76R12915 CMR-F
By Moncrief S.B. No. 1260
Substitute the following for S.B. No. 1260:
By Maxey C.S.S.B. No. 1260
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to certain advance directives for medical treatment;
1-3 providing administrative penalties.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 ARTICLE 1. ADVANCE DIRECTIVES
1-6 SECTION 1.01. Subtitle H, Title 2, Health and Safety Code,
1-7 is amended by adding a chapter heading for Chapter 166 to read as
1-8 follows:
1-9 CHAPTER 166. ADVANCE DIRECTIVES
1-10 SECTION 1.02. Subtitle H, Title 2, Health and Safety Code,
1-11 is amended by adding Subchapter A, Chapter 166, to read as follows:
1-12 SUBCHAPTER A. GENERAL PROVISIONS
1-13 Sec. 166.001. SHORT TITLE. This chapter may be cited as the
1-14 Advance Directives Act.
1-15 Sec. 166.002. DEFINITIONS. In this chapter:
1-16 (1) "Advance directive" means:
1-17 (A) a directive, as that term is defined by
1-18 Section 166.031;
1-19 (B) an out-of-hospital DNR order, as that term
1-20 is defined by Section 166.081; or
1-21 (C) a medical power of attorney under Subchapter
1-22 D.
1-23 (2) "Artificial nutrition and hydration" means the
1-24 provision of nutrients or fluids by a tube inserted in a vein,
2-1 under the skin in the subcutaneous tissues, or in the stomach
2-2 (gastrointestinal tract).
2-3 (3) "Attending physician" means a physician selected
2-4 by or assigned to a patient who has primary responsibility for a
2-5 patient's treatment and care.
2-6 (4) "Competent" means possessing the ability, based on
2-7 reasonable medical judgment, to understand and appreciate the
2-8 nature and consequences of a treatment decision, including the
2-9 significant benefits and harms of and reasonable alternatives to a
2-10 proposed treatment decision.
2-11 (5) "Declarant" means a person who has executed or
2-12 issued a directive under this chapter.
2-13 (6) "Ethics or medical committee" means a committee
2-14 established under Sections 161.031-161.033.
2-15 (7) "Health care or treatment decision" means consent,
2-16 refusal to consent, or withdrawal of consent to health care,
2-17 treatment, service, or a procedure to maintain, diagnose, or treat
2-18 an individual's physical or mental condition.
2-19 (8) "Incompetent" means lacking the ability, based on
2-20 reasonable medical judgment, to understand and appreciate the
2-21 nature and consequences of a treatment decision, including the
2-22 significant benefits and harms of and reasonable alternatives to a
2-23 proposed treatment decision.
2-24 (9) "Irreversible condition" means a condition,
2-25 injury, or illness:
2-26 (A) that may be treated but is never cured or
2-27 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
3-27 medical judgment will produce death within six months, even with
4-1 available life-sustaining treatment provided in accordance with the
4-2 prevailing standard of medical care. A patient who has been
4-3 admitted to a program under which the person receives hospice
4-4 services provided by a home and community support services agency
4-5 licensed under Chapter 142 is presumed to have a terminal condition
4-6 for purposes of this chapter.
4-7 (14) "Witness" means a person who may serve as a
4-8 witness under Section 166.003.
4-9 Sec. 166.003. WITNESSES. In any circumstance in which this
4-10 chapter requires the execution of an advance directive or the
4-11 issuance of a nonwritten advance directive to be witnessed:
4-12 (1) each witness must be a competent adult; and
4-13 (2) at least one of the witnesses must be a person who
4-14 is not:
4-15 (A) a person designated by the declarant to make
4-16 a treatment decision;
4-17 (B) a person related to the declarant by blood
4-18 or marriage;
4-19 (C) a person entitled to any part of the
4-20 declarant's estate after the declarant's death under a will or
4-21 codicil executed by the declarant or by operation of law;
4-22 (D) the attending physician;
4-23 (E) an employee of the attending physician;
4-24 (F) an employee of a health care facility in
4-25 which the declarant is a patient if the employee is providing
4-26 direct patient care to the declarant or is an officer, director,
4-27 partner, or business office employee of the health care facility or
5-1 of any parent organization of the health care facility; or
5-2 (G) a person who, at the time the written
5-3 advance directive is executed or, if the directive is a nonwritten
5-4 directive issued under this chapter, at the time the nonwritten
5-5 directive is issued, has a claim against any part of the
5-6 declarant's estate after the declarant's death.
5-7 Sec. 166.004. STATEMENT RELATING TO ADVANCE DIRECTIVE. (a)
5-8 In this section, "health care provider" means:
5-9 (1) a hospital;
5-10 (2) an institution licensed under Chapter 242,
5-11 including a skilled nursing facility;
5-12 (3) a home and community support services agency;
5-13 (4) a personal care facility; and
5-14 (5) a special care facility.
5-15 (b) A health care provider shall maintain written policies
5-16 regarding the implementation of advance directives. The policies
5-17 must include a clear and precise statement of any procedure the
5-18 health care provider is unwilling or unable to provide or withhold
5-19 in accordance with an advance directive.
5-20 (c) Except as provided by Subsection (g), the health care
5-21 provider shall provide written notice to an individual of the
5-22 written policies described by Subsection (b). The notice must be
5-23 provided at the earlier of:
5-24 (1) the time the individual is admitted to receive
5-25 services from the health care provider; or
5-26 (2) the time the health care provider begins providing
5-27 care to the individual.
6-1 (d) If, at the time notice is to be provided under
6-2 Subsection (c), the individual is incompetent or otherwise
6-3 incapacitated and unable to receive the notice required by this
6-4 section, the provider shall provide the required written notice, in
6-5 the following order of preference, to:
6-6 (1) the individual's legal guardian;
6-7 (2) a person responsible for the health care decisions
6-8 of the individual;
6-9 (3) the individual's spouse;
6-10 (4) the individual's adult child;
6-11 (5) the individual's parent; or
6-12 (6) the person admitting the individual.
6-13 (e) If Subsection (d) applies and except as provided by
6-14 Subsection (f), if a health care provider is unable, after diligent
6-15 search, to locate an individual listed by Subsection (d), the
6-16 health care provider is not required to provide the notice.
6-17 (f) If an individual who was incompetent or otherwise
6-18 incapacitated and unable to receive the notice required by this
6-19 section at the time notice was to be provided under Subsection (c)
6-20 later becomes able to receive the notice, the health care provider
6-21 shall provide the written notice at the time the individual becomes
6-22 able to receive the notice.
6-23 (g) This section does not apply to outpatient hospital
6-24 services, including emergency services.
6-25 Sec. 166.005. ENFORCEABILITY OF ADVANCE DIRECTIVES EXECUTED
6-26 IN ANOTHER JURISDICTION. An advance directive or similar
6-27 instrument validly executed in another state or jurisdiction shall
7-1 be given the same effect as an advance directive validly executed
7-2 under the law of this state. This section does not authorize the
7-3 administration, withholding, or withdrawal of health care otherwise
7-4 prohibited by the laws of this state.
7-5 Sec. 166.006. EFFECT OF ADVANCE DIRECTIVE ON INSURANCE
7-6 POLICY AND PREMIUMS. (a) The fact that a person has executed or
7-7 issued an advance directive does not:
7-8 (1) restrict, inhibit, or impair in any manner the
7-9 sale, procurement, or issuance of a life insurance policy to that
7-10 person; or
7-11 (2) modify the terms of an existing life insurance
7-12 policy.
7-13 (b) Notwithstanding the terms of any life insurance policy,
7-14 the fact that life-sustaining treatment is withheld or withdrawn
7-15 from an insured qualified patient under this chapter does not
7-16 legally impair or invalidate that person's life insurance policy
7-17 and may not be a factor for the purpose of determining, under the
7-18 life insurance policy, whether benefits are payable or the cause of
7-19 death.
7-20 (c) The fact that a person has executed or issued or failed
7-21 to execute or issue an advance directive may not be considered in
7-22 any way in establishing insurance premiums.
7-23 Sec. 166.007. EXECUTION OF ADVANCE DIRECTIVE MAY NOT BE
7-24 REQUIRED. A physician, health facility, health care provider,
7-25 insurer, or health care service plan may not require a person to
7-26 execute or issue an advance directive as a condition for obtaining
7-27 insurance for health care services or receiving health care
8-1 services.
8-2 Sec. 166.008. CONFLICT BETWEEN ADVANCE DIRECTIVES. To the
8-3 extent that a treatment decision or an advance directive validly
8-4 executed or issued under this chapter conflicts with another
8-5 treatment decision or an advance directive executed or issued under
8-6 this chapter, the treatment decision made or instrument executed
8-7 later in time controls.
8-8 Sec. 166.009. CERTAIN LIFE-SUSTAINING TREATMENT NOT
8-9 REQUIRED. This chapter may not be construed to require the
8-10 provision of life-sustaining treatment that cannot be provided to a
8-11 patient without denying the same treatment to another patient.
8-12 SECTION 1.03. Chapter 672, Health and Safety Code, is
8-13 transferred to Subtitle H, Title 2, Health and Safety Code, is
8-14 redesignated as Subchapter B, Chapter 166, Health and Safety Code,
8-15 and is amended to read as follows:
8-16 SUBCHAPTER B. DIRECTIVE TO PHYSICIANS [CHAPTER 672. NATURAL]
8-17 [DEATH ACT]
8-18 [Sec. 672.001. SHORT TITLE. This chapter may be cited as
8-19 the Natural Death Act.]
8-20 Sec. 166.031 [672.002]. DEFINITIONS. In this subchapter
8-21 [chapter]:
8-22 (1) ["Attending physician" means the physician who has
8-23 primary responsibility for a patient's treatment and care.]
8-24 [(2) "Competent" means possessing the ability, based
8-25 on reasonable medical judgment, to understand and appreciate the
8-26 nature and consequences of a treatment decision, including the
8-27 significant benefits and harms of and reasonable alternatives to a
9-1 proposed treatment decision.]
9-2 [(3) "Declarant" means a person who has executed or
9-3 issued a directive under this chapter.]
9-4 [(4)] "Directive" means an instruction made under
9-5 Section 166.032, 166.034, or 166.035 [672.003, 672.005, or 672.006]
9-6 to administer, withhold, or withdraw life-sustaining treatment
9-7 [procedures] in the event of a terminal or irreversible condition.
9-8 (2) [(5) "Incompetent" means lacking the ability,
9-9 based on reasonable medical judgment, to understand and appreciate
9-10 the nature and consequences of a treatment decision, including the
9-11 significant benefits and harms of and reasonable alternatives to a
9-12 proposed treatment decision.]
9-13 [(6) "Life-sustaining procedure" means a medical
9-14 procedure or intervention that uses mechanical or other artificial
9-15 means to sustain, restore, or supplant a vital function, and only
9-16 artificially postpones the moment of death of a patient in a
9-17 terminal condition whose death is imminent or will result within a
9-18 relatively short time without the application of the procedure.
9-19 The term does not include the administration of medication or the
9-20 performance of a medical procedure considered to be necessary to
9-21 provide comfort or care or to alleviate pain.]
9-22 [(7) "Physician" means a physician licensed by the
9-23 Texas State Board of Medical Examiners or a properly credentialed
9-24 physician who holds a commission in the uniformed services of the
9-25 United States and who is serving on active duty in this state.]
9-26 [(8)] "Qualified patient" means a patient with a
9-27 terminal or irreversible condition that has been diagnosed and
10-1 certified in writing by the attending physician [and one other
10-2 physician who have personally examined the patient].
10-3 [(9) "Terminal condition" means an incurable or
10-4 irreversible condition caused by injury, disease, or illness that
10-5 would produce death without the application of life-sustaining
10-6 procedures, according to reasonable medical judgment, and in which
10-7 the application of life-sustaining procedures serves only to
10-8 postpone the moment of the patient's death.]
10-9 Sec. 166.032 [672.003]. WRITTEN DIRECTIVE BY COMPETENT
10-10 ADULT; NOTICE TO PHYSICIAN. (a) A competent adult may at any time
10-11 execute a written directive.
10-12 (b) The declarant must sign the directive in the presence of
10-13 two witnesses who qualify under Section 166.003, at least one of
10-14 whom must be a witness who qualifies under Section 166.003(2). The
10-15 [and those] witnesses must sign the directive.
10-16 (c) [A witness may not be:]
10-17 [(1) a person designated by the declarant to make a
10-18 treatment decision;]
10-19 [(2) a person related to the declarant by blood or
10-20 marriage;]
10-21 [(3) a person entitled to any part of the declarant's
10-22 estate after the declarant's death under a will or codicil executed
10-23 by the declarant or by operation of law;]
10-24 [(4) the attending physician;]
10-25 [(5) an employee of the attending physician;]
10-26 [(6) an employee of a health care facility in which
10-27 the declarant is a patient if the employee is providing direct
11-1 patient care to the declarant or is an officer, director, partner,
11-2 or business office employee of the health care facility or of any
11-3 parent organization of the health care facility; or]
11-4 [(7) a person who, at the time the written directive
11-5 is executed or if the directive is a nonwritten directive issued
11-6 under Section 672.005, at the time the nonwritten directive is
11-7 issued, has a claim against any part of the declarant's estate
11-8 after the declarant's death.]
11-9 [(d)] A declarant may include in a directive directions
11-10 other than those provided by Section 166.033 [672.004] and may
11-11 designate in a directive a person to make a treatment decision for
11-12 the declarant in the event the declarant becomes [comatose,]
11-13 incompetent[,] or otherwise mentally or physically incapable of
11-14 communication.
11-15 (d) [(e)] A declarant shall notify the attending physician
11-16 of the existence of a written directive. If the declarant is
11-17 [comatose,] incompetent[,] or otherwise mentally or physically
11-18 incapable of communication, another person may notify the attending
11-19 physician of the existence of the written directive. The attending
11-20 physician shall make the directive a part of the declarant's
11-21 medical record.
11-22 Sec. 166.033 [672.004]. FORM OF WRITTEN DIRECTIVE. A
11-23 written directive may be in the following form:
11-24 DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
11-25 Instructions for completing this document:
11-26 This is an important legal document known as an Advance
11-27 Directive. It is designed to help you communicate your wishes
12-1 about medical treatment at some time in the future when you are
12-2 unable to make your wishes known because of illness or injury.
12-3 These wishes are usually based on personal values. In particular,
12-4 you may want to consider what burdens or hardships of treatment you
12-5 would be willing to accept for a particular amount of benefit
12-6 obtained if you were seriously ill.
12-7 You are encouraged to discuss your values and wishes with
12-8 your family or chosen spokesperson, as well as your physician.
12-9 Your physician, other health care provider, or medical institution
12-10 may provide you with various resources to assist you in completing
12-11 your advance directive. Brief definitions are listed below and may
12-12 aid you in your discussions and advance planning. Initial the
12-13 treatment choices that best reflect your personal preferences.
12-14 Provide a copy of your directive to your physician, usual hospital,
12-15 and family or spokesperson. Consider a periodic review of this
12-16 document. By periodic review, you can best assure that the
12-17 directive reflects your preferences.
12-18 In addition to this advance directive, Texas law provides for
12-19 two other types of directives that can be important during a
12-20 serious illness. These are the Medical Power of Attorney and the
12-21 Out-of-Hospital Do-Not-Resuscitate Order. You may wish to discuss
12-22 these with your physician, family, hospital representative, or
12-23 other advisers. You may also wish to complete a directive related
12-24 to the donation of organs and tissues.
12-25 DIRECTIVE
12-26 I, ______________, recognize that the best health care is
12-27 based upon a partnership of trust and communication with my
13-1 physician. My physician and I will make health care decisions
13-2 together as long as I am of sound mind and able to make my wishes
13-3 known. If there comes a time that I am unable to make medical
13-4 decisions about myself because of illness or injury, I direct that
13-5 the following treatment preferences be honored:
13-6 If, in the judgment of my physician, I am suffering with a
13-7 terminal condition from which I am expected to die within six
13-8 months, even with available life-sustaining treatment provided in
13-9 accordance with prevailing standards of medical care:
13-10 ____ I request that all treatments other than those needed to keep
13-11 me comfortable be discontinued or withheld and my physician
13-12 allow me to die as gently as possible; OR
13-13 ____ I request that I be kept alive in this terminal condition
13-14 using available life-sustaining treatment. (THIS SELECTION
13-15 DOES NOT APPLY TO HOSPICE CARE.)
13-16 If, in the judgment of my physician, I am suffering with an
13-17 irreversible condition so that I cannot care for myself or make
13-18 decisions for myself and am expected to die without life-sustaining
13-19 treatment provided in accordance with prevailing standards of 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 irreversible condition
13-24 using available life-sustaining treatment. (THIS SELECTION
13-25 DOES NOT APPLY TO HOSPICE CARE.)
13-26 Additional requests: (After discussion with your physician,
13-27 you may wish to consider listing particular treatments in this
14-1 space that you do or do not want in specific circumstances, such as
14-2 artificial nutrition and fluids, intravenous antibiotics, etc. Be
14-3 sure to state whether you do or do not want the particular
14-4 treatment.)
14-5 ___________________________________________________________________
14-6 ___________________________________________________________________
14-7 ___________________________________________________________________
14-8 After signing this directive, if my representative or I elect
14-9 hospice care, I understand and agree that only those treatments
14-10 needed to keep me comfortable would be provided and I would not be
14-11 given available life-sustaining treatments.
14-12 If I do not have a Medical Power of Attorney, and I am unable
14-13 to make my wishes known, I designate the following person(s) to
14-14 make treatment decisions with my physician compatible with my
14-15 personal values:
14-16 1._____________________
14-17 2._____________________
14-18 (If a Medical Power of Attorney has been executed, then an agent
14-19 already has been named and you should not list additional names in
14-20 this document.)
14-21 If the above persons are not available, or if I have not
14-22 designated a spokesperson, I understand that a spokesperson will be
14-23 chosen for me following standards specified in the laws of Texas.
14-24 If, in the judgment of my physician, my death is imminent within
14-25 minutes to hours, even with the use of all available medical
14-26 treatment provided within the prevailing standard of care, I
14-27 acknowledge that all treatments may be withheld or removed except
15-1 those needed to maintain my comfort. I understand that under Texas
15-2 law this directive has no effect if I have been diagnosed as
15-3 pregnant. This directive will remain in effect until I revoke it.
15-4 No other person may do so.
15-5 Signed__________________________________ Date______________________
15-6 City, County, State of Residence __________________________________
15-7 Two competent adult witnesses must sign below, acknowledging
15-8 the signature of the declarant. The witness designated as Witness
15-9 1 may not be a person designated to make a treatment decision for
15-10 the patient and may not be related to the patient by blood or
15-11 marriage. This witness may not be entitled to any part of the
15-12 estate and may not have a claim against the estate of the patient.
15-13 This witness may not be the attending physician or an employee of
15-14 the attending physician. If this witness is an employee of a
15-15 health care facility in which the patient is being cared for, this
15-16 witness may not be involved in providing direct patient care to the
15-17 patient. This witness may not be an officer, director, partner, or
15-18 business office employee of a health care facility in which the
15-19 patient is being cared for or of any parent organization of the
15-20 health care facility.
15-21 Witness 1________________________Witness 2_________________________
15-22 Definitions:
15-23 "Artificial nutrition and hydration" means the provision of
15-24 nutrients or fluids by a tube inserted in a vein, under the skin in
15-25 the subcutaneous tissues, or in the stomach (gastrointestinal
15-26 tract).
15-27 "Irreversible condition" means a condition, injury, or
16-1 illness:
16-2 (1) that may be treated, but is never cured or
16-3 eliminated;
16-4 (2) that leaves a person unable to care for or make
16-5 decisions for the person's own self; and
16-6 (3) that, without life-sustaining treatment provided
16-7 in accordance with the prevailing standard of medical care, is
16-8 fatal.
16-9 Explanation: Many serious illnesses such as cancer, failure
16-10 of major organs (kidney, heart, liver, or lung), and serious brain
16-11 disease such as Alzheimer's dementia may be considered irreversible
16-12 early on. There is no cure, but the patient may be kept alive for
16-13 prolonged periods of time if the patient receives life-sustaining
16-14 treatments. Late in the course of the same illness, the disease
16-15 may be considered terminal when, even with treatment, the patient
16-16 is expected to die. You may wish to consider which burdens of
16-17 treatment you would be willing to accept in an effort to achieve a
16-18 particular outcome. This is a very personal decision that you may
16-19 wish to discuss with your physician, family, or other important
16-20 persons in your life.
16-21 "Life-sustaining treatment" means treatment that, based on
16-22 reasonable medical judgment, sustains the life of a patient and
16-23 without which the patient will die. The term includes both
16-24 life-sustaining medications and artificial life support such as
16-25 mechanical breathing machines, kidney dialysis treatment, and
16-26 artificial hydration and nutrition. The term does not include the
16-27 administration of pain management medication, the performance of a
17-1 medical procedure necessary to provide comfort care, or any other
17-2 medical care provided to alleviate a patient's pain.
17-3 "Terminal condition" means an incurable condition caused by
17-4 injury, disease, or illness that according to reasonable medical
17-5 judgment will produce death within six months, even with available
17-6 life-sustaining treatment provided in accordance with the
17-7 prevailing standard of medical care.
17-8 Explanation: Many serious illnesses may be considered
17-9 irreversible early in the course of the illness, but they may not
17-10 be considered terminal until the disease is fairly advanced. In
17-11 thinking about terminal illness and its treatment, you again may
17-12 wish to consider the relative benefits and burdens of treatment and
17-13 discuss your wishes with your physician, family, or other important
17-14 persons in your life.
17-15 ["DIRECTIVE TO PHYSICIANS]
17-16 ["Directive made this __________ day of __________ (month,
17-17 year).]
17-18 ["I ________________________, being of sound mind, wilfully
17-19 and voluntarily make known my desire that my life shall not be
17-20 artificially prolonged under the circumstances set forth in this
17-21 directive.]
17-22 ["1. If at any time I should have an incurable or
17-23 irreversible condition caused by injury, disease, or illness
17-24 certified to be a terminal condition by two physicians, and if the
17-25 application of life-sustaining procedures would serve only to
17-26 artificially postpone the moment of my death, and if my attending
17-27 physician determines that my death is imminent or will result
18-1 within a relatively short time without the application of
18-2 life-sustaining procedures, I direct that those procedures be
18-3 withheld or withdrawn, and that I be permitted to die
18-4 naturally.]
18-5 ["2. In the absence of my ability to give directions
18-6 regarding the use of those life-sustaining procedures, it is my
18-7 intention that this directive be honored by my family and
18-8 physicians as the final expression of my legal right to refuse
18-9 medical or surgical treatment and accept the consequences from that
18-10 refusal.]
18-11 ["3. If I have been diagnosed as pregnant and that diagnosis
18-12 is known to my physician, this directive has no effect during my
18-13 pregnancy.]
18-14 ["4. This directive is in effect until it is revoked.]
18-15 ["5. I understand the full import of this directive and I am
18-16 emotionally and mentally competent to make this directive.]
18-17 ["6. I understand that I may revoke this directive at any
18-18 time.]
18-19 ["Signed
18-20 _____________________________]
18-21 [____________________________________]
18-22 [(City, County, and State of Residence)]
18-23 [I am not a person designated by the declarant to make a
18-24 treatment decision. I am not related to the declarant by blood or
18-25 marriage. I would not be entitled to any portion of the
18-26 declarant's estate on the declarant's death. I am not the
18-27 attending physician of the declarant or an employee of the
19-1 attending physician. I have no claim against any portion of the
19-2 declarant's estate on the declarant's death. Furthermore, if I am
19-3 an employee of a health care facility in which the declarant is a
19-4 patient, I am not involved in providing direct patient care to the
19-5 declarant and am not an officer, director, partner, or business
19-6 office employee of the health care facility or of any parent
19-7 organization of the health care facility.]
19-8 ["Witness________________________________]
19-9 ["Witness_______________________________"]
19-10 Sec. 166.034 [672.005]. ISSUANCE OF NONWRITTEN DIRECTIVE BY
19-11 COMPETENT ADULT QUALIFIED PATIENT. (a) A competent qualified
19-12 patient who is an adult may issue a directive by a nonwritten means
19-13 of communication.
19-14 (b) A declarant must issue the nonwritten directive in the
19-15 presence of the attending physician and two witnesses who qualify
19-16 under Section 166.003, at least one of whom must be a witness who
19-17 qualifies under Section 166.003(2). [The witnesses must possess
19-18 the same qualifications as are required by Section 672.003(c).]
19-19 (c) The physician shall make the fact of the existence of
19-20 the directive a part of the declarant's medical record, and the
19-21 names of the witnesses shall be entered [sign the entry] in the
19-22 medical record.
19-23 Sec. 166.035 [672.006]. EXECUTION OF DIRECTIVE ON BEHALF OF
19-24 PATIENT YOUNGER THAN 18 YEARS OF AGE. The following persons may
19-25 execute a directive on behalf of a qualified patient who is younger
19-26 than 18 years of age:
19-27 (1) the patient's spouse, if the spouse is an adult;
20-1 (2) the patient's parents; or
20-2 (3) the patient's legal guardian.
20-3 Sec. 166.036. NOTARIZED DOCUMENT NOT REQUIRED; REQUIREMENT
20-4 OF SPECIFIC FORM PROHIBITED. (a) A written directive executed
20-5 under Section 166.033 or 166.035 is effective without regard to
20-6 whether the document has been notarized.
20-7 (b) A physician, health care facility, or health care
20-8 professional may not require that:
20-9 (1) a directive be notarized; or
20-10 (2) a person use a form provided by the physician,
20-11 health care facility, or health care professional.
20-12 Sec. 166.037 [672.007]. PATIENT DESIRE SUPERSEDES DIRECTIVE.
20-13 The desire of a [competent] qualified patient, including a
20-14 [competent] qualified patient younger than 18 years of age,
20-15 supersedes the effect of a directive.
20-16 Sec. 166.038 [672.008]. PROCEDURE WHEN DECLARANT IS
20-17 INCOMPETENT OR INCAPABLE OF COMMUNICATION. (a) This section
20-18 applies when an adult qualified patient has executed or issued a
20-19 directive and is [comatose,] incompetent[,] or otherwise mentally
20-20 or physically incapable of communication.
20-21 (b) If the adult qualified patient has designated a person
20-22 to make a treatment decision as authorized by Section 166.032(c)
20-23 [672.003(d)], the attending physician and the designated person may
20-24 make a treatment decision in accordance with the declarant's
20-25 directions [to withhold or withdraw life-sustaining procedures from
20-26 the patient].
20-27 (c) If the adult qualified patient has not designated a
21-1 person to make a treatment decision, the attending physician shall
21-2 comply with the directive unless the physician believes that the
21-3 directive does not reflect the patient's present desire.
21-4 Sec. 166.039 [672.009]. PROCEDURE WHEN PERSON HAS NOT
21-5 EXECUTED OR ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF
21-6 COMMUNICATION. (a) If an adult qualified patient has not executed
21-7 or issued a directive and is [comatose,] incompetent[,] or
21-8 otherwise mentally or physically incapable of communication, the
21-9 attending physician and the patient's legal guardian or an agent
21-10 under a medical power of attorney may make a treatment decision
21-11 that may include a decision to withhold or withdraw life-sustaining
21-12 treatment [procedures] from the patient.
21-13 (b) If the patient does not have a legal guardian or an
21-14 agent under a medical power of attorney, the attending physician
21-15 and one person, if available, from one [at least two persons, if
21-16 available,] of the following categories, in the following priority,
21-17 may make a treatment decision that may include a decision to
21-18 withhold or withdraw life-sustaining treatment [procedures]:
21-19 (1) the patient's spouse;
21-20 (2) [a majority of] the patient's reasonably available
21-21 adult children;
21-22 (3) the patient's parents; or
21-23 (4) the patient's nearest living relative.
21-24 (c) A treatment decision made under Subsection (a) or
21-25 (b) must be based on knowledge of what the patient would desire,
21-26 if known.
21-27 (d) A treatment decision made under Subsection (b) must be
22-1 documented in the patient's medical record and signed by the
22-2 attending physician.
22-3 (e) If the patient does not have a legal guardian and a
22-4 person listed in Subsection (b) is not available, a treatment
22-5 decision made under Subsection (b) must be concurred in [witnessed]
22-6 by another physician who is not involved in the treatment of the
22-7 patient or who is a representative of an ethics or medical
22-8 committee of the health care facility in which the person is a
22-9 patient.
22-10 (f) The fact that an adult qualified patient has not
22-11 executed or issued a directive does not create a presumption that
22-12 the patient does not want a treatment decision to be made to
22-13 withhold or withdraw life-sustaining treatment [procedures].
22-14 (g) A person listed in Subsection (b) who wishes to
22-15 challenge a treatment decision made under this section must apply
22-16 for temporary guardianship under Section 875, Texas Probate Code.
22-17 The court may waive applicable fees in that proceeding.
22-18 Sec. 166.040 [672.010]. PATIENT CERTIFICATION AND
22-19 PREREQUISITES FOR COMPLYING WITH DIRECTIVE. (a) An attending
22-20 physician who has been notified of the existence of a directive
22-21 shall provide for the declarant's certification as a qualified
22-22 patient on diagnosis of a terminal or irreversible condition.
22-23 (b) Before withholding or withdrawing life-sustaining
22-24 treatment [procedures] from a qualified patient under this
22-25 subchapter [chapter], the attending physician must[:]
22-26 [(1) determine that the patient's death is imminent or
22-27 will result within a relatively short time without application of
23-1 those procedures;]
23-2 [(2) note that determination in the patient's medical
23-3 record; and]
23-4 [(3)] determine that the steps proposed to be taken
23-5 are in accord with this subchapter [chapter] and the patient's
23-6 existing desires.
23-7 Sec. 166.041 [672.011]. DURATION OF DIRECTIVE. A directive
23-8 is effective until it is revoked as prescribed by Section 166.042
23-9 [672.012].
23-10 Sec. 166.042 [672.012]. REVOCATION OF DIRECTIVE. (a) A
23-11 declarant may revoke a directive at any time without regard to the
23-12 declarant's mental state or competency. A directive may be revoked
23-13 by:
23-14 (1) the declarant or someone in the declarant's
23-15 presence and at the declarant's direction canceling, defacing,
23-16 obliterating, burning, tearing, or otherwise destroying the
23-17 directive;
23-18 (2) the declarant signing and dating a written
23-19 revocation that expresses the declarant's intent to revoke the
23-20 directive; or
23-21 (3) the declarant orally stating the declarant's
23-22 intent to revoke the directive.
23-23 (b) A written revocation executed as prescribed by
23-24 Subsection (a)(2) takes effect only when the declarant or a person
23-25 acting on behalf of the declarant notifies the attending physician
23-26 of its existence or mails the revocation to the attending
23-27 physician. The attending physician or the physician's designee
24-1 shall record in the patient's medical record the time and date when
24-2 the physician received notice of the written revocation and shall
24-3 enter the word "VOID" on each page of the copy of the directive in
24-4 the patient's medical record.
24-5 (c) An oral revocation issued as prescribed by Subsection
24-6 (a)(3) takes effect only when the declarant or a person acting on
24-7 behalf of the declarant notifies the attending physician of the
24-8 revocation. The attending physician or the physician's designee
24-9 shall record in the patient's medical record the time, date, and
24-10 place of the revocation, and, if different, the time, date, and
24-11 place that the physician received notice of the revocation. The
24-12 attending physician or the physician's designees shall also enter
24-13 the word "VOID" on each page of the copy of the directive in the
24-14 patient's medical record.
24-15 (d) Except as otherwise provided by this subchapter
24-16 [chapter], a person is not civilly or criminally liable for failure
24-17 to act on a revocation made under this section unless the person
24-18 has actual knowledge of the revocation.
24-19 Sec. 166.043 [672.013]. REEXECUTION OF DIRECTIVE. A
24-20 declarant may at any time reexecute a directive in accordance with
24-21 the procedures prescribed by Section 166.032 [672.003], including
24-22 reexecution after the declarant is diagnosed as having a terminal
24-23 or irreversible condition.
24-24 [Sec. 672.014. EFFECT OF DIRECTIVE ON INSURANCE POLICY AND
24-25 PREMIUMS. (a) The fact that a person has executed or issued a
24-26 directive under this chapter does not:]
24-27 [(1) restrict, inhibit, or impair in any manner the
25-1 sale, procurement, or issuance of a life insurance policy to that
25-2 person; or]
25-3 [(2) modify the terms of an existing life insurance
25-4 policy.]
25-5 [(b) Notwithstanding the terms of any life insurance policy,
25-6 the fact that life-sustaining procedures are withheld or withdrawn
25-7 from an insured qualified patient under this chapter does not
25-8 legally impair or invalidate that person's life insurance policy.]
25-9 [(c) A physician, health facility, health provider, insurer,
25-10 or health care service plan may not require a person to execute or
25-11 issue a directive as a condition for obtaining insurance for health
25-12 care services or receiving health care services.]
25-13 [(d) The fact that a person has executed or issued or failed
25-14 to execute or issue a directive under this chapter may not be
25-15 considered in any way in establishing insurance premiums.]
25-16 Sec. 166.044 [672.015]. LIMITATION OF LIABILITY FOR
25-17 WITHHOLDING OR WITHDRAWING LIFE-SUSTAINING PROCEDURES. (a) A
25-18 physician or health care facility that causes life-sustaining
25-19 treatment [procedures] to be withheld or withdrawn from a qualified
25-20 patient in accordance with this subchapter [chapter] is not civilly
25-21 liable for that action unless the physician or health care facility
25-22 fails to exercise reasonable care when applying the patient's
25-23 advance directive [negligent].
25-24 (b) A health professional, acting under the direction of a
25-25 physician, who participates in withholding or withdrawing
25-26 life-sustaining treatment [procedures] from a qualified patient in
25-27 accordance with this subchapter [chapter] is not civilly liable for
26-1 that action unless the health professional fails to exercise
26-2 reasonable care when applying the patient's advance directive
26-3 [negligent].
26-4 (c) A physician, or a health professional acting under the
26-5 direction of a physician, who participates in withholding or
26-6 withdrawing life-sustaining treatment [procedures] from a qualified
26-7 patient in accordance with this subchapter [chapter] is not
26-8 criminally liable or guilty of unprofessional conduct as a result
26-9 of that action unless the physician or health professional fails to
26-10 exercise reasonable care when applying the patient's advance
26-11 directive [negligent].
26-12 (d) The standard of care that a physician, health care
26-13 facility, or health care professional shall exercise under this
26-14 section is that degree of care that a physician, health care
26-15 facility, or health care professional, as applicable, of ordinary
26-16 prudence and skill would have exercised under the same or similar
26-17 circumstances in the same or a similar community.
26-18 Sec. 166.045 [672.016]. [LIMITATION OF] LIABILITY FOR
26-19 FAILURE TO EFFECTUATE DIRECTIVE. (a) A physician, health care
26-20 facility, or health care professional who has no knowledge of a
26-21 directive is not civilly or criminally liable for failing to act in
26-22 accordance with the directive.
26-23 (b) A physician, or a health professional acting under the
26-24 direction of a physician, is subject to review and disciplinary
26-25 action by the appropriate licensing board [not civilly or
26-26 criminally liable] for failing to effectuate a qualified patient's
26-27 directive in violation of this subchapter or other laws of this
27-1 state. This subsection does not limit remedies available under
27-2 other laws of this state.
27-3 (c) If an attending physician refuses to comply with a
27-4 directive or treatment decision and does not wish to follow the
27-5 procedure established under Section 166.046, life-sustaining
27-6 treatment shall be provided to the patient, but only until a
27-7 reasonable opportunity has been afforded for the [physician shall
27-8 make a reasonable effort to] transfer of the patient to another
27-9 physician or health care facility willing to comply with the
27-10 directive or treatment decision.
27-11 (d) A physician, health professional acting under the
27-12 direction of a physician, or health care facility is not civilly or
27-13 criminally liable or subject to review or disciplinary action by
27-14 the person's appropriate licensing board if the person has complied
27-15 with the procedures outlined in Section 166.046.
27-16 Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE.
27-17 (a) If an attending physician refuses to honor a patient's advance
27-18 directive or a treatment decision under Section 166.039, the
27-19 physician's refusal shall be reviewed by an ethics or medical
27-20 committee. The attending physician may not be a member of that
27-21 committee. The patient shall be given life-sustaining treatment
27-22 during the review.
27-23 (b) The patient or the person responsible for the health
27-24 care decisions of the individual who has made the decision
27-25 regarding the directive or treatment decision:
27-26 (1) shall be informed of the committee review process
27-27 not less than 48 hours before the meeting called to discuss the
28-1 patient's directive, unless the time period is waived by mutual
28-2 agreement; and
28-3 (2) is entitled to:
28-4 (A) attend the meeting; and
28-5 (B) receive a written explanation of the
28-6 decision reached during the review process.
28-7 (c) The written explanation required by Subsection (b)(2)(B)
28-8 must be included in the patient's medical record.
28-9 (d) If the attending physician, the patient, or the person
28-10 responsible for the health care decisions of the individual does
28-11 not agree with the decision reached during the review process under
28-12 Subsection (b), the physician shall make a reasonable effort to
28-13 transfer the patient to a physician who is willing to comply with
28-14 the directive. If the patient is a patient in a health care
28-15 facility, the facility's personnel shall assist the physician in
28-16 arranging the patient's transfer to:
28-17 (1) another physician;
28-18 (2) an alternative care setting within that facility;
28-19 or
28-20 (3) another facility.
28-21 (e) If the patient is requesting life-sustaining treatment
28-22 that the attending physician and the review process have decided is
28-23 inappropriate treatment, the patient shall be given available
28-24 life-sustaining treatment pending transfer under Subsection (d).
28-25 The patient is responsible for any costs incurred in transferring
28-26 the patient to another facility. The physician and the health care
28-27 facility are not obligated to provide life-sustaining treatment
29-1 after the 10th day after the written decision required under
29-2 Subsection (b) is provided to the patient or the person responsible
29-3 for the health care decisions of the patient unless ordered to do
29-4 so under Subsection (g).
29-5 (f) Life-sustaining treatment under this section may not be
29-6 entered in the patient's medical record as medically unnecessary
29-7 treatment until the time period provided under Subsection (e) has
29-8 expired.
29-9 (g) At the request of the patient or the person responsible
29-10 for the health care decisions of the patient, the appropriate
29-11 district or county court shall extend the time period provided
29-12 under Subsection (e) only if the court finds, by a preponderance of
29-13 the evidence, that there is a reasonable expectation that a
29-14 physician or health care facility that will honor the patient's
29-15 directive will be found if the time extension is granted.
29-16 (h) This section may not be construed to impose an
29-17 obligation on a facility or a home and community support services
29-18 agency licensed under Chapter 142 or similar organization that is
29-19 beyond the scope of the services or resources of the facility or
29-20 agency. This section does not apply to hospice services provided
29-21 by a home or community support services agency licensed under
29-22 Chapter 142.
29-23 Sec. 166.047 [672.017]. HONORING DIRECTIVE DOES NOT
29-24 CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not commit an
29-25 offense under Section 22.08, Penal Code, by withholding or
29-26 withdrawing life-sustaining treatment [procedures] from a qualified
29-27 patient in accordance with this subchapter [chapter].
30-1 Sec. 166.048 [672.018]. CRIMINAL PENALTY; PROSECUTION.
30-2 (a) A person commits an offense if the person intentionally
30-3 conceals, cancels, defaces, obliterates, or damages another
30-4 person's directive without that person's consent. An offense under
30-5 this subsection is a Class A misdemeanor.
30-6 (b) A person is subject to prosecution for criminal homicide
30-7 under Chapter 19, Penal Code, if the person, with the intent to
30-8 cause life-sustaining treatment [procedures] to be withheld or
30-9 withdrawn from another person contrary to the other person's
30-10 desires, falsifies or forges a directive or intentionally conceals
30-11 or withholds personal knowledge of a revocation and thereby
30-12 directly causes life-sustaining treatment [procedures] to be
30-13 withheld or withdrawn from the other person with the result that
30-14 the other person's death is hastened.
30-15 Sec. 166.049 [672.019]. PREGNANT PATIENTS. A person may not
30-16 withdraw or withhold life-sustaining treatment [procedures] under
30-17 this subchapter [chapter] from a pregnant patient.
30-18 Sec. 166.050 [672.020]. MERCY KILLING NOT CONDONED. This
30-19 subchapter [chapter] does not condone, authorize, or approve mercy
30-20 killing or permit an affirmative or deliberate act or omission to
30-21 end life except to permit the natural process of dying as provided
30-22 by this subchapter [chapter].
30-23 Sec. 166.051 [672.021]. LEGAL RIGHT OR RESPONSIBILITY NOT
30-24 AFFECTED. This subchapter [chapter] does not impair or supersede
30-25 any legal right or responsibility a person may have to effect the
30-26 withholding or withdrawal of life-sustaining treatment [procedures]
30-27 in a lawful manner, provided that if an attending physician or
31-1 health care facility is unwilling to honor a patient's advance
31-2 directive or a treatment decision to provide life-sustaining
31-3 treatment, life-sustaining treatment is required to be provided the
31-4 patient, but only until a reasonable opportunity has been afforded
31-5 for transfer of the patient to another physician or health care
31-6 facility willing to comply with the advance directive or treatment
31-7 decision.
31-8 SECTION 1.04. Chapter 674, Health and Safety Code, is
31-9 transferred to Subtitle H, Title 2, Health and Safety Code, is
31-10 redesignated as Subchapter C, Chapter 166, Health and Safety Code,
31-11 and is amended to read as follows:
31-12 SUBCHAPTER C [CHAPTER 674]. OUT-OF-HOSPITAL
31-13 DO-NOT-RESUSCITATE ORDERS
31-14 Sec. 166.081 [674.001]. DEFINITIONS. In this subchapter
31-15 [chapter]:
31-16 (1) ["Attending physician" means the physician who has
31-17 primary responsibility for a person's treatment and care.]
31-18 [(2) "Board" means the Texas Board of Health.]
31-19 [(3)] "Cardiopulmonary resuscitation" means any
31-20 medical intervention used to restore circulatory or respiratory
31-21 function that has ceased [includes a component of cardiopulmonary
31-22 resuscitation].
31-23 (2) [(4) "Competent" means possessing the ability,
31-24 based on reasonable medical judgment, to understand and appreciate
31-25 the nature and consequences of a treatment decision, including the
31-26 significant benefits and harms of, and reasonable alternatives to,
31-27 a proposed treatment decision.]
32-1 [(5) "Declarant" means a person who has executed or
32-2 issued an out-of-hospital do-not-resuscitate order under this
32-3 chapter.]
32-4 [(6) "Department" means the Texas Department of
32-5 Health.]
32-6 [(7)] "DNR identification device" means an
32-7 identification device specified by the board under Section 166.101
32-8 [674.023] that is worn for the purpose of identifying a person who
32-9 has executed or issued an out-of-hospital DNR order or on whose
32-10 behalf an out-of-hospital DNR order has been executed or issued
32-11 under this subchapter [chapter].
32-12 (3) [(8) "Durable power of attorney for health care"
32-13 means a document delegating to an agent the authority to make
32-14 health care decisions for a person in accordance with Chapter 135,
32-15 Civil Practice and Remedies Code.]
32-16 [(9)] "Emergency medical services" has the meaning
32-17 assigned by Section 773.003.
32-18 (4) [(10)] "Emergency medical services personnel" has
32-19 the meaning assigned by Section 773.003.
32-20 (5) [(11)] "Health care professionals" means
32-21 physicians, physician assistants, nurses, and emergency medical
32-22 services personnel and, unless the context requires otherwise,
32-23 includes hospital emergency personnel.
32-24 (6) [(12) "Incompetent" means lacking the ability,
32-25 based on reasonable medical judgment, to understand and appreciate
32-26 the nature and consequences of a treatment decision, including the
32-27 significant benefits and harms of, and reasonable alternatives to,
33-1 a proposed treatment decision.]
33-2 [(13) "Life-sustaining procedure" means a medical
33-3 procedure, treatment, or intervention that uses mechanical or other
33-4 artificial means to sustain, restore, or supplant a spontaneous
33-5 vital function and, when applied to a person in a terminal
33-6 condition, serves only to prolong the process of dying. The term
33-7 does not include the administration of medication or the
33-8 performance of a medical procedure considered to be necessary to
33-9 provide comfort or care or to alleviate pain or the provision of
33-10 water or nutrition.]
33-11 [(14)] "Out-of-hospital DNR order":
33-12 (A) means a legally binding out-of-hospital
33-13 do-not-resuscitate order, in the form specified by the board under
33-14 Section 166.083 [674.003], prepared and signed by the attending
33-15 physician of a person [who has been diagnosed as having a terminal
33-16 condition], that documents the instructions of a person or the
33-17 person's legally authorized representative and directs health care
33-18 professionals acting in an out-of-hospital setting not to initiate
33-19 or continue the following life-sustaining treatment [procedures]:
33-20 (i) cardiopulmonary resuscitation;
33-21 (ii) [endotrachacheal intubation or other
33-22 means of] advanced airway management;
33-23 (iii) artificial ventilation;
33-24 (iv) defibrillation;
33-25 (v) transcutaneous cardiac pacing; and
33-26 (vi) [the administration of cardiac
33-27 resuscitation medications; and]
34-1 [(vii)] other life-sustaining treatment
34-2 [procedures] specified by the board under Section 166.101(a)
34-3 [674.023(a)]; and
34-4 (B) does not include authorization to withhold
34-5 medical interventions or therapies considered necessary to provide
34-6 comfort [or] care or to alleviate pain or to provide water or
34-7 nutrition.
34-8 (7) [(15)] "Out-of-hospital setting" means a location
34-9 [any setting outside of a licensed acute care hospital] in which
34-10 health care professionals are called for assistance, including
34-11 long-term care facilities, in-patient hospice facilities, private
34-12 homes, hospital outpatient or emergency departments, physician's
34-13 offices, and vehicles during transport.
34-14 (8) [(16) "Physician" means a physician licensed by
34-15 the Texas State Board of Medical Examiners or a properly
34-16 credentialed physician who holds a commission in the uniformed
34-17 services of the United States and who is serving on active duty in
34-18 this state.]
34-19 [(17)] "Proxy" means a person designated and
34-20 authorized by a directive executed or issued in accordance with
34-21 Subchapter B [Chapter 672] to make a treatment decision for another
34-22 person in the event the other person becomes [comatose,]
34-23 incompetent[,] or otherwise mentally or physically incapable of
34-24 communication.
34-25 (9) [(18)] "Qualified relatives" means those persons
34-26 authorized to execute or issue an out-of-hospital DNR order on
34-27 behalf of a person who is [comatose,] incompetent[,] or otherwise
35-1 mentally or physically incapable of communication under Section
35-2 166.088 [674.008].
35-3 (10) [(19)] "Statewide out-of-hospital DNR protocol"
35-4 means a set of statewide standardized procedures adopted by the
35-5 board under Section 166.101(a) [674.023] for withholding
35-6 cardiopulmonary resuscitation and certain other life-sustaining
35-7 treatment [procedures] by health care professionals acting in
35-8 out-of-hospital settings.
35-9 [(20) "Terminal condition" means an incurable or
35-10 irreversible condition caused by injury, disease, or illness that
35-11 would produce death without the application of life-sustaining
35-12 procedures, according to reasonable medical judgment, and in which
35-13 the application of life-sustaining procedures serves only to
35-14 postpone the moment of the person's death.]
35-15 Sec. 166.082 [674.002]. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE
35-16 TO PHYSICIANS. (a) A competent person [who has been diagnosed by
35-17 a physician as having a terminal condition] may at any time execute
35-18 a written out-of-hospital DNR order directing health care
35-19 professionals acting in an out-of-hospital setting to withhold
35-20 cardiopulmonary resuscitation and certain other life-sustaining
35-21 treatment [procedures] designated by the board.
35-22 (b) The declarant must sign the out-of-hospital DNR order in
35-23 the presence of two witnesses who qualify under Section 166.003, at
35-24 least one of whom must be a witness who qualifies under Section
35-25 166.003(2). The [and those] witnesses must sign the order. The
35-26 attending physician of the declarant must sign the order and shall
35-27 make the fact of the existence of the order and the reasons for
36-1 execution of the order a part of the declarant's medical record.
36-2 (c) [A witness must have the same qualifications as those
36-3 provided by Section 672.003(c).]
36-4 [(d)] If the person is incompetent but previously executed
36-5 or issued a directive to physicians in accordance with Subchapter B
36-6 [Chapter 672], the physician may rely on the directive as the
36-7 person's instructions to issue an out-of-hospital DNR order and
36-8 shall place a copy of the directive in the person's medical record.
36-9 The physician shall sign the order in lieu of the person signing
36-10 under Subsection (b).
36-11 (d) [(e)] If the person is incompetent but previously
36-12 executed or issued a directive to physicians in accordance with
36-13 Subchapter B [Chapter 672] designating a proxy, the proxy may make
36-14 any decisions required of the designating person as to an
36-15 out-of-hospital DNR order and shall sign the order in lieu of the
36-16 person signing under Subsection (b).
36-17 (e) [(f)] If the person is now incompetent but previously
36-18 executed or issued a medical [durable] power of attorney [for
36-19 health care in accordance with Chapter 135, Civil Practice and
36-20 Remedies Code,] designating an agent, the agent may make any
36-21 decisions required of the designating person as to an
36-22 out-of-hospital DNR order and shall sign the order in lieu of the
36-23 person signing under Subsection (b).
36-24 (f) [(g)] The board, on the recommendation of the
36-25 department, shall by rule adopt procedures for the disposition and
36-26 maintenance of records of an original out-of-hospital DNR order and
36-27 any copies of the order.
37-1 (g) [(h)] An out-of-hospital DNR order is effective on its
37-2 execution.
37-3 Sec. 166.083 [674.003]. FORM OF OUT-OF-HOSPITAL DNR ORDER.
37-4 (a) A written out-of-hospital DNR order shall be in the standard
37-5 form specified by board rule as recommended by the department.
37-6 (b) The standard form of an out-of-hospital DNR order
37-7 specified by the board must, at a minimum, contain the following:
37-8 (1) a distinctive single-page format that readily
37-9 identifies the document as an out-of-hospital DNR order;
37-10 (2) a title that readily identifies the document as an
37-11 out-of-hospital DNR order;
37-12 (3) the printed or typed name of the person;
37-13 (4) a statement that the physician signing the
37-14 document is the attending physician of the person[, that the
37-15 physician has diagnosed the person as having a terminal condition,]
37-16 and that the physician is directing health care professionals
37-17 acting in out-of-hospital settings, including a hospital emergency
37-18 department, not to initiate or continue certain life-sustaining
37-19 treatment [procedures] on behalf of the person, and a listing of
37-20 those procedures not to be initiated or continued;
37-21 (5) a statement that the person understands that the
37-22 person may revoke the out-of-hospital DNR order at any time by
37-23 destroying the order and removing the DNR identification device, if
37-24 any, or by communicating to health care professionals at the scene
37-25 the person's desire to revoke the out-of-hospital DNR order;
37-26 (6) places for the printed names and signatures of the
37-27 witnesses and attending physician of the person and the medical
38-1 license number of the attending physician;
38-2 (7) a separate section for execution of the document
38-3 by the legal guardian of the person, the person's proxy, an agent
38-4 of the person having a medical [durable] power of attorney [for
38-5 health care], or the attending physician attesting to the issuance
38-6 of an out-of-hospital DNR order by nonwritten means of
38-7 communication or acting in accordance with a previously executed or
38-8 previously issued directive to physicians under Section 166.082(c)
38-9 [674.002(d)] that includes the following:
38-10 (A) a statement that the legal guardian, the
38-11 proxy, the agent, the person by nonwritten means of communication,
38-12 or the physician directs that each [the] listed life-sustaining
38-13 treatment [procedures] should not be initiated or continued in
38-14 behalf of the person; and
38-15 (B) places for the printed names and signatures
38-16 of the witnesses and, as applicable, the legal guardian, proxy,
38-17 agent, or physician;
38-18 (8) a separate section for execution of the document
38-19 by at least one [two] qualified relative [relatives] of the person
38-20 when the person does not have a legal guardian, proxy, or agent
38-21 having a medical [durable] power of attorney [for health care] and
38-22 is [comatose,] incompetent[,] or otherwise mentally or physically
38-23 incapable of communication, including:
38-24 (A) a statement that the relative [relatives] of
38-25 the person is [are] qualified to make a treatment decision to
38-26 withhold cardiopulmonary resuscitation and certain other
38-27 designated life-sustaining treatment [procedures] under Section
39-1 166.088 [674.008] and, based on the known desires of the person or
39-2 a determination of the best interest of the person, directs
39-3 [direct] that each [the] listed life-sustaining treatment
39-4 [procedures] should not be initiated or continued in behalf of the
39-5 person; and
39-6 (B) places for the printed names and signatures
39-7 of the witnesses and qualified relative [relatives] of the person;
39-8 (9) a place for entry of the date of execution of the
39-9 document;
39-10 (10) a statement that the document is in effect on the
39-11 date of its execution and remains in effect until the death of the
39-12 person or until the document is revoked;
39-13 (11) a statement that the document must accompany the
39-14 person during transport;
39-15 (12) a statement regarding the proper disposition of
39-16 the document or copies of the document, as the board determines
39-17 appropriate; and
39-18 (13) a statement at the bottom of the document, with
39-19 places for the signature of each person executing the document,
39-20 that the document has been properly completed.
39-21 (c) The board may, by rule and as recommended by the
39-22 department, modify the standard form of the out-of-hospital DNR
39-23 order described by Subsection (b) in order to accomplish the
39-24 purposes of this subchapter [chapter].
39-25 (d) A photocopy or other complete facsimile of the original
39-26 written out-of-hospital DNR order executed under this subchapter
39-27 may be used for any purpose for which the original written order
40-1 may be used under this subchapter.
40-2 Sec. 166.084 [674.004]. ISSUANCE OF OUT-OF-HOSPITAL DNR
40-3 ORDER BY NONWRITTEN COMMUNICATION. (a) A competent person who is
40-4 an adult may issue an out-of-hospital DNR order by nonwritten
40-5 communication.
40-6 (b) A declarant must issue the nonwritten out-of-hospital
40-7 DNR order in the presence of the attending physician and two
40-8 witnesses who qualify under Section 166.003, at least one of whom
40-9 must be a witness who qualifies under Section 166.003(2). [The
40-10 witnesses must possess the same qualifications as those provided by
40-11 Section 672.003(c).]
40-12 (c) The attending physician and witnesses shall sign the
40-13 out-of-hospital DNR order in the [that] place of the document
40-14 provided by Section 166.083(b)(7) [674.003(b)(7)] and the attending
40-15 physician shall sign the document in the place required by Section
40-16 166.083(b)(13) [674.003(b)(13)]. The physician shall make the fact
40-17 of the existence of the out-of-hospital DNR order a part of the
40-18 declarant's medical record and the names of the witnesses shall be
40-19 entered [sign that entry] in the medical record.
40-20 (d) An out-of-hospital DNR order issued in the manner
40-21 provided by this section is valid and shall be honored by
40-22 responding health care professionals as if executed in the manner
40-23 provided by Section 166.082 [674.002].
40-24 Sec. 166.085 [674.005]. EXECUTION OF OUT-OF-HOSPITAL DNR
40-25 ORDER ON BEHALF OF A MINOR. The following persons may execute an
40-26 out-of-hospital DNR order on behalf of a minor:
40-27 (1) the minor's parents;
41-1 (2) the minor's legal guardian; or
41-2 (3) the minor's managing conservator.
41-3 Sec. 166.086 [674.006]. DESIRE OF PERSON SUPERSEDES
41-4 OUT-OF-HOSPITAL DNR ORDER. The desire of a competent person,
41-5 including a competent minor, supersedes the effect of an
41-6 out-of-hospital DNR order executed or issued by or on behalf of the
41-7 person when the desire is communicated to responding health care
41-8 professionals as provided by this subchapter [chapter].
41-9 Sec. 166.087 [674.007]. PROCEDURE WHEN DECLARANT IS
41-10 INCOMPETENT OR INCAPABLE OF COMMUNICATION. (a) This section
41-11 applies when a person 18 years of age or older has executed or
41-12 issued an out-of-hospital DNR order and subsequently becomes
41-13 [comatose,] incompetent[,] or otherwise mentally or physically
41-14 incapable of communication.
41-15 (b) If the adult person has designated a person to make a
41-16 treatment decision as authorized by Section 166.032(c)
41-17 [672.003(d)], the attending physician and the designated person
41-18 shall comply with the out-of-hospital DNR order.
41-19 (c) If the adult person has not designated a person to make
41-20 a treatment decision as authorized by Section 166.032(c)
41-21 [672.003(d)], the attending physician shall comply with the
41-22 out-of-hospital DNR order unless the physician believes that the
41-23 order does not reflect the person's present desire.
41-24 Sec. 166.088 [674.008]. PROCEDURE WHEN PERSON HAS NOT
41-25 EXECUTED OR ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR
41-26 INCAPABLE OF COMMUNICATION. (a) If an adult person has not
41-27 executed or issued an out-of-hospital DNR order and is [comatose,]
42-1 incompetent[,] or otherwise mentally or physically incapable of
42-2 communication, the attending physician and the person's legal
42-3 guardian, proxy, or agent having a medical [durable] power of
42-4 attorney [for health care] may execute an out-of-hospital DNR order
42-5 on behalf of the person.
42-6 (b) If the person does not have a legal guardian, proxy, or
42-7 agent under a medical power of attorney, the attending physician
42-8 and at least one [two] qualified relative from a category listed by
42-9 Section 166.039(b), subject to the priority established under that
42-10 subsection, [relatives] may execute an out-of-hospital DNR order
42-11 in the same manner as a treatment decision made under Section
42-12 166.039(b) [672.009(b)].
42-13 (c) A decision to execute an out-of-hospital DNR order made
42-14 under Subsection (a) or (b) must be based on knowledge of what the
42-15 person would desire, if known.
42-16 (d) An out-of-hospital DNR order executed under Subsection
42-17 (b) must be made in the presence of at least two witnesses who
42-18 qualify under Section 166.003, at least one of whom must be a
42-19 witness who qualifies under Section 166.003(2) [who possess the
42-20 same qualifications that are required by Section 672.003(c)].
42-21 (e) The fact that an adult person has not executed or issued
42-22 an out-of-hospital DNR order does not create a presumption that the
42-23 person does not want a treatment decision made to withhold
42-24 cardiopulmonary resuscitation and certain other designated
42-25 life-sustaining treatment [procedures] designated by the board.
42-26 (f) If there is not a qualified relative available to act
42-27 for the person under Subsection (b), an out-of-hospital DNR order
43-1 must be concurred in by another physician who is not involved in
43-2 the treatment of the patient or who is a representative of the
43-3 ethics or medical committee of the health care facility in which
43-4 the person is a patient.
43-5 (g) A person listed in Section 166.039(b) who wishes to
43-6 challenge a decision made under this section must apply for
43-7 temporary guardianship under Section 875, Texas Probate Code. The
43-8 court may waive applicable fees in that proceeding.
43-9 Sec. 166.089 [674.009]. COMPLIANCE WITH OUT-OF-HOSPITAL DNR
43-10 ORDER. (a) When responding to a call for assistance, health care
43-11 professionals shall honor an out-of-hospital DNR order in
43-12 accordance with the statewide out-of-hospital DNR protocol and,
43-13 where applicable, locally adopted out-of-hospital DNR protocols not
43-14 in conflict with the statewide protocol if:
43-15 (1) the responding health care professionals discover
43-16 an executed or issued out-of-hospital DNR order form on their
43-17 arrival at the scene; and
43-18 (2) the responding health care professionals comply
43-19 with this section.
43-20 (b) If the person is wearing a DNR identification device,
43-21 the responding health care professionals must comply with Section
43-22 166.090 [674.010].
43-23 (c) The responding health care professionals must establish
43-24 the identity of the person as the person who executed or issued the
43-25 out-of-hospital DNR order or for whom the out-of-hospital DNR order
43-26 was executed or issued.
43-27 (d) The responding health care professionals must determine
44-1 that the out-of-hospital DNR order form appears to be valid in that
44-2 it includes:
44-3 (1) written responses in the places designated on the
44-4 form for the names, signatures, and other information required of
44-5 persons executing or issuing, or witnessing the execution or
44-6 issuance of, the order;
44-7 (2) a date in the place designated on the form for the
44-8 date the order was executed or issued; and
44-9 (3) the signature of the declarant or persons
44-10 executing or issuing the order and the attending physician in the
44-11 appropriate places designated on the form for indicating that the
44-12 order form has been properly completed.
44-13 (e) If the conditions prescribed by Subsections (a) through
44-14 (d) are not determined to apply by the responding health care
44-15 professionals at the scene, the out-of-hospital DNR order may not
44-16 be honored and life-sustaining procedures otherwise required by law
44-17 or local emergency medical services protocols shall be initiated or
44-18 continued. Health care professionals acting in out-of-hospital
44-19 settings are not required to accept or interpret an out-of-hospital
44-20 DNR order that does not meet the requirements of this subchapter
44-21 [chapter].
44-22 (f) The out-of-hospital DNR order form or a copy of the
44-23 form, when available, must accompany the person during transport.
44-24 (g) A record shall be made and maintained of the
44-25 circumstances of each emergency medical services response in which
44-26 an out-of-hospital DNR order or DNR identification device is
44-27 encountered, in accordance with the statewide out-of-hospital DNR
45-1 protocol and any applicable local out-of-hospital DNR protocol not
45-2 in conflict with the statewide protocol.
45-3 (h) An out-of-hospital DNR order executed or issued and
45-4 documented or evidenced in the manner prescribed by this subchapter
45-5 [chapter] is valid and shall be honored by responding health care
45-6 professionals unless the person or persons found at the scene:
45-7 (1) identify themselves as the declarant or as the
45-8 attending physician, legal guardian, qualified relative, or agent
45-9 of the person having a medical [durable] power of attorney [for
45-10 health care] who executed or issued the out-of-hospital DNR order
45-11 on behalf of the person; and
45-12 (2) request that cardiopulmonary resuscitation or
45-13 certain other life-sustaining treatment [procedures] designated by
45-14 the board be initiated or continued.
45-15 (i) If the policies of a health care facility preclude
45-16 compliance with the out-of-hospital DNR order of a person or an
45-17 out-of-hospital DNR order issued by an attending physician on
45-18 behalf of a person who is admitted to or a resident of the
45-19 facility, or if the facility is unwilling to accept DNR
45-20 identification devices as evidence of the existence of an
45-21 out-of-hospital DNR order, that facility shall take all reasonable
45-22 steps to notify the person or, if the person is incompetent, the
45-23 person's guardian or the person or persons having authority to make
45-24 health care treatment decisions on behalf of the person, of the
45-25 facility's policy and shall take all reasonable steps to effect the
45-26 transfer of the person to the person's home or to a facility where
45-27 the provisions of this subchapter [chapter] can be carried out.
46-1 Sec. 166.090 [674.010]. DNR IDENTIFICATION DEVICE. (a) A
46-2 person who has a valid out-of-hospital DNR order under this
46-3 subchapter [chapter] may wear a DNR identification device around
46-4 the neck or on the wrist as prescribed by board rule adopted under
46-5 Section 166.101 [674.023].
46-6 (b) The presence of a DNR identification device on the body
46-7 of a person is conclusive evidence that the person has executed or
46-8 issued a valid out-of-hospital DNR order or has a valid
46-9 out-of-hospital DNR order executed or issued on the person's
46-10 behalf. Responding health care professionals shall honor the DNR
46-11 identification device as if a valid out-of-hospital DNR order form
46-12 executed or issued by the person were found in the possession of
46-13 the person.
46-14 Sec. 166.091 [674.011]. DURATION OF OUT-OF-HOSPITAL DNR
46-15 ORDER. An out-of-hospital DNR order is effective until it is
46-16 revoked as prescribed by Section 166.092 [674.012].
46-17 Sec. 166.092 [674.012]. REVOCATION OF OUT-OF-HOSPITAL DNR
46-18 ORDER. (a) A declarant may revoke an out-of-hospital DNR order at
46-19 any time without regard to the declarant's mental state or
46-20 competency. An order may be revoked by:
46-21 (1) the declarant or someone in the declarant's
46-22 presence and at the declarant's direction destroying the order form
46-23 and removing the DNR identification device, if any;
46-24 (2) a person who identifies himself or herself as the
46-25 legal guardian, as a qualified relative, or as the agent of the
46-26 declarant having a medical [durable] power of attorney [for health
46-27 care] who executed the out-of-hospital DNR order or another person
47-1 in the person's presence and at the person's direction destroying
47-2 the order form and removing the DNR identification device, if any;
47-3 (3) the declarant communicating the declarant's intent
47-4 to revoke the order; or
47-5 (4) a person who identifies himself or herself as the
47-6 legal guardian, a qualified relative, or the agent of the declarant
47-7 having a medical [durable] power of attorney [for health care] who
47-8 executed the out-of-hospital DNR order orally stating the person's
47-9 intent to revoke the order.
47-10 (b) An oral revocation under Subsection (a)(3) or (a)(4)
47-11 takes effect only when the declarant or a person who identifies
47-12 himself or herself as the legal guardian, a qualified relative, or
47-13 the agent of the declarant having a medical [durable] power of
47-14 attorney [for health care] who executed the out-of-hospital DNR
47-15 order communicates the intent to revoke the order to the responding
47-16 health care professionals or the attending physician at the scene.
47-17 The responding health care professionals shall record the time,
47-18 date, and place of the revocation in accordance with the statewide
47-19 out-of-hospital DNR protocol and rules adopted by the board and any
47-20 applicable local out-of-hospital DNR protocol. The attending
47-21 physician or the physician's designee shall record in the person's
47-22 medical record the time, date, and place of the revocation and, if
47-23 different, the time, date, and place that the physician received
47-24 notice of the revocation. The attending physician or the
47-25 physician's designee shall also enter the word "VOID" on each page
47-26 of the copy of the order in the person's medical record.
47-27 (c) Except as otherwise provided by this subchapter
48-1 [chapter], a person is not civilly or criminally liable for failure
48-2 to act on a revocation made under this section unless the person
48-3 has actual knowledge of the revocation.
48-4 Sec. 166.093 [674.013]. REEXECUTION OF OUT-OF-HOSPITAL DNR
48-5 ORDER. A declarant may at any time reexecute or reissue an
48-6 out-of-hospital DNR order in accordance with the procedures
48-7 prescribed by Section 166.082 [674.002], including reexecution or
48-8 reissuance after the declarant is diagnosed as having a terminal or
48-9 irreversible condition.
48-10 [Sec. 674.014. CONFLICT WITH NATURAL DEATH ACT OR DURABLE
48-11 POWER OF ATTORNEY FOR HEALTH CARE. To the extent that an
48-12 out-of-hospital DNR order conflicts with a directive or treatment
48-13 decision executed or issued under Chapter 672 or a durable power of
48-14 attorney for health care executed or issued in accordance with
48-15 Chapter 135, Civil Practice and Remedies Code, the instrument
48-16 executed later in time controls.]
48-17 [Sec. 674.015. EFFECT OF OUT-OF-HOSPITAL DNR ORDER ON
48-18 INSURANCE POLICY AND PREMIUMS. (a) The fact that a person has
48-19 executed or issued an out-of-hospital DNR order under this chapter
48-20 does not:]
48-21 [(1) restrict, inhibit, or impair in any manner the
48-22 sale, procurement, or issuance of a life insurance policy to that
48-23 person; or]
48-24 [(2) modify the terms of an existing life insurance
48-25 policy.]
48-26 [(b) Notwithstanding the terms of any life insurance policy,
48-27 the fact that cardiopulmonary resuscitation or certain other
49-1 life-sustaining procedures designated by the board are withheld
49-2 from an insured person under this chapter does not legally impair
49-3 or invalidate that person's life insurance policy and may not be a
49-4 factor for the purpose of determining the payability of benefits or
49-5 the cause of death under the life insurance policy.]
49-6 [(c) A physician, health facility, health care provider,
49-7 insurer, or health care service plan may not require a person to
49-8 execute or issue an out-of-hospital DNR order as a condition for
49-9 obtaining insurance for health care services or receiving health
49-10 care services.]
49-11 [(d) The fact that a person has executed or issued or failed
49-12 to execute or issue an out-of-hospital DNR order under this chapter
49-13 may not be considered in any way in establishing insurance
49-14 premiums.]
49-15 Sec. 166.094 [674.016]. LIMITATION ON LIABILITY FOR
49-16 WITHHOLDING CARDIOPULMONARY RESUSCITATION AND CERTAIN OTHER
49-17 LIFE-SUSTAINING PROCEDURES. (a) A health care professional or
49-18 health care facility or entity that in good faith causes
49-19 cardiopulmonary resuscitation or certain other life-sustaining
49-20 treatment [procedures] designated by the board to be withheld from
49-21 a person in accordance with this subchapter [chapter] is not
49-22 civilly liable for that action.
49-23 (b) A health care professional or health care facility or
49-24 entity that in good faith participates in withholding
49-25 cardiopulmonary resuscitation or certain other life-sustaining
49-26 treatment [procedures] designated by the board from a person in
49-27 accordance with this subchapter [chapter] is not civilly liable for
50-1 that action.
50-2 (c) A health care professional or health care facility or
50-3 entity that in good faith participates in withholding
50-4 cardiopulmonary resuscitation or certain other life-sustaining
50-5 treatment [procedures] designated by the board from a person in
50-6 accordance with this subchapter [chapter] is not criminally liable
50-7 or guilty of unprofessional conduct as a result of that action.
50-8 (d) A health care professional or health care facility or
50-9 entity that in good faith causes or participates in withholding
50-10 cardiopulmonary resuscitation or certain other life-sustaining
50-11 treatment [procedures] designated by the board from a person in
50-12 accordance with this subchapter [chapter] and rules adopted under
50-13 this subchapter [chapter] is not in violation of any other
50-14 licensing or regulatory laws or rules of this state and is not
50-15 subject to any disciplinary action or sanction by any licensing or
50-16 regulatory agency of this state as a result of that action.
50-17 Sec. 166.095 [674.017]. LIMITATION ON LIABILITY FOR FAILURE
50-18 TO EFFECTUATE OUT-OF-HOSPITAL DNR ORDER. (a) A health care
50-19 professional or health care facility or entity that has no actual
50-20 knowledge of an out-of-hospital DNR order is not civilly or
50-21 criminally liable for failing to act in accordance with the order.
50-22 (b) A health care professional or health care facility or
50-23 entity is subject to review and disciplinary action by the
50-24 appropriate licensing board [not civilly or criminally liable] for
50-25 failing to effectuate an out-of-hospital DNR order. This
50-26 subsection does not limit remedies available under other laws of
50-27 this state.
51-1 (c) If an attending physician refuses to execute or comply
51-2 with an out-of-hospital DNR order, the physician shall inform the
51-3 person, the legal guardian or qualified relatives of the person, or
51-4 the agent of the person having a medical [durable] power of
51-5 attorney [for health care] and, if the person or another authorized
51-6 to act on behalf of the person so directs, shall make a reasonable
51-7 effort to transfer the person to another physician who is willing
51-8 to execute or comply with an out-of-hospital DNR order.
51-9 Sec. 166.096 [674.018]. HONORING OUT-OF-HOSPITAL DNR ORDER
51-10 DOES NOT CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not
51-11 commit an offense under Section 22.08, Penal Code, by withholding
51-12 cardiopulmonary resuscitation or certain other life-sustaining
51-13 treatment [procedures] designated by the board from a person in
51-14 accordance with this subchapter [chapter].
51-15 Sec. 166.097 [674.019]. CRIMINAL PENALTY; PROSECUTION.
51-16 (a) A person commits an offense if the person intentionally
51-17 conceals, cancels, defaces, obliterates, or damages another
51-18 person's out-of-hospital DNR order or DNR identification device
51-19 without that person's consent or the consent of the person or
51-20 persons authorized to execute or issue an out-of-hospital DNR order
51-21 on behalf of the person under this subchapter [chapter]. An
51-22 offense under this subsection is a Class A misdemeanor.
51-23 (b) A person is subject to prosecution for criminal homicide
51-24 under Chapter 19, Penal Code, if the person, with the intent to
51-25 cause cardiopulmonary resuscitation or certain other
51-26 life-sustaining treatment [procedures] designated by the board to
51-27 be withheld from another person contrary to the other person's
52-1 desires, falsifies or forges an out-of-hospital DNR order or
52-2 intentionally conceals or withholds personal knowledge of a
52-3 revocation and thereby directly causes cardiopulmonary
52-4 resuscitation and certain other life-sustaining treatment
52-5 [procedures] designated by the board to be withheld from the other
52-6 person with the result that the other person's death is hastened.
52-7 Sec. 166.098 [674.020]. PREGNANT PERSONS. A person may not
52-8 withhold cardiopulmonary resuscitation or certain other
52-9 life-sustaining treatment [procedures] designated by the board
52-10 under this subchapter [chapter] from a person known by the
52-11 responding health care professionals to be pregnant.
52-12 Sec. 166.099 [674.021]. MERCY KILLING NOT CONDONED. This
52-13 subchapter [chapter] does not condone, authorize, or approve mercy
52-14 killing or permit an affirmative or deliberate act or omission to
52-15 end life except to permit the natural process of dying as provided
52-16 by this subchapter [chapter].
52-17 Sec. 166.100 [674.022]. LEGAL RIGHT OR RESPONSIBILITY NOT
52-18 AFFECTED. This subchapter [chapter] does not impair or supersede
52-19 any legal right or responsibility a person may have under a
52-20 constitution, other statute, regulation, or court decision to
52-21 effect the withholding of cardiopulmonary resuscitation or certain
52-22 other life-sustaining treatment [procedures] designated by the
52-23 board.
52-24 Sec. 166.101 [674.023]. DUTIES OF DEPARTMENT AND BOARD.
52-25 (a) The board shall, on the recommendation of the department,
52-26 adopt all reasonable and necessary rules to carry out the purposes
52-27 of this subchapter [chapter], including rules:
53-1 (1) adopting a statewide out-of-hospital DNR order
53-2 protocol that sets out standard procedures for the withholding of
53-3 cardiopulmonary resuscitation and certain other life-sustaining
53-4 treatment [procedures] by health care professionals acting in
53-5 out-of-hospital settings;
53-6 (2) designating life-sustaining treatment [procedures]
53-7 that may be included in an out-of-hospital DNR order, including all
53-8 procedures listed in Sections 166.081(6)(A)(i) through (v) [Section
53-9 674.001(14)(A)(i) through (vi)]; and
53-10 (3) governing recordkeeping in circumstances in which
53-11 an out-of-hospital DNR order or DNR identification device is
53-12 encountered by responding health care professionals.
53-13 (b) The rules adopted by the board under Subsection (a) are
53-14 not effective until approved by the Texas State Board of Medical
53-15 Examiners.
53-16 (c) Local emergency medical services authorities may adopt
53-17 local out-of-hospital DNR order protocols if the local protocols do
53-18 not conflict with the statewide out-of-hospital DNR order protocol
53-19 adopted by the board.
53-20 (d) The board by rule shall specify a distinctive standard
53-21 design for a necklace and a bracelet DNR identification device that
53-22 signifies, when worn by a person, that the possessor has executed
53-23 or issued a valid out-of-hospital DNR order under this subchapter
53-24 [chapter] or is a person for whom a valid out-of-hospital DNR order
53-25 has been executed or issued.
53-26 (e) The department shall report to the board from time to
53-27 time regarding issues identified in emergency medical services
54-1 responses in which an out-of-hospital DNR order or DNR
54-2 identification device is encountered. The report may contain
54-3 recommendations to the board for necessary modifications to the
54-4 form of the standard out-of-hospital DNR order or the designated
54-5 life-sustaining procedures listed in the standard out-of-hospital
54-6 DNR order, the statewide out-of-hospital DNR order protocol, or the
54-7 DNR identification devices.
54-8 [Sec. 674.024. RECOGNITION OF OUT-OF-HOSPITAL DNR ORDER
54-9 EXECUTED OR ISSUED IN OTHER STATE. An out-of-hospital DNR order
54-10 executed, issued, or authorized in another state or a territory or
54-11 possession of the United States in compliance with the law of that
54-12 jurisdiction is effective for purposes of this chapter.]
54-13 SECTION 1.05. Chapter 135, Civil Practice and Remedies Code,
54-14 is transferred to Subtitle H, Title 2, Health and Safety Code, is
54-15 redesignated as Subchapter D, Chapter 166, Health and Safety Code,
54-16 and is amended to read as follows:
54-17 SUBCHAPTER D [CHAPTER 135]. MEDICAL [DURABLE]
54-18 POWER OF ATTORNEY [FOR HEALTH CARE]
54-19 Sec. 166.151 [135.001]. DEFINITIONS. In this subchapter
54-20 [chapter]:
54-21 (1) "Adult" means a person 18 years of age or older or
54-22 a person under 18 years of age who has had the disabilities of
54-23 minority removed.
54-24 (2) "Agent" means an adult to whom authority to make
54-25 health care decisions is delegated under a medical [durable] power
54-26 of attorney [for health care].
54-27 (3) ["Attending physician" means the physician,
55-1 selected by or assigned to a patient, who has primary
55-2 responsibility for the treatment and care of the patient.]
55-3 [(4) "Capacity to make health care decisions" means
55-4 the ability to understand and appreciate the nature and
55-5 consequences of a health care decision, including the significant
55-6 benefits and harms of and reasonable alternatives to any proposed
55-7 health care.]
55-8 [(5) "Durable power of attorney for health care" means
55-9 a document delegating to an agent the authority to make health care
55-10 decisions as provided by this chapter.]
55-11 [(6) "Health care decision" means consent, refusal to
55-12 consent, or withdrawal of consent to health care, treatment,
55-13 service, or procedure to maintain, diagnose, or treat an
55-14 individual's physical or mental condition.]
55-15 [(7)] "Health care provider" means an individual or
55-16 facility licensed, certified, or otherwise authorized to administer
55-17 health care, for profit or otherwise, in the ordinary course of
55-18 business or professional practice and includes a physician.
55-19 (4) [(8) "Physician" means:]
55-20 [(A) a physician licensed by the Texas State
55-21 Board of Medical Examiners; or]
55-22 [(B) a physician with proper credentials who
55-23 holds a commission in a branch of the armed services of the United
55-24 States and who is serving on active duty in this state.]
55-25 [(9)] "Principal" means an adult who has executed a
55-26 medical [durable] power of attorney [for health care].
55-27 (5) [(10)] "Residential care provider" means an
56-1 individual or facility licensed, certified, or otherwise authorized
56-2 to operate, for profit or otherwise, a residential care home.
56-3 Sec. 166.152 [135.002]. SCOPE AND DURATION OF AUTHORITY.
56-4 (a) Subject to this subchapter [chapter] or any express limitation
56-5 on the authority of the agent contained in the medical [durable]
56-6 power of attorney [for health care], the agent may make any health
56-7 care decision on the principal's behalf that the principal could
56-8 make if the principal were competent [but for the principal's lack
56-9 of capacity to make health care decisions].
56-10 (b) An agent may exercise authority only if the principal's
56-11 attending physician certifies in writing and files the
56-12 certification in the principal's medical record that, based on the
56-13 attending physician's reasonable medical judgment, the principal is
56-14 incompetent [lacks capacity to make health care decisions].
56-15 (c) Notwithstanding any other provisions of this subchapter
56-16 [chapter], treatment may not be given to or withheld from the
56-17 principal if the principal objects regardless of whether, at the
56-18 time of the objection:
56-19 (1) a medical [durable] power of attorney [for health
56-20 care] is in effect; or
56-21 (2) the principal is competent [has the capacity to
56-22 make health care decisions].
56-23 (d) The principal's attending physician shall make
56-24 reasonable efforts to inform the principal of any proposed
56-25 treatment or of any proposal to withdraw or withhold treatment
56-26 before implementing an agent's advance directive.
56-27 (e) After consultation with the attending physician and
57-1 other health care providers, the agent shall make a health care
57-2 decision:
57-3 (1) according to the agent's knowledge of the
57-4 principal's wishes, including the principal's religious and moral
57-5 beliefs; or
57-6 (2) if the agent does not know the principal's wishes,
57-7 according to the agent's assessment of the principal's best
57-8 interests.
57-9 (f) Notwithstanding any other provision of this subchapter
57-10 [chapter], an agent may not consent to:
57-11 (1) voluntary inpatient mental health services;
57-12 (2) convulsive treatment;
57-13 (3) psychosurgery;
57-14 (4) abortion; or
57-15 (5) neglect of the principal through the omission of
57-16 care primarily intended to provide for the comfort of the
57-17 principal.
57-18 (g) The power of attorney is effective indefinitely on
57-19 execution as provided by this subchapter [chapter] and delivery of
57-20 the document to the agent, unless it is revoked as provided by this
57-21 subchapter [chapter] or the principal becomes competent [regains
57-22 the capacity to make health care decisions]. If the medical
57-23 [durable] power of attorney includes an expiration date and on that
57-24 date the principal is incompetent [lacks the capacity to make
57-25 health care decisions], the power of attorney continues to be
57-26 effective until the principal becomes competent [regains the
57-27 capacity to make health care decisions] unless it is revoked as
58-1 provided by this subchapter [chapter].
58-2 Sec. 166.153 [135.003]. PERSONS WHO MAY NOT EXERCISE
58-3 AUTHORITY OF AGENT. A person may not exercise the authority of an
58-4 agent while the person serves as:
58-5 (1) the principal's health care provider;
58-6 (2) an employee of the principal's health care
58-7 provider unless the person is a relative of the principal;
58-8 (3) the principal's residential care provider; or
58-9 (4) an employee of the principal's residential care
58-10 provider unless the person is a relative of the principal.
58-11 Sec. 166.154 [135.004]. EXECUTION AND WITNESSES. (a) The
58-12 medical [durable] power of attorney [for health care] must be
58-13 signed by the principal in the presence of [at least] two [or more
58-14 subscribing] witnesses who qualify under Section 166.003, at least
58-15 one of whom must be a witness who qualifies under Section
58-16 166.003(2). The witnesses must sign the document.
58-17 (b) [A witness may not, at the time of execution, be:]
58-18 [(1) the agent;]
58-19 [(2) the principal's health or residential care
58-20 provider or the provider's employee;]
58-21 [(3) the principal's spouse or heir;]
58-22 [(4) a person entitled to any part of the estate of
58-23 the principal on the death of the principal under a will or deed in
58-24 existence or by operation of law; or]
58-25 [(5) any other person who has any claim against the
58-26 estate of the principal.]
58-27 [(c) The witnesses shall affirm that, at the time the
59-1 durable power of attorney for health care was signed, the
59-2 principal:]
59-3 [(1) appeared to be of sound mind to make a health
59-4 care decision;]
59-5 [(2) stated in the witness's presence that the
59-6 principal was aware of the nature of the durable power of attorney
59-7 for health care and that the principal was signing the document
59-8 voluntarily and free from any duress; and]
59-9 [(3) requested that the witness serve as a witness to
59-10 the principal's execution of the document.]
59-11 [(d)] If the principal is physically unable to sign, another
59-12 person may sign the medical [durable] power of attorney [for health
59-13 care] with the principal's name in the principal's presence and at
59-14 the principal's express direction.
59-15 Sec. 166.155 [135.005]. REVOCATION. (a) A medical
59-16 [durable] power of attorney [for health care] is revoked by:
59-17 (1) oral or written notification at any time by the
59-18 principal to the agent or a licensed or certified health or
59-19 residential care provider or by any other act evidencing a specific
59-20 intent to revoke the power, without regard to whether the principal
59-21 is competent or the principal's mental state[, competency, or
59-22 capacity to make health care decisions];
59-23 (2) execution by the principal of a subsequent medical
59-24 [durable] power of attorney [for health care]; or
59-25 (3) the divorce of the principal and spouse, if the
59-26 spouse is the principal's agent, unless the medical power of
59-27 attorney provides otherwise.
60-1 (b) A principal's licensed or certified health or
60-2 residential care provider who is informed of or provided with a
60-3 revocation of a medical [durable] power of attorney [for health
60-4 care] shall immediately record the revocation in the principal's
60-5 medical record and give notice of the revocation to the agent and
60-6 any known health and residential care providers currently
60-7 responsible for the principal's care.
60-8 Sec. 166.156 [135.006]. APPOINTMENT OF GUARDIAN. (a) On
60-9 motion filed in connection with a petition for appointment of a
60-10 guardian or, if a guardian has been appointed, on petition of the
60-11 guardian, a probate court shall determine whether to suspend or
60-12 revoke the authority of the agent.
60-13 (b) The court shall consider the preferences of the
60-14 principal as expressed in the medical [durable] power of attorney
60-15 [for health care].
60-16 (c) During the pendency of the court's determination under
60-17 Subsection (a), the guardian has the sole authority to make any
60-18 health care decisions unless the court orders otherwise. If a
60-19 guardian has not been appointed, the agent has the authority to
60-20 make any health care decisions unless the court orders otherwise.
60-21 (d) A person, including any attending physician or health or
60-22 residential care provider, who does not have actual knowledge of
60-23 the appointment of a guardian or an order of the court granting
60-24 authority to someone other than the agent to make health care
60-25 decisions is not subject to criminal or civil liability and has not
60-26 engaged in unprofessional conduct for implementing an agent's
60-27 health care decision.
61-1 Sec. 166.157 [135.007]. DISCLOSURE OF MEDICAL INFORMATION.
61-2 Subject to any limitations in the medical [durable] power of
61-3 attorney [for health care], an agent may, for the purpose of making
61-4 a health care decision:
61-5 (1) request, review, and receive any information, oral
61-6 or written, regarding the principal's physical or mental health,
61-7 including medical and hospital records;
61-8 (2) execute a release or other document required to
61-9 obtain the information; and
61-10 (3) consent to the disclosure of the information.
61-11 Sec. 166.158 [135.008]. DUTY OF HEALTH OR RESIDENTIAL CARE
61-12 PROVIDER. (a) A principal's health or residential care provider
61-13 and an employee of the provider who knows of the existence of the
61-14 principal's medical [durable] power of attorney [for health care]
61-15 shall follow a directive of the principal's agent to the extent it
61-16 is consistent with the desires of the principal, this subchapter
61-17 [chapter], and the medical [durable] power of attorney [for health
61-18 care].
61-19 (b) The attending physician does not have a duty to verify
61-20 that the agent's directive is consistent with the principal's
61-21 wishes or religious or moral beliefs.
61-22 (c) A principal's health or residential care provider who
61-23 finds it impossible to follow a directive by the agent because of a
61-24 conflict with this subchapter [chapter] or the medical [durable]
61-25 power of attorney [for health care] shall inform the agent as soon
61-26 as is reasonably possible. The agent may select another attending
61-27 physician. The procedures established under Sections 166.045 and
62-1 166.046 apply if the agent's directive concerns providing,
62-2 withholding, or withdrawing life-sustaining treatment.
62-3 (d) This subchapter [chapter] may not be construed to
62-4 require a health or residential care provider who is not a
62-5 physician to act in a manner contrary to a physician's order.
62-6 Sec. 166.159 [135.009]. DISCRIMINATION RELATING TO EXECUTION
62-7 OF MEDICAL [DURABLE] POWER OF ATTORNEY [FOR HEALTH CARE]. A health
62-8 or residential care provider, health care service plan, insurer
62-9 issuing disability insurance, self-insured employee benefit plan,
62-10 or nonprofit hospital service plan may not:
62-11 (1) charge a person a different rate solely because
62-12 the person has executed a medical [durable] power of attorney [for
62-13 health care];
62-14 (2) require a person to execute a medical [durable]
62-15 power of attorney [for health care] before:
62-16 (A) admitting the person to a hospital, nursing
62-17 home, or residential care home;
62-18 (B) insuring the person; or
62-19 (C) allowing the person to receive health or
62-20 residential care; or
62-21 (3) refuse health or residential care to a person
62-22 solely because the person has executed a medical [durable] power of
62-23 attorney [for health care].
62-24 Sec. 166.160 [135.010]. LIMITATION ON LIABILITY. (a) An
62-25 agent is not subject to criminal or civil liability for a health
62-26 care decision if the decision is made in good faith under the terms
62-27 of the medical [durable] power of attorney [for health care] and
63-1 the provisions of this subchapter [chapter].
63-2 (b) An attending physician, health or residential care
63-3 provider, or a person acting as an agent for or under the
63-4 physician's or provider's control is not subject to criminal or
63-5 civil liability and has not engaged in unprofessional conduct for
63-6 an act or omission if the act or omission:
63-7 (1) is done in good faith under the terms of the
63-8 medical [durable] power of attorney [for health care], the
63-9 directives of the agent, and the provisions of this subchapter
63-10 [chapter]; and
63-11 (2) does not constitute a failure to exercise
63-12 reasonable [due] care in the provision of health care services.
63-13 (c) The standard of care that the attending physician,
63-14 health or residential care provider, or person acting as an agent
63-15 for or under the physician's or provider's control shall exercise
63-16 under Subsection (b) is that degree of care that an attending
63-17 physician, health or residential care provider, or person acting as
63-18 an agent for or under the physician's or provider's control, as
63-19 applicable, of ordinary prudence and skill would have exercised
63-20 under the same or similar circumstances in the same or similar
63-21 community.
63-22 (d) [(c)] An attending physician, health or residential care
63-23 provider, or person acting as an agent for or under the physician's
63-24 or provider's control has not engaged in unprofessional conduct
63-25 for:
63-26 (1) failure to act as required by the directive of an
63-27 agent or a medical [durable] power of attorney [for health care] if
64-1 the physician, provider, or person was not provided with a copy of
64-2 the medical [durable] power of attorney [for health care] or had no
64-3 knowledge of a directive; or
64-4 (2) acting as required by an agent's directive if the
64-5 medical [durable] power of attorney [for health care] has expired
64-6 or been revoked but the physician, provider, or person does not
64-7 have knowledge of the expiration or revocation.
64-8 Sec. 166.161 [135.011]. LIABILITY FOR HEALTH CARE COSTS.
64-9 Liability for the cost of health care provided as a result of the
64-10 agent's decision is the same as if the health care were provided as
64-11 a result of the principal's decision.
64-12 [Sec. 135.012. NATURAL DEATH ACT. To the extent that a
64-13 durable power of attorney for health care conflicts with a
64-14 directive or treatment decision executed under the Natural Death
64-15 Act (Chapter 672, Health and Safety Code), the instrument executed
64-16 later in time controls. A physician who withholds or withdraws
64-17 life-sustaining procedures from a principal with a terminal
64-18 condition as required by an agent's directive is not required to
64-19 comply with the Natural Death Act.]
64-20 [Sec. 135.013. ENFORCEABILITY OF DURABLE POWER OF ATTORNEY
64-21 EXECUTED IN ANOTHER JURISDICTION. This chapter does not limit the
64-22 enforceability of a durable power of attorney for health care or
64-23 similar instrument executed in another state or jurisdiction if the
64-24 instrument complies with the law of the state or jurisdiction.]
64-25 Sec. 166.162 [135.014]. DISCLOSURE STATEMENT. A medical
64-26 [durable] power of attorney [for health care] is not effective
64-27 unless the principal, before executing the medical [durable] power
65-1 of attorney [for health care], signs a statement that the principal
65-2 has received a disclosure statement and has read and understood its
65-3 contents.
65-4 Sec. 166.163 [135.015]. FORM OF DISCLOSURE STATEMENT. The
65-5 disclosure statement must be in substantially the following form:
65-6 INFORMATION CONCERNING THE MEDICAL [DURABLE]
65-7 POWER OF ATTORNEY [FOR HEALTH CARE]
65-8 THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT,
65-9 YOU SHOULD KNOW THESE IMPORTANT FACTS:
65-10 Except to the extent you state otherwise, this document gives
65-11 the person you name as your agent the authority to make any and all
65-12 health care decisions for you in accordance with your wishes,
65-13 including your religious and moral beliefs, when you are no longer
65-14 capable of making them yourself. Because "health care" means any
65-15 treatment, service, or procedure to maintain, diagnose, or treat
65-16 your physical or mental condition, your agent has the power to make
65-17 a broad range of health care decisions for you. Your agent may
65-18 consent, refuse to consent, or withdraw consent to medical
65-19 treatment and may make decisions about withdrawing or withholding
65-20 life-sustaining treatment. Your agent may not consent to voluntary
65-21 inpatient mental health services, convulsive treatment,
65-22 psychosurgery, or abortion. A physician must comply with your
65-23 agent's instructions or allow you to be transferred to another
65-24 physician.
65-25 Your agent's authority begins when your doctor certifies that
65-26 you lack the competence [capacity] to make health care decisions.
65-27 Your agent is obligated to follow your instructions when
66-1 making decisions on your behalf. Unless you state otherwise, your
66-2 agent has the same authority to make decisions about your health
66-3 care as you would have had.
66-4 It is important that you discuss this document with your
66-5 physician or other health care provider before you sign it to make
66-6 sure that you understand the nature and range of decisions that may
66-7 be made on your behalf. If you do not have a physician, you should
66-8 talk with someone else who is knowledgeable about these issues and
66-9 can answer your questions. You do not need a lawyer's assistance
66-10 to complete this document, but if there is anything in this
66-11 document that you do not understand, you should ask a lawyer to
66-12 explain it to you.
66-13 The person you appoint as agent should be someone you know
66-14 and trust. The person must be 18 years of age or older or a person
66-15 under 18 years of age who has had the disabilities of minority
66-16 removed. If you appoint your health or residential care provider
66-17 (e.g., your physician or an employee of a home health agency,
66-18 hospital, nursing home, or residential care home, other than a
66-19 relative), that person has to choose between acting as your agent
66-20 or as your health or residential care provider; the law does not
66-21 permit a person to do both at the same time.
66-22 You should inform the person you appoint that you want the
66-23 person to be your health care agent. You should discuss this
66-24 document with your agent and your physician and give each a signed
66-25 copy. You should indicate on the document itself the people and
66-26 institutions who have signed copies. Your agent is not liable for
66-27 health care decisions made in good faith on your behalf.
67-1 Even after you have signed this document, you have the right
67-2 to make health care decisions for yourself as long as you are able
67-3 to do so and treatment cannot be given to you or stopped over your
67-4 objection. You have the right to revoke the authority granted to
67-5 your agent by informing your agent or your health or residential
67-6 care provider orally or in writing or by your execution of a
67-7 subsequent medical [durable] power of attorney [for health care].
67-8 Unless you state otherwise, your appointment of a spouse dissolves
67-9 on divorce.
67-10 This document may not be changed or modified. If you want to
67-11 make changes in the document, you must make an entirely new one.
67-12 You may wish to designate an alternate agent in the event
67-13 that your agent is unwilling, unable, or ineligible to act as your
67-14 agent. Any alternate agent you designate has the same authority to
67-15 make health care decisions for you.
67-16 THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS SIGNED IN THE
67-17 PRESENCE OF TWO COMPETENT ADULT [OR MORE QUALIFIED] WITNESSES. THE
67-18 FOLLOWING PERSONS MAY NOT ACT AS ONE OF THE WITNESSES:
67-19 (1) the person you have designated as your agent;
67-20 (2) a person related to you by blood or marriage [your
67-21 health or residential care provider or an employee of your health
67-22 or residential care provider];
67-23 (3) a person entitled to any part of your estate after
67-24 your death under a will or codicil executed by you or by operation
67-25 of law [your spouse];
67-26 (4) your attending physician [lawful heirs or
67-27 beneficiaries named in your will or a deed]; [or]
68-1 (5) an employee of your attending physician;
68-2 (6) an employee of a health care facility in which you
68-3 are a patient if the employee is providing direct patient care to
68-4 you or is an officer, director, partner, or business office
68-5 employee of the health care facility or of any parent organization
68-6 of the health care facility; or
68-7 (7) a person who, at the time this power of attorney
68-8 is executed, has a claim against any part of your estate after your
68-9 death [creditors or persons who have a claim against you].
68-10 Sec. 166.164 [135.016]. FORM OF MEDICAL [DURABLE] POWER OF
68-11 ATTORNEY. The medical [durable] power of attorney [for health
68-12 care] must be in substantially the following form:
68-13 MEDICAL [DURABLE] POWER OF ATTORNEY [FOR HEALTH CARE]
68-14 DESIGNATION OF HEALTH CARE AGENT.
68-15 I,_______________________________(insert your name) appoint:
68-16 Name:________________________________________________________
68-17 Address:_____________________________________________________
68-18 Phone____________________________________________
68-19 as my agent to make any and all health care decisions for me,
68-20 except to the extent I state otherwise in this document. This
68-21 medical [durable] power of attorney [for health care] takes effect
68-22 if I become unable to make my own health care decisions and this
68-23 fact is certified in writing by my physician.
68-24 LIMITATIONS ON THE DECISION-MAKING AUTHORITY OF MY AGENT ARE AS
68-25 FOLLOWS:_______________________________________________________
68-26 _______________________________________________________________
68-27 DESIGNATION OF ALTERNATE AGENT.
69-1 (You are not required to designate an alternate agent but you
69-2 may do so. An alternate agent may make the same health care
69-3 decisions as the designated agent if the designated agent is unable
69-4 or unwilling to act as your agent. If the agent designated is your
69-5 spouse, the designation is automatically revoked by law if your
69-6 marriage is dissolved.)
69-7 If the person designated as my agent is unable or unwilling
69-8 to make health care decisions for me, I designate the following
69-9 persons to serve as my agent to make health care decisions for me
69-10 as authorized by this document, who serve in the following order:
69-11 A. First Alternate Agent
69-12 Name:________________________________________
69-13 Address:_____________________________________
69-14 Phone__________________________________
69-15 B. Second Alternate Agent
69-16 Name:________________________________________
69-17 Address:_____________________________________
69-18 Phone__________________________________
69-19 The original of this document is kept at:
69-20 ______________________________________________________
69-21 ______________________________________________________
69-22 ______________________________________________________
69-23 The following individuals or institutions have signed copies:
69-24 Name:_________________________________________________
69-25 Address:______________________________________________
69-26 ______________________________________________________
69-27 Name:_________________________________________________
70-1 Address:______________________________________________
70-2 ______________________________________________________
70-3 DURATION.
70-4 I understand that this power of attorney exists indefinitely
70-5 from the date I execute this document unless I establish a shorter
70-6 time or revoke the power of attorney. If I am unable to make
70-7 health care decisions for myself when this power of attorney
70-8 expires, the authority I have granted my agent continues to exist
70-9 until the time I become able to make health care decisions for
70-10 myself.
70-11 (IF APPLICABLE) This power of attorney ends on the following
70-12 date:_____
70-13 PRIOR DESIGNATIONS REVOKED.
70-14 I revoke any prior medical [durable] power of attorney [for
70-15 health care].
70-16 ACKNOWLEDGMENT OF DISCLOSURE STATEMENT.
70-17 I have been provided with a disclosure statement explaining
70-18 the effect of this document. I have read and understand that
70-19 information contained in the disclosure statement.
70-20 (YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY.)
70-21 I sign my name to this medical [durable] power of attorney
70-22 [for health care] on ___________ day of _____________(month, year)
70-23 [19] at
70-24 _________________________________________________________
70-25 (City and State)
70-26 _________________________________________________________
70-27 (Signature)
71-1 _________________________________________________________
71-2 (Print Name)
71-3 STATEMENT OF FIRST WITNESS [WITNESSES].
71-4 [I declare under penalty of perjury that the principal has
71-5 identified himself or herself to me, that the principal signed or
71-6 acknowledged this durable power of attorney in my presence, that I
71-7 believe the principal to be of sound mind, that the principal has
71-8 affirmed that the principal is aware of the nature of the document
71-9 and is signing it voluntarily and free from duress, that the
71-10 principal requested that I serve as witness to the principal's
71-11 execution of this document, that] I am not the person appointed as
71-12 agent by this document.[, and that] I am not related to the
71-13 principal by blood or marriage. I would not be entitled to any
71-14 portion of the principal's estate on the principal's death. I am
71-15 not the attending physician of the principal or an employee of the
71-16 attending physician. I have no claim against any portion of the
71-17 principal's estate on the principal's death. Furthermore, if I am
71-18 an employee of a health care facility in which the principal is a
71-19 patient, I am not involved in providing direct patient care to the
71-20 principal and am not an officer, director, partner, or business
71-21 office employee of the health care facility or of any parent
71-22 organization of the health care facility [a provider of health or
71-23 residential care, an employee of a provider of health or
71-24 residential care, the operator of a community care facility, or an
71-25 employee of an operator of a health care facility.]
71-26 [I declare that I am not related to the principal by blood,
71-27 marriage, or adoption and that to the best of my knowledge I am not
72-1 entitled to any part of the estate of the principal on the death of
72-2 the principal under a will or by operation of law].
72-3 [Witness] Signature:____________________________________
72-4 Print Name:______________________Date:__________________
72-5 Address:________________________________________________
72-6 SIGNATURE OF SECOND WITNESS.
72-7 [Witness] Signature:____________________________________
72-8 Print Name:______________________Date:__________________
72-9 Address:________________________________________________
72-10 Sec. 166.165 [135.017]. CIVIL ACTION. (a) A person who is
72-11 a near relative of the principal or a responsible adult who is
72-12 directly interested in the principal, including a guardian, social
72-13 worker, physician, or clergyman, may bring an action in district
72-14 court to request that the medical [durable] power of attorney [for
72-15 health care] be revoked because the principal, at the time the
72-16 medical [durable] power of attorney [for health care] was signed:
72-17 (1) was not competent [of sound mind to make a health
72-18 care decision]; or
72-19 (2) was under duress, fraud, or undue influence.
72-20 (b) The action may be brought in the county of the
72-21 principal's residence or the residence of the person bringing the
72-22 action.
72-23 (c) During the pendency of the action, the authority of the
72-24 agent to make health care decisions continues in effect unless the
72-25 district court orders otherwise.
72-26 Sec. 166.166 [135.018]. OTHER RIGHTS OR RESPONSIBILITIES NOT
72-27 AFFECTED. This subchapter [chapter] does not limit or impair any
73-1 legal right or responsibility that any person, including a
73-2 physician or health or residential care provider, may have to make
73-3 or implement health care decisions on behalf of a person, provided
73-4 that if an attending physician or health care facility is unwilling
73-5 to honor a patient's advance directive or a treatment decision to
73-6 provide life-sustaining treatment, life-sustaining treatment is
73-7 required to be provided the patient, but only until a reasonable
73-8 opportunity has been afforded for transfer of the patient to
73-9 another physician or health care facility willing to comply with
73-10 the advance directive or treatment decision.
73-11 ARTICLE 2. CONFORMING AMENDMENTS
73-12 SECTION 2.01. Subsection (a), Section 313.003, Health and
73-13 Safety Code, is amended to read as follows:
73-14 (a) This chapter does not apply to:
73-15 (1) a decision to withhold or withdraw life-sustaining
73-16 treatment from qualified terminal or irreversible patients under
73-17 Subchapter B, Chapter 166 [the terms of Chapter 672];
73-18 (2) a health care decision made under a medical
73-19 [durable] power of attorney [for health care] under Subchapter D,
73-20 Chapter 166 [Chapter 135, Civil Practice and Remedies Code], or
73-21 under Chapter XII, Texas Probate Code;
73-22 (3) consent to medical treatment of minors under
73-23 Chapter 32 [35], Family Code;
73-24 (4) consent for emergency care under Chapter 773;
73-25 (5) hospital patient transfers under Chapter 241; or
73-26 (6) a patient's legal guardian who has the authority
73-27 to make a decision regarding the patient's medical treatment.
74-1 SECTION 2.02. Subchapter A, Chapter 142, Health and Safety
74-2 Code, is amended by adding Section 142.0145 to read as follows:
74-3 Sec. 142.0145. VIOLATION OF LAW RELATING TO ADVANCE
74-4 DIRECTIVES. (a) The department shall assess an administrative
74-5 penalty against a home and community support services agency that
74-6 violates Section 166.004.
74-7 (b) A penalty assessed under this section shall be $500.
74-8 (c) The penalty shall be assessed in accordance with
74-9 department rules. The rules must provide for notice and an
74-10 opportunity for a hearing.
74-11 SECTION 2.03. Subsections (a) and (c), Section 241.059,
74-12 Health and Safety Code, are amended to read as follows:
74-13 (a) The commissioner of health may assess an administrative
74-14 penalty against a hospital that violates this chapter, a rule
74-15 adopted pursuant to this chapter, a special license provision, an
74-16 order or emergency order issued by the commissioner or the
74-17 commissioner's designee, or another enforcement procedure permitted
74-18 under this chapter. The commissioner shall assess an administrative
74-19 penalty against a hospital that violates Section 166.004.
74-20 (c) The penalty may not exceed $1,000 for each violation,
74-21 except that the penalty for a violation of Section 166.004 shall be
74-22 $500. Each day of a continuing violation, other than a violation
74-23 of Section 166.004, may be considered a separate violation.
74-24 SECTION 2.04. Subchapter C, Chapter 242, Health and Safety
74-25 Code, is amended by adding Section 242.0663 to read as follows:
74-26 Sec. 242.0663. VIOLATION OF LAW RELATING TO ADVANCE
74-27 DIRECTIVES. (a) The department shall assess an administrative
75-1 penalty under this subchapter against an institution that violates
75-2 Section 166.004.
75-3 (b) Notwithstanding Sections 242.066(b) and (c), a penalty
75-4 assessed in accordance with this section shall be $500 and a
75-5 separate penalty may not be assessed for a separate day of a
75-6 continuing violation.
75-7 (c) Section 242.0665 does not apply to a penalty assessed in
75-8 accordance with this section.
75-9 SECTION 2.05. Subchapter C, Chapter 247, Health and Safety
75-10 Code, is amended by adding Section 247.0455 to read as follows:
75-11 Sec. 247.0455. VIOLATION OF LAW RELATING TO ADVANCE
75-12 DIRECTIVES. (a) The department shall assess an administrative
75-13 penalty against a personal care facility that violates Section
75-14 166.004.
75-15 (b) A penalty assessed under this section shall be $500.
75-16 (c) The penalty shall be assessed in accordance with
75-17 department rules. The rules must provide for notice and an
75-18 opportunity for a hearing.
75-19 SECTION 2.06. Subchapter C, Chapter 248, Health and Safety
75-20 Code, is amended by adding Section 248.0545 to read as follows:
75-21 Sec. 248.0545. VIOLATION OF LAW RELATING TO ADVANCE
75-22 DIRECTIVES. (a) The department shall assess an administrative
75-23 penalty against a special care facility that violates Section
75-24 166.004.
75-25 (b) A penalty assessed under this section shall be $500.
75-26 (c) The penalty shall be assessed in accordance with
75-27 department rules. The rules must provide for notice and an
76-1 opportunity for a hearing.
76-2 ARTICLE 3. TRANSITION AND EMERGENCY CLAUSE
76-3 SECTION 3.01. This Act takes effect September 1, 1999.
76-4 SECTION 3.02. (a) The change in law made by this Act does
76-5 not affect the validity of a document executed under Chapter 672 or
76-6 674, Health and Safety Code, or Chapter 135, Civil Practice and
76-7 Remedies Code, before the effective date of this Act. A document
76-8 executed before the effective date of this Act is governed by the
76-9 law in effect on the date the document was executed, and that law
76-10 continues in effect for that purpose.
76-11 (b) A reference in a law to a durable power of attorney for
76-12 health care means a medical power of attorney, as defined by
76-13 Section 166.002, Health and Safety Code, as added by this Act.
76-14 SECTION 3.03. (a) The change in law made by this Act applies
76-15 only to the punishment for an offense committed on or after the
76-16 effective date of this Act. For purposes of this section, an
76-17 offense is committed before the effective date of this Act if any
76-18 element of the offense occurs before the effective date.
76-19 (b) An offense committed before the effective date of this
76-20 Act is covered by the law in effect when the offense was committed,
76-21 and the former law is continued in effect for that purpose.
76-22 SECTION 3.04. The change in law made by this Act to Sections
76-23 166.045(b) and 166.095(b), Health and Safety Code, as redesignated
76-24 by this Act, applies only to conduct that occurs on or after
76-25 January 1, 2000. Conduct that occurs before January 1, 2000, is
76-26 governed by the law as it existed immediately before the effective
76-27 date of this Act, and that law is continued in effect for that
77-1 purpose.
77-2 SECTION 3.05. The importance of this legislation and the
77-3 crowded condition of the calendars in both houses create an
77-4 emergency and an imperative public necessity that the
77-5 constitutional rule requiring bills to be read on three several
77-6 days in each house be suspended, and this rule is hereby suspended.