83R9613 JSC-D
By: Klick H.B. No. 1889
A BILL TO BE ENTITLED
AN ACT
relating to withdrawal of certain life-sustaining treatment.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 166, Health and Safety
Code, is amended by adding Section 166.0335 to read as follows:
Sec. 166.0335. ADDITIONAL FORM FOR WITHHOLDING ARTIFICIAL
NUTRITION AND HYDRATION. (a) If the patient or person responsible
for the health care decisions of the patient desires the
withholding of artificial nutrition and hydration, the patient or
responsible person must execute a written, signed statement on a
form prescribed by the department that the patient does not wish to
receive artificial nutrition, artificial hydration, or both.
(b) The form described by Subsection (a) must be delivered
in person by the patient or person responsible for the health care
decisions of the patient to the physician and the facility
administrator, who shall provide a signed receipt to the patient or
responsible person acknowledging that the physician and facility
administrator have received the completed form.
(c) On receipt of the form under Subsection (b), the
physician shall place that form in a separate and conspicuously
colored section at or near the top of the patient's medical chart or
record.
(d) Notwithstanding any other provision of this chapter,
artificial nutrition and hydration may not be withdrawn if a form
has not been delivered under this section.
(e) The department by rule shall adopt a form for use under
this section.
SECTION 2. Section 166.046, Health and Safety Code, is
amended by adding Subsection (b-1) to read as follows:
(b-1) An ethics or medical committee under this section may
not find that the provision of artificial nutrition and hydration
is inappropriate treatment if the patient or the person responsible
for the health care decisions of the patient has not delivered an
executed form under Section 166.0335.
SECTION 3. Section 166.052(a), Health and Safety Code, is
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
Section 166.046(b)(3)(A) [166.046(b)(2)(A)] shall be in
substantially the following form:
When There Is A Disagreement About Medical Treatment: The
Physician Recommends Against Life-Sustaining Treatment That You
Wish To Continue
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 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.
You are entitled to receive a written explanation of the
decision reached during the review process.
The ethics or medical review committee may not determine that
the provision of artificial nutrition and hydration is
inappropriate if you wish to continue artificial nutrition and
hydration. Artificial nutrition and hydration may only be
withdrawn at your written, signed request.
If after this review process both the attending physician and
the ethics or medical committee conclude that life-sustaining
treatment, other than artificial nutrition and hydration, 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 Texas Health 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 until he or she can be transferred to a willing provider
for up to 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 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 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.
SECTION 4. (a) Except as provided by Subsection (b) of this
section, the change in law made by this Act applies only to a health
care or treatment decision made on or after the effective date of
this Act.
(b) A physician, facility, or other health care provider may
not withdraw artificial nutrition and hydration on or after the
effective date of this Act without a form issued in accordance with
Section 166.0335, Health and Safety Code, as added by this Act,
regardless of whether the patient or other person responsible for
the health care decisions of the patient has issued an advance
directive that authorizes the withdrawal of artificial nutrition
and hydration before, on, or after the effective date of this Act.
This section does not require the resumption of the provision of
artificial nutrition and hydration for a patient for whom that
treatment was legally discontinued before the effective date of
this Act under the law as it existed immediately before the
effective date of this Act.
SECTION 5. This Act takes effect September 1, 2013.