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A BILL TO BE ENTITLED
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AN ACT
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relating to advance directives and health care and treatment |
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decisions. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 166.046(a), (b) and (e), Health and |
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Safety Code, are amended to read as follows: |
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Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR |
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TREATMENT DECISION. (a) If an attending physician refuses to |
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honor a patient's advance directive or a health care or treatment |
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decision made by or on behalf of a patient, the physician's refusal |
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shall be reviewed by an ethics or medical committee. The attending |
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physician may not be a member of that committee. The patient shall |
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be given life-sustaining treatment during the review. If |
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artificial nutrition and hydration are the only life-sustaining |
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treatment being provided to a patient with a terminal condition, |
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the process established under this section may not be invoked |
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unless reasonable medical evidence indicates the provision of |
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artificial nutrition and hydration may hasten the patient's death |
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or exacerbate other medical problems and the risk of serious |
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medical pain or discomfort that cannot be alleviated based on |
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reasonable medical judgment outweighs the benefit of continued |
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artificial nutrition and hydration. |
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(b) The patient or the person responsible for the health |
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care decisions of the individual who has made the decision |
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regarding the directive or treatment decision: |
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(1) may be given a written description of the ethics or |
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medical committee review process and any other policies and |
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procedures related to this section adopted by the health care |
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facility; |
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(2) shall be informed of the committee review process |
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not less than 48 hours before the meeting called to discuss the |
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patient's directive, unless the time period is waived by mutual |
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agreement; |
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(3) at the time of being so informed, shall be |
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provided: |
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(A) a copy of the appropriate statement set forth |
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in Section 166.052; [and] |
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(B) a copy of the registry list of health care |
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providers and referral groups that have volunteered their readiness |
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to consider accepting transfer or to assist in locating a provider |
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willing to accept transfer that is posted on the website maintained |
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by the department [Texas Health Care Information Council] under |
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Section 166.053[.] and |
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(C) a patient liaison, appointed by the ethics of |
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medical committee, familiar with end-of-life issues and hospice |
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care options to assist the person responsible for the health care |
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decisions of the individual throughout the process described by |
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this section. |
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(4) is entitled to: |
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(A) attend the meeting; and |
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(B) receive a written explanation of the decision |
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reached during the review process. |
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(e) If the patient or the person responsible for the health |
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care decisions of the patient is requesting life-sustaining |
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treatment that the attending physician has decided and the review |
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process has affirmed is inappropriate treatment, the patient shall |
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be given available life-sustaining treatment pending transfer |
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under Subsection (d). The patient is responsible for any costs |
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incurred in transferring the patient to another facility. The |
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physician and the health care facility are not obligated to provide |
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life-sustaining treatment, except for the provision of artificial |
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nutrition and hydration, unless providing the artificial nutrition |
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and hydration would hasten death or seriously exacerbate other |
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major medical conditions and the risk of serious medical pain or |
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discomfort that cannot be alleviated based on reasonable medical |
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judgment outweighs the benefit of continued artificial nutrition |
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and hydration, after the 14th calendar [10th] day after the written |
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decision required under Subsection (b) is provided to the patient |
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or the person responsible for the health care decisions of the |
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patient. |
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SECTION 2. Sections 166.052(a) and (b), Health and Safety |
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Code, are amended to read as follows: (a) In cases in which the |
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attending physician refuses to honor an advance directive or |
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treatment decision requesting the provision of life-sustaining |
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treatment, the statement required by 166.046(b)(2)(A) shall be in |
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substantially the following form: |
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You have been given this information because you have requested |
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life-sustaining treatment,* which the attending physician believes |
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is not appropriate. This information is being provided to help you |
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understand state law, your rights, and the resources available to |
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you in such circumstances. It outlines the process for resolving |
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disagreements about treatment among patients, families, and |
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physicians. It is based upon Section 166.046 of the Texas Advance |
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Directives Act, codified in Chapter 166 of the Texas Health and |
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Safety Code |
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When There Is A Disagreement About Medical Treatment: The |
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Physician Recommends Against Life-Sustaining Treatment That You |
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Wish To Continue |
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When an attending physician refuses to comply with an advance |
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directive or other request for life-sustaining treatment because of |
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the physician's judgment that the treatment would be inappropriate, |
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the case will be reviewed by an ethics or medical committee. |
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Life-sustaining treatment will be provided through the review. |
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You will receive notification of this review at least 48 |
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hours before a meeting of the committee related to your case. You |
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are entitled to attend the meeting. With your agreement, the |
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meeting may be held sooner than 48 hours, if possible. The committee |
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will appoint a patient liaison to assist you through this process. |
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You are entitled to receive a written explanation of the |
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decision reached during the review process. |
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If after this review process both the attending physician and |
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the ethics or medical committee conclude that life-sustaining |
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treatment is inappropriate and yet you continue to request such |
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treatment, then the following procedure will occur: |
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1. The physician, with the help of the health care facility, |
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will assist you in trying to find a physician and facility willing |
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to provide the requested treatment. |
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2. You are being given a list of health care providers and |
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referral groups that have volunteered their readiness to consider |
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accepting transfer, or to assist in locating a provider willing to |
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accept transfer, maintained by the Department of State [Texas] |
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Health Services [Care Information Council]. You may wish to |
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contact providers or referral groups on the list or others of your |
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choice to get help in arranging a transfer. |
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3. The patient will continue to be given life-sustaining |
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treatment, including artificial nutrition and hydration unless |
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reasonable medical evidence indicates the provision of artificial |
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nutrition and hydration may hasten the patient's death or |
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exacerbate other medical problems and the risk of serious medical |
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pain or discomfort that cannot be alleviated based on reasonable |
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medical judgment outweighs the benefit of continued artificial |
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nutrition and hydration, until he or she can be transferred to a |
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willing provider for up to 14 calendar [10] days from the time you |
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were given the committee's written decision that life-sustaining |
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treatment is not appropriate. |
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4. If a transfer can be arranged, the patient will be |
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responsible for the costs of the transfer. |
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5. If a provider cannot be found willing to give the |
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requested treatment within 14 calendar [10] days, life-sustaining |
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treatment may be withdrawn unless a court of law has granted an |
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extension. |
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6. You may ask the appropriate district or county court to |
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extend the 14-day [10-day] period if the court finds that there is a |
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reasonable expectation that a physician or health care facility |
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willing to provide life-sustaining treatment will be found if the |
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extension is granted. |
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*"Life-sustaining treatment" means treatment that, based on |
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reasonable medical judgment, sustains the life of a patient and |
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without which the patient will die. The term includes both |
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life-sustaining medications and artificial life support, such as |
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mechanical breathing machines, kidney dialysis treatment, and |
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artificial nutrition and hydration. The term does not include the |
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administration of pain management medication or the performance of |
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a medical procedure considered to be necessary to provide comfort |
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care, or any other medical care provided to alleviate a patient's |
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pain. |
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(b) In cases in which the attending physician refuses to |
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comply with an advance directive or treatment decision requesting |
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the withholding or withdrawal of life-sustaining treatment, the |
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statement required by Section 166.046(b)(3)(A) shall be in |
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substantially the following form: |
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You have been given this information because you have |
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requested the withdrawal or withholding of life-sustaining |
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treatment* and the attending physician refuses to comply with that |
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request. The information is being provided to help you understand |
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state law, your rights, and the resources available to you in such |
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circumstances. It outlines the process for resolving disagreements |
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about treatment among patients, families, and physicians. It is |
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based upon Section 166.046 of the Texas Advance Directives Act, |
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codified in Chapter 166 of the Texas Health and Safety Code. |
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When There Is A Disagreement About Medical Treatment: The |
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Physician Recommends Life-Sustaining Treatment That You Wish To |
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Stop |
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When an attending physician refuses to comply with an advance |
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directive or other request for withdrawal or withholding of |
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life-sustaining treatment for any reason, the case will be reviewed |
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by an ethics or medical committee. Life-sustaining treatment will |
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be provided through the review. |
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You will receive notification of this review at least 48 |
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hours before a meeting of the committee related to your case. You |
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are entitled to attend the meeting. With your agreement, the |
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meeting may be held sooner than 48 hours, if possible. The |
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committee will appoint a patient liaison to assist you through this |
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process. |
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You are entitled to receive a written explanation of the |
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decision reached during the review process. |
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If you or the attending physician do not agree with the |
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decision reached during the review process, and the attending |
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physician still refuses to comply with your request to withhold or |
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withdraw life-sustaining treatment, then the following procedure |
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will occur: |
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1. The physician, with the help of the health care facility, |
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will assist you in trying to find a physician and facility willing |
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to withdraw or withhold the life-sustaining treatment. |
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2. You are being given a list of health care providers and |
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referral groups that have volunteered their readiness to consider |
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accepting transfer, or to assist in locating a provider willing to |
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accept transfer, maintained by the Department of State [Texas] |
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Health Services [Care Information Council]. You may wish to |
|
contact providers or referral groups on the list or others of your |
|
choice to get help in arranging a transfer. |
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*"Life-sustaining treatment" means treatment that, based on |
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reasonable medical judgment, sustains the life of a patient and |
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without which the patient will die. The term includes both |
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life-sustaining medications and artificial life support, such as |
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mechanical breathing machines, kidney dialysis treatment, and |
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artificial nutrition and hydration. The term does not include the |
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administration of pain management medication or the performance of |
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a medical procedure considered to be necessary to provide comfort |
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care, or any other medical care provided to alleviate a patient's |
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pain. |
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SECTION 3. An advance directive form executed under Chapter |
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166, Health and Safety Code, before the effective date of this Act |
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is valid and shall be honored as if the form were executed on or |
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after the effective date of this Act. |
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SECTION 4. This Act takes effect September 1, 2009. |