal
61-22 is competent or the principal's mental state[, competency, or
61-23 capacity to make health care decisions];
61-24 (2) execution by the principal of a subsequent medical
61-25 [durable] power of attorney [for health care]; or
61-26 (3) the divorce of the principal and spouse, if the
62-1 spouse is the principal's agent, unless the medical power of
62-2 attorney provides otherwise.
62-3 (b) A principal's licensed or certified health or
62-4 residential care provider who is informed of or provided with a
62-5 revocation of a medical [durable] power of attorney [for health
62-6 care] shall immediately record the revocation in the principal's
62-7 medical record and give notice of the revocation to the agent and
62-8 any known health and residential care providers currently
62-9 responsible for the principal's care.
62-10 Sec. 166.156 [135.006]. APPOINTMENT OF GUARDIAN. (a) On
62-11 motion filed in connection with a petition for appointment of a
62-12 guardian or, if a guardian has been appointed, on petition of the
62-13 guardian, a probate court shall determine whether to suspend or
62-14 revoke the authority of the agent.
62-15 (b) The court shall consider the preferences of the
62-16 principal as expressed in the medical [durable] power of attorney
62-17 [for health care].
62-18 (c) During the pendency of the court's determination under
62-19 Subsection (a), the guardian has the sole authority to make any
62-20 health care decisions unless the court orders otherwise. If a
62-21 guardian has not been appointed, the agent has the authority to
62-22 make any health care decisions unless the court orders otherwise.
62-23 (d) A person, including any attending physician or health or
62-24 residential care provider, who does not have actual knowledge of
62-25 the appointment of a guardian or an order of the court granting
62-26 authority to someone other than the agent to make health care
63-1 decisions is not subject to criminal or civil liability and has not
63-2 engaged in unprofessional conduct for implementing an agent's
63-3 health care decision.
63-4 Sec. 166.157 [135.007]. DISCLOSURE OF MEDICAL INFORMATION.
63-5 Subject to any limitations in the medical [durable] power of
63-6 attorney [for health care], an agent may, for the purpose of making
63-7 a health care decision:
63-8 (1) request, review, and receive any information, oral
63-9 or written, regarding the principal's physical or mental health,
63-10 including medical and hospital records;
63-11 (2) execute a release or other document required to
63-12 obtain the information; and
63-13 (3) consent to the disclosure of the information.
63-14 Sec. 166.158 [135.008]. DUTY OF HEALTH OR RESIDENTIAL CARE
63-15 PROVIDER. (a) A principal's health or residential care provider
63-16 and an employee of the provider who knows of the existence of the
63-17 principal's medical [durable] power of attorney [for health care]
63-18 shall follow a directive of the principal's agent to the extent it
63-19 is consistent with the desires of the principal, this subchapter
63-20 [chapter], and the medical [durable] power of attorney [for health
63-21 care].
63-22 (b) The attending physician does not have a duty to verify
63-23 that the agent's directive is consistent with the principal's
63-24 wishes or religious or moral beliefs.
63-25 (c) A principal's health or residential care provider who
63-26 finds it impossible to follow a directive by the agent because of a
64-1 conflict with this subchapter [chapter] or the medical [durable]
64-2 power of attorney [for health care] shall inform the agent as soon
64-3 as is reasonably possible. The agent may select another attending
64-4 physician. The procedures established under Sections 166.045 and
64-5 166.046 apply if the agent's directive concerns providing,
64-6 withholding, or withdrawing life-sustaining treatment.
64-7 (d) This subchapter [chapter] may not be construed to
64-8 require a health or residential care provider who is not a
64-9 physician to act in a manner contrary to a physician's order.
64-10 Sec. 166.159 [135.009]. DISCRIMINATION RELATING TO EXECUTION
64-11 OF MEDICAL [DURABLE] POWER OF ATTORNEY [FOR HEALTH CARE]. A health
64-12 or residential care provider, health care service plan, insurer
64-13 issuing disability insurance, self-insured employee benefit plan,
64-14 or nonprofit hospital service plan may not:
64-15 (1) charge a person a different rate solely because
64-16 the person has executed a medical [durable] power of attorney [for
64-17 health care];
64-18 (2) require a person to execute a medical [durable]
64-19 power of attorney [for health care] before:
64-20 (A) admitting the person to a hospital, nursing
64-21 home, or residential care home;
64-22 (B) insuring the person; or
64-23 (C) allowing the person to receive health or
64-24 residential care; or
64-25 (3) refuse health or residential care to a person
64-26 solely because the person has executed a medical [durable] power of
65-1 attorney [for health care].
65-2 Sec. 166.160 [135.010]. LIMITATION ON LIABILITY. (a) An
65-3 agent is not subject to criminal or civil liability for a health
65-4 care decision if the decision is made in good faith under the terms
65-5 of the medical [durable] power of attorney [for health care] and
65-6 the provisions of this subchapter [chapter].
65-7 (b) An attending physician, health or residential care
65-8 provider, or a person acting as an agent for or under the
65-9 physician's or provider's control is not subject to criminal or
65-10 civil liability and has not engaged in unprofessional conduct for
65-11 an act or omission if the act or omission:
65-12 (1) is done in good faith under the terms of the
65-13 medical [durable] power of attorney [for health care], the
65-14 directives of the agent, and the provisions of this subchapter
65-15 [chapter]; and
65-16 (2) does not constitute a failure to exercise
65-17 reasonable [due] care in the provision of health care services.
65-18 (c) The standard of care that the attending physician,
65-19 health or residential care provider, or person acting as an agent
65-20 for or under the physician's or provider's control shall exercise
65-21 under Subsection (b) is that degree of care that an attending
65-22 physician, health or residential care provider, or person acting as
65-23 an agent for or under the physician's or provider's control, as
65-24 applicable, of ordinary prudence and skill would have exercised
65-25 under the same or similar circumstances in the same or similar
65-26 community.
66-1 (d) An attending physician, health or residential care
66-2 provider, or person acting as an agent for or under the physician's
66-3 or provider's control has not engaged in unprofessional conduct
66-4 for:
66-5 (1) failure to act as required by the directive of an
66-6 agent or a medical [durable] power of attorney [for health care] if
66-7 the physician, provider, or person was not provided with a copy of
66-8 the medical [durable] power of attorney [for health care] or had no
66-9 knowledge of a directive; or
66-10 (2) acting as required by an agent's directive if the
66-11 medical [durable] power of attorney [for health care] has expired
66-12 or been revoked but the physician, provider, or person does not
66-13 have knowledge of the expiration or revocation.
66-14 Sec. 166.161 [135.011]. LIABILITY FOR HEALTH CARE COSTS.
66-15 Liability for the cost of health care provided as a result of the
66-16 agent's decision is the same as if the health care were provided as
66-17 a result of the principal's decision.
66-18 [Sec. 135.012. NATURAL DEATH ACT. To the extent that a
66-19 durable power of attorney for health care conflicts with a
66-20 directive or treatment decision executed under the Natural Death
66-21 Act (Chapter 672, Health and Safety Code), the instrument executed
66-22 later in time controls. A physician who withholds or withdraws
66-23 life-sustaining procedures from a principal with a terminal
66-24 condition as required by an agent's directive is not required to
66-25 comply with the Natural Death Act.]
66-26 [Sec. 135.013. ENFORCEABILITY OF DURABLE POWER OF ATTORNEY
67-1 EXECUTED IN ANOTHER JURISDICTION. This chapter does not limit the
67-2 enforceability of a durable power of attorney for health care or
67-3 similar instrument executed in another state or jurisdiction if the
67-4 instrument complies with the law of the state or jurisdiction.]
67-5 Sec. 166.162 [135.014]. DISCLOSURE STATEMENT. A medical
67-6 [durable] power of attorney [for health care] is not effective
67-7 unless the principal, before executing the medical [durable] power
67-8 of attorney [for health care], signs a statement that the principal
67-9 has received a disclosure statement and has read and understood its
67-10 contents.
67-11 Sec. 166.163 [135.015]. FORM OF DISCLOSURE STATEMENT. The
67-12 disclosure statement must be in substantially the following form:
67-13 INFORMATION CONCERNING THE MEDICAL [DURABLE]
67-14 POWER OF ATTORNEY [FOR HEALTH CARE]
67-15 THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT,
67-16 YOU SHOULD KNOW THESE IMPORTANT FACTS:
67-17 Except to the extent you state otherwise, this document gives
67-18 the person you name as your agent the authority to make any and all
67-19 health care decisions for you in accordance with your wishes,
67-20 including your religious and moral beliefs, when you are no longer
67-21 capable of making them yourself. Because "health care" means any
67-22 treatment, service, or procedure to maintain, diagnose, or treat
67-23 your physical or mental condition, your agent has the power to make
67-24 a broad range of health care decisions for you. Your agent may
67-25 consent, refuse to consent, or withdraw consent to medical
67-26 treatment and may make decisions about withdrawing or withholding
68-1 life-sustaining treatment. Your agent may not consent to voluntary
68-2 inpatient mental health services, convulsive treatment,
68-3 psychosurgery, or abortion. A physician must comply with your
68-4 agent's instructions or allow you to be transferred to another
68-5 physician.
68-6 Your agent's authority begins when your doctor certifies that
68-7 you lack the competence [capacity] to make health care decisions.
68-8 Your agent is obligated to follow your instructions when
68-9 making decisions on your behalf. Unless you state otherwise, your
68-10 agent has the same authority to make decisions about your health
68-11 care as you would have had.
68-12 It is important that you discuss this document with your
68-13 physician or other health care provider before you sign it to make
68-14 sure that you understand the nature and range of decisions that may
68-15 be made on your behalf. If you do not have a physician, you should
68-16 talk with someone else who is knowledgeable about these issues and
68-17 can answer your questions. You do not need a lawyer's assistance
68-18 to complete this document, but if there is anything in this
68-19 document that you do not understand, you should ask a lawyer to
68-20 explain it to you.
68-21 The person you appoint as agent should be someone you know
68-22 and trust. The person must be 18 years of age or older or a person
68-23 under 18 years of age who has had the disabilities of minority
68-24 removed. If you appoint your health or residential care provider
68-25 (e.g., your physician or an employee of a home health agency,
68-26 hospital, nursing home, or residential care home, other than a
69-1 relative), that person has to choose between acting as your agent
69-2 or as your health or residential care provider; the law does not
69-3 permit a person to do both at the same time.
69-4 You should inform the person you appoint that you want the
69-5 person to be your health care agent. You should discuss this
69-6 document with your agent and your physician and give each a signed
69-7 copy. You should indicate on the document itself the people and
69-8 institutions who have signed copies. Your agent is not liable for
69-9 health care decisions made in good faith on your behalf.
69-10 Even after you have signed this document, you have the right
69-11 to make health care decisions for yourself as long as you are able
69-12 to do so and treatment cannot be given to you or stopped over your
69-13 objection. You have the right to revoke the authority granted to
69-14 your agent by informing your agent or your health or residential
69-15 care provider orally or in writing or by your execution of a
69-16 subsequent medical [durable] power of attorney [for health care].
69-17 Unless you state otherwise, your appointment of a spouse dissolves
69-18 on divorce.
69-19 This document may not be changed or modified. If you want to
69-20 make changes in the document, you must make an entirely new one.
69-21 You may wish to designate an alternate agent in the event
69-22 that your agent is unwilling, unable, or ineligible to act as your
69-23 agent. Any alternate agent you designate has the same authority to
69-24 make health care decisions for you.
69-25 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS SIGNED IN THE
69-26 PRESENCE OF TWO COMPETENT ADULT [OR MORE QUALIFIED] WITNESSES. THE
70-1 FOLLOWING PERSONS MAY NOT ACT AS ONE OF THE WITNESSES:
70-2 (1) the person you have designated as your agent;
70-3 (2) a person related to you by blood or marriage [your
70-4 health or residential care provider or an employee of your health
70-5 or residential care provider];
70-6 (3) a person entitled to any part of your estate after
70-7 your death under a will or codicil executed by you or by operation
70-8 of law [your spouse];
70-9 (4) your attending physician [lawful heirs or
70-10 beneficiaries named in your will or a deed]; [or]
70-11 (5) an employee of your attending physician;
70-12 (6) an employee of a health care facility in which you
70-13 are a patient if the employee is providing direct patient care to
70-14 you or is an officer, director, partner, or business office
70-15 employee of the health care facility or of any parent organization
70-16 of the health care facility; or
70-17 (7) a person who, at the time this power of attorney
70-18 is executed, has a claim against any part of your estate after your
70-19 death [creditors or persons who have a claim against you].
70-20 Sec. 166.164 [135.016]. FORM OF MEDICAL [DURABLE] POWER OF
70-21 ATTORNEY. The medical [durable] power of attorney [for health
70-22 care] must be in substantially the following form:
71-1 MEDICAL [DURABLE] POWER OF ATTORNEY [FOR HEALTH CARE]
71-2 DESIGNATION OF HEALTH CARE AGENT.
71-3 I,_______________________________(insert your name) appoint:
71-4 Name:________________________________________________________
71-5 Address:_____________________________________________________
71-6 Phone____________________________________________
71-7 as my agent to make any and all health care decisions for me,
71-8 except to the extent I state otherwise in this document. This
71-9 medical [durable] power of attorney [for health care] takes effect
71-10 if I become unable to make my own health care decisions and this
71-11 fact is certified in writing by my physician.
71-12 LIMITATIONS ON THE DECISION-MAKING AUTHORITY OF MY AGENT ARE AS
71-13 FOLLOWS:_______________________________________________________
71-14 _______________________________________________________________
71-15 DESIGNATION OF ALTERNATE AGENT.
71-16 (You are not required to designate an alternate agent but you
71-17 may do so. An alternate agent may make the same health care
71-18 decisions as the designated agent if the designated agent is unable
71-19 or unwilling to act as your agent. If the agent designated is your
71-20 spouse, the designation is automatically revoked by law if your
71-21 marriage is dissolved.)
71-22 If the person designated as my agent is unable or unwilling
71-23 to make health care decisions for me, I designate the following
71-24 persons to serve as my agent to make health care decisions for me
71-25 as authorized by this document, who serve in the following order:
72-1 A. First Alternate Agent
72-2 Name:________________________________________
72-3 Address:_____________________________________
72-4 Phone__________________________________
72-5 B. Second Alternate Agent
72-6 Name:________________________________________
72-7 Address:_____________________________________
72-8 Phone__________________________________
72-9 The original of this document is kept at:
72-10 ______________________________________________________
72-11 ______________________________________________________
72-12 ______________________________________________________
72-13 The following individuals or institutions have signed copies:
72-14 Name:_________________________________________________
72-15 Address:______________________________________________
72-16 ______________________________________________________
72-17 Name:_________________________________________________
72-18 Address:______________________________________________
72-19 ______________________________________________________
72-20 DURATION.
72-21 I understand that this power of attorney exists indefinitely
72-22 from the date I execute this document unless I establish a shorter
72-23 time or revoke the power of attorney. If I am unable to make
72-24 health care decisions for myself when this power of attorney
72-25 expires, the authority I have granted my agent continues to exist
72-26 until the time I become able to make health care decisions for
73-1 myself.
73-2 (IF APPLICABLE) This power of attorney ends on the following
73-3 date:_____
73-4 PRIOR DESIGNATIONS REVOKED.
73-5 I revoke any prior medical [durable] power of attorney [for
73-6 health care].
73-7 ACKNOWLEDGMENT OF DISCLOSURE STATEMENT.
73-8 I have been provided with a disclosure statement explaining
73-9 the effect of this document. I have read and understand that
73-10 information contained in the disclosure statement.
73-11 (YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY.)
73-12 I sign my name to this medical [durable] power of attorney
73-13 [for health care] on ___________ day of _____________(month, year)
73-14 [19] at
73-15 _________________________________________________________
73-16 (City and State)
73-17 _________________________________________________________
73-18 (Signature)
73-19 _________________________________________________________
73-20 (Print Name)
73-21 STATEMENT OF FIRST WITNESS [WITNESSES].
73-22 [I declare under penalty of perjury that the principal has
73-23 identified himself or herself to me, that the principal signed or
73-24 acknowledged this durable power of attorney in my presence, that I
73-25 believe the principal to be of sound mind, that the principal has
73-26 affirmed that the principal is aware of the nature of the document
74-1 and is signing it voluntarily and free from duress, that the
74-2 principal requested that I serve as witness to the principal's
74-3 execution of this document, that] I am not the person appointed as
74-4 agent by this document.[, and that] I am not related to the
74-5 principal by blood or marriage. I would not be entitled to any
74-6 portion of the principal's estate on the principal's death. I am
74-7 not the attending physician of the principal or an employee of the
74-8 attending physician. I have no claim against any portion of the
74-9 principal's estate on the principal's death. Furthermore, if I am
74-10 an employee of a health care facility in which the principal is a
74-11 patient, I am not involved in providing direct patient care to the
74-12 principal and am not an officer, director, partner, or business
74-13 office employee of the health care facility or of any parent
74-14 organization of the health care facility [a provider of health or
74-15 residential care, an employee of a provider of health or
74-16 residential care, the operator of a community care facility, or an
74-17 employee of an operator of a health care facility.]
74-18 [I declare that I am not related to the principal by blood,
74-19 marriage, or adoption and that to the best of my knowledge I am not
74-20 entitled to any part of the estate of the principal on the death of
74-21 the principal under a will or by operation of law].
74-22 [Witness] Signature:____________________________________
74-23 Print Name:______________________Date:__________________
74-24 Address:________________________________________________
75-1 SIGNATURE OF SECOND WITNESS.
75-2 [Witness] Signature:____________________________________
75-3 Print Name:______________________Date:__________________
75-4 Address:________________________________________________
75-5 Sec. 166.165 [135.017]. CIVIL ACTION. (a) A person who is
75-6 a near relative of the principal or a responsible adult who is
75-7 directly interested in the principal, including a guardian, social
75-8 worker, physician, or clergyman, may bring an action in district
75-9 court to request that the medical [durable] power of attorney [for
75-10 health care] be revoked because the principal, at the time the
75-11 medical [durable] power of attorney [for health care] was signed:
75-12 (1) was not competent [of sound mind to make a health
75-13 care decision]; or
75-14 (2) was under duress, fraud, or undue influence.
75-15 (b) The action may be brought in the county of the
75-16 principal's residence or the residence of the person bringing the
75-17 action.
75-18 (c) During the pendency of the action, the authority of the
75-19 agent to make health care decisions continues in effect unless the
75-20 district court orders otherwise.
75-21 Sec. 166.166 [135.018]. OTHER RIGHTS OR RESPONSIBILITIES NOT
75-22 AFFECTED. This subchapter [chapter] does not limit or impair any
75-23 legal right or responsibility that any person, including a
75-24 physician or health or residential care provider, may have to make
75-25 or implement health care decisions on behalf of a person, provided
75-26 that if an attending physician or health care facility is unwilling
76-1 to honor a patient's advance directive or a treatment decision to
76-2 provide life-sustaining treatment, life-sustaining treatment is
76-3 required to be provided the patient, but only until a reasonable
76-4 opportunity has been afforded for transfer of the patient to
76-5 another physician or health care facility willing to comply with
76-6 the advance directive or treatment decision.
76-7 ARTICLE 2. CONFORMING AMENDMENTS
76-8 SECTION 2.01. Subsection (a), Section 313.003, Health and
76-9 Safety Code, is amended to read as follows:
76-10 (a) This chapter does not apply to:
76-11 (1) a decision to withhold or withdraw life-sustaining
76-12 treatment from qualified terminal or irreversible patients under
76-13 Subchapter B, Chapter 166 [the terms of Chapter 672];
76-14 (2) a health care decision made under a medical
76-15 [durable] power of attorney [for health care] under Subchapter D,
76-16 Chapter 166 [Chapter 135, Civil Practice and Remedies Code], or
76-17 under Chapter XII, Texas Probate Code;
76-18 (3) consent to medical treatment of minors under
76-19 Chapter 32 [35], Family Code;
76-20 (4) consent for emergency care under Chapter 773;
76-21 (5) hospital patient transfers under Chapter 241; or
76-22 (6) a patient's legal guardian who has the authority
76-23 to make a decision regarding the patient's medical treatment.
76-24 SECTION 2.02. Subchapter A, Chapter 142, Health and Safety
76-25 Code, is amended by adding Section 142.0145 to read as follows:
76-26 Sec. 142.0145. VIOLATION OF LAW RELATING TO ADVANCE
77-1 DIRECTIVES. (a) The department shall assess an administrative
77-2 penalty against a home and community support services agency that
77-3 violates Section 166.004.
77-4 (b) A penalty assessed under this section shall be $500.
77-5 (c) The penalty shall be assessed in accordance with
77-6 department rules. The rules must provide for notice and an
77-7 opportunity for a hearing.
77-8 SECTION 2.03. Subsections (a) and (c), Section 241.059,
77-9 Health and Safety Code, are amended to read as follows:
77-10 (a) The commissioner of health may assess an administrative
77-11 penalty against a hospital that violates this chapter, a rule
77-12 adopted pursuant to this chapter, a special license provision, an
77-13 order or emergency order issued by the commissioner or the
77-14 commissioner's designee, or another enforcement procedure permitted
77-15 under this chapter. The commissioner shall assess an
77-16 administrative penalty against a hospital that violates Section
77-17 166.004.
77-18 (c) The penalty may not exceed $1,000 for each violation,
77-19 except that the penalty for a violation of Section 166.004 shall be
77-20 $500. Each day of a continuing violation, other than a violation
77-21 of Section 166.004, may be considered a separate violation.
77-22 SECTION 2.04. Subchapter C, Chapter 242, Health and Safety
77-23 Code, is amended by adding Section 242.0663 to read as follows:
77-24 Sec. 242.0663. VIOLATION OF LAW RELATING TO ADVANCE
77-25 DIRECTIVES. (a) The department shall assess an administrative
77-26 penalty under this subchapter against an institution that violates
78-1 Section 166.004.
78-2 (b) Notwithstanding Sections 242.066(b) and (c), a penalty
78-3 assessed in accordance with this section shall be $500 and a
78-4 separate penalty may not be assessed for a separate day of a
78-5 continuing violation.
78-6 (c) Section 242.0665 does not apply to a penalty assessed in
78-7 accordance with this section.
78-8 SECTION 2.05. Subchapter C, Chapter 247, Health and Safety
78-9 Code, is amended by adding Section 247.0455 to read as follows:
78-10 Sec. 247.0455. VIOLATION OF LAW RELATING TO ADVANCE
78-11 DIRECTIVES. (a) The department shall assess an administrative
78-12 penalty against a personal care facility that violates Section
78-13 166.004.
78-14 (b) A penalty assessed under this section shall be $500.
78-15 (c) The penalty shall be assessed in accordance with
78-16 department rules. The rules must provide for notice and an
78-17 opportunity for a hearing.
78-18 SECTION 2.06. Subchapter C, Chapter 248, Health and Safety
78-19 Code, is amended by adding Section 248.0545 to read as follows:
78-20 Sec. 248.0545. VIOLATION OF LAW RELATING TO ADVANCE
78-21 DIRECTIVES. (a) The department shall assess an administrative
78-22 penalty against a special care facility that violates Section
78-23 166.004.
78-24 (b) A penalty assessed under this section shall be $500.
78-25 (c) The penalty shall be assessed in accordance with
78-26 department rules. The rules must provide for notice and an
79-1 opportunity for a hearing.
79-2 ARTICLE 3. TRANSITION AND EMERGENCY CLAUSE
79-3 SECTION 3.01. This Act takes effect September 1, 1999.
79-4 SECTION 3.02. (a) The change in law made by this Act does
79-5 not affect the validity of a document executed under Chapter 672 or
79-6 674, Health and Safety Code, or Chapter 135, Civil Practice and
79-7 Remedies Code, before the effective date of this Act. A document
79-8 executed before the effective date of this Act is governed by the
79-9 law in effect on the date the document was executed, and that law
79-10 continues in effect for that purpose.
79-11 (b) A reference in a law to a durable power of attorney for
79-12 health care means a medical power of attorney, as defined by
79-13 Section 166.002, Health and Safety Code, as added by this Act.
79-14 SECTION 3.03. (a) The change in law made by this Act
79-15 applies only to the punishment for an offense committed on or after
79-16 the effective date of this Act. For purposes of this section, an
79-17 offense is committed before the effective date of this Act if any
79-18 element of the offense occurs before the effective date.
79-19 (b) An offense committed before the effective date of this
79-20 Act is covered by the law in effect when the offense was committed,
79-21 and the former law is continued in effect for that purpose.
79-22 SECTION 3.04. The change in law made by this Act to
79-23 Subsection (b), Section 166.045, and Subsection (b), Section
79-24 166.095, Health and Safety Code, as redesignated by this Act,
79-25 applies only to conduct that occurs on or after January 1, 2000.
79-26 Conduct that occurs before January 1, 2000, is governed by the law
80-1 as it existed immediately before the effective date of this Act,
80-2 and that law is continued in effect for that purpose.
80-3 SECTION 3.05. The importance of this legislation and the
80-4 crowded condition of the calendars in both houses create an
80-5 emergency and an imperative public necessity that the
80-6 constitutional rule requiring bills to be read on three several
80-7 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1260 passed the Senate on
April 26, 1999, by the following vote: Yeas 30, Nays 0; and that
the Senate concurred in House amendment on May 18, 1999, by a
viva-voce vote.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1260 passed the House, with
amendment, on May 11, 1999, by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor