81R14608 T
By: Coleman H.B. No. 2964
A BILL TO BE ENTITLED
AN ACT
relating to advance directives and health care and treatment
decisions.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 166.046(a), (b) and (e), Health and
Safety Code, are amended to read as follows:
Sec. 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR
TREATMENT DECISION. (a) If an attending physician refuses to
honor a patient's advance directive or a health care or treatment
decision made by or on behalf of a patient, the physician's refusal
shall be reviewed by an ethics or medical committee. The attending
physician may not be a member of that committee. The patient shall
be given life-sustaining treatment during the review. If
artificial nutrition and hydration are the only life-sustaining
treatment being provided to a patient with a terminal condition,
the process established under this section may not be invoked
unless reasonable medical evidence indicates the provision of
artificial nutrition and hydration may hasten the patient's death
or exacerbate other medical problems and the risk of serious
medical pain or discomfort that cannot be alleviated based on
reasonable medical judgment outweighs the benefit of continued
artificial nutrition and hydration.
(b) The patient or the person responsible for the health
care decisions of the individual who has made the decision
regarding the directive or treatment decision:
(1) may be given a written description of the ethics or
medical committee review process and any other policies and
procedures related to this section adopted by the health care
facility;
(2) shall be informed of the committee review process
not less than 48 hours before the meeting called to discuss the
patient's directive, unless the time period is waived by mutual
agreement;
(3) at the time of being so informed, shall be
provided:
(A) a copy of the appropriate statement set forth
in Section 166.052; [and]
(B) a copy of the registry list of health care
providers and referral groups that have volunteered their readiness
to consider accepting transfer or to assist in locating a provider
willing to accept transfer that is posted on the website maintained
by the department [Texas Health Care Information Council] under
Section 166.053[.] and
(C) a patient liaison, appointed by the ethics of
medical committee, familiar with end-of-life issues and hospice
care options to assist the person responsible for the health care
decisions of the individual throughout the process described by
this section.
(4) is entitled to:
(A) attend the meeting; and
(B) receive a written explanation of the decision
reached during the review process.
(e) If the patient or the person responsible for the health
care decisions of the patient is requesting life-sustaining
treatment that the attending physician has decided and the review
process has affirmed is inappropriate treatment, the patient shall
be given available life-sustaining treatment pending transfer
under Subsection (d). The patient is responsible for any costs
incurred in transferring the patient to another facility. The
physician and the health care facility are not obligated to provide
life-sustaining treatment, except for the provision of artificial
nutrition and hydration, unless providing the artificial nutrition
and hydration would hasten death or seriously exacerbate other
major medical conditions and the risk of serious medical pain or
discomfort that cannot be alleviated based on reasonable medical
judgment outweighs the benefit of continued artificial nutrition
and hydration, after the 14th calendar [10th] day after the written
decision required under Subsection (b) is provided to the patient
or the person responsible for the health care decisions of the
patient.
SECTION 2. Sections 166.052(a) and (b), Health and Safety
Code, are amended to read as follows: (a) In cases in which the
attending physician refuses to honor an advance directive or
treatment decision requesting the provision of life-sustaining
treatment, the statement required by 166.046(b)(2)(A) shall be in
substantially the following form:
You have been given this information because you have requested
life-sustaining treatment,* which the attending physician believes
is not appropriate. This information is being provided to help you
understand state law, your rights, and the resources available to
you in such circumstances. It outlines the process for resolving
disagreements about treatment among patients, families, and
physicians. It is based upon Section 166.046 of the Texas Advance
Directives Act, codified in Chapter 166 of the Texas Health and
Safety Code
When There Is A Disagreement About Medical Treatment: The
Physician Recommends Against Life-Sustaining Treatment That You
Wish To Continue
When an attending physician refuses to comply with an advance
directive or other request for life-sustaining treatment because of
the physician's judgment that the treatment would be inappropriate,
the case will be reviewed by an ethics or medical committee.
Life-sustaining treatment will be provided through the review.
You will receive notification of this review at least 48
hours before a meeting of the committee related to your case. You
are entitled to attend the meeting. With your agreement, the
meeting may be held sooner than 48 hours, if possible. The committee
will appoint a patient liaison to assist you through this process.
You are entitled to receive a written explanation of the
decision reached during the review process.
If after this review process both the attending physician and
the ethics or medical committee conclude that life-sustaining
treatment is inappropriate and yet you continue to request such
treatment, then the following procedure will occur:
1. The physician, with the help of the health care facility,
will assist you in trying to find a physician and facility willing
to provide the requested treatment.
2. You are being given a list of health care providers and
referral groups that have volunteered their readiness to consider
accepting transfer, or to assist in locating a provider willing to
accept transfer, maintained by the Department of State [Texas]
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.
3. The patient will continue to be given life-sustaining
treatment, including artificial nutrition and hydration unless
reasonable medical evidence indicates the provision of artificial
nutrition and hydration may hasten the patient's death or
exacerbate other medical problems and the risk of serious medical
pain or discomfort that cannot be alleviated based on reasonable
medical judgment outweighs the benefit of continued artificial
nutrition and hydration, until he or she can be transferred to a
willing provider for up to 14 calendar [10] days from the time you
were given the committee's written decision that life-sustaining
treatment is not appropriate.
4. If a transfer can be arranged, the patient will be
responsible for the costs of the transfer.
5. If a provider cannot be found willing to give the
requested treatment within 14 calendar [10] days, life-sustaining
treatment may be withdrawn unless a court of law has granted an
extension.
6. You may ask the appropriate district or county court to
extend the 14-day [10-day] period if the court finds that there is a
reasonable expectation that a physician or health care facility
willing to provide life-sustaining treatment will be found if the
extension is granted.
*"Life-sustaining treatment" means treatment that, based on
reasonable medical judgment, sustains the life of a patient and
without which the patient will die. The term includes both
life-sustaining medications and artificial life support, such as
mechanical breathing machines, kidney dialysis treatment, and
artificial nutrition and hydration. The term does not include the
administration of pain management medication or the performance of
a medical procedure considered to be necessary to provide comfort
care, or any other medical care provided to alleviate a patient's
pain.
(b) In cases in which the attending physician refuses to
comply with an advance directive or treatment decision requesting
the withholding or withdrawal of life-sustaining treatment, the
statement required by Section 166.046(b)(3)(A) shall be in
substantially the following form:
You have been given this information because you have
requested the withdrawal or withholding of life-sustaining
treatment* and the attending physician refuses to comply with that
request. The information is being provided to help you understand
state law, your rights, and the resources available to you in such
circumstances. It outlines the process for resolving disagreements
about treatment among patients, families, and physicians. It is
based upon Section 166.046 of the Texas Advance Directives Act,
codified in Chapter 166 of the Texas Health and Safety Code.
When There Is A Disagreement About Medical Treatment: The
Physician Recommends Life-Sustaining Treatment That You Wish To
Stop
When an attending physician refuses to comply with an advance
directive or other request for withdrawal or withholding of
life-sustaining treatment for any reason, the case will be reviewed
by an ethics or medical committee. Life-sustaining treatment will
be provided through the review.
You will receive notification of this review at least 48
hours before a meeting of the committee related to your case. You
are entitled to attend the meeting. With your agreement, the
meeting may be held sooner than 48 hours, if possible. The
committee will appoint a patient liaison to assist you through this
process.
You are entitled to receive a written explanation of the
decision reached during the review process.
If you or the attending physician do not agree with the
decision reached during the review process, and the attending
physician still refuses to comply with your request to withhold or
withdraw life-sustaining treatment, then the following procedure
will occur:
1. The physician, with the help of the health care facility,
will assist you in trying to find a physician and facility willing
to withdraw or withhold the life-sustaining treatment.
2. You are being given a list of health care providers and
referral groups that have volunteered their readiness to consider
accepting transfer, or to assist in locating a provider willing to
accept transfer, maintained by the Department of State [Texas]
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.
*"Life-sustaining treatment" means treatment that, based on
reasonable medical judgment, sustains the life of a patient and
without which the patient will die. The term includes both
life-sustaining medications and artificial life support, such as
mechanical breathing machines, kidney dialysis treatment, and
artificial nutrition and hydration. The term does not include the
administration of pain management medication or the performance of
a medical procedure considered to be necessary to provide comfort
care, or any other medical care provided to alleviate a patient's
pain.
SECTION 3. An advance directive form executed under Chapter
166, Health and Safety Code, before the effective date of this Act
is valid and shall be honored as if the form were executed on or
after the effective date of this Act.
SECTION 4. This Act takes effect September 1, 2009.