Texas 2015 - 84th Regular

Texas House Bill HB2949 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	84R11966 AJZ-F
2	2	By: Klick H.B. No. 2949
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to advance directives, including do-not-resuscitate
8	8	orders; creating a criminal offense.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 166.002, Health and Safety Code, is
11	11	amended by amending Subdivision (1) and adding Subdivision (12-a)
12	12	to read as follows:
13	13	(1) "Advance directive" means:
14	14	(A) a directive, as that term is defined by
15	15	Section 166.031;
16	16	(B) a [an out-of-hospital] DNR order, as that
17	17	term is defined by Section 166.081; or
18	18	(C) a medical power of attorney under Subchapter
19	19	D.
20	20	(12-a) "Reasonable medical judgment" means a medical
21	21	judgment that would be made by a reasonably prudent physician,
22	22	knowledgeable about the case and the treatment possibilities with
23	23	respect to the medical conditions involved.
24	24	SECTION 2. Section 166.033, Health and Safety Code, is
25	25	amended to read as follows:
26	26	Sec. 166.033. FORM OF WRITTEN DIRECTIVE. A written
27	27	directive may be in the following form:
28	28	DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
29	29	Instructions for completing this document:
30	30	This is an important legal document known as an Advance
31	31	Directive. It is designed to help you communicate your wishes about
32	32	medical treatment at some time in the future when you are unable to
33	33	make your wishes known because of illness or injury. These wishes
34	34	are usually based on personal values. In particular, you may want
35	35	to consider what burdens or hardships of treatment you would be
36	36	willing to accept for a particular amount of benefit obtained if you
37	37	were seriously ill.
38	38	You are encouraged to discuss your values and wishes with
39	39	your family or chosen spokesperson, as well as your physician. Your
40	40	physician, other health care provider, or medical institution may
41	41	provide you with various resources to assist you in completing your
42	42	advance directive. Brief definitions are listed below and may aid
43	43	you in your discussions and advance planning. Initial the
44	44	treatment choices that best reflect your personal preferences.
45	45	Provide a copy of your directive to your physician, usual hospital,
46	46	and family or spokesperson. Consider a periodic review of this
47	47	document. By periodic review, you can best assure that the
48	48	directive reflects your preferences.
49	49	In addition to this advance directive, Texas law provides for
50	50	two other types of directives that can be important during a serious
51	51	illness. These are the Medical Power of Attorney and the
52	52	[Out-of-Hospital] Do-Not-Resuscitate Order. A Do-Not-Resuscitate
53	53	Order requires the consent of the patient and the signature of a
54	54	physician. You may wish to discuss these with your physician,
55	55	family, hospital representative, or other advisers. You may also
56	56	wish to complete a directive related to the donation of organs and
57	57	tissues.
58	58	DIRECTIVE
59	59	I, __________, recognize that the best health care is based
60	60	upon a partnership of trust and communication with my physician. My
61	61	physician and I will make health care decisions together as long as
62	62	I am of sound mind and able to make my wishes known. If there comes
63	63	a time that I am unable to make medical decisions about myself
64	64	because of illness or injury, I direct that the following treatment
65	65	preferences be honored:
66	66	If, in the judgment of my physician, I am suffering with a
67	67	terminal condition from which I am expected to die within six
68	68	months, even with available life-sustaining treatment provided in
69	69	accordance with prevailing standards of medical care:
70	70	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR __________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
71	71	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
72	72	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.) __________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
73	73	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
74	74	If, in the judgment of my physician, I am suffering with an
75	75	irreversible condition so that I cannot care for myself or make
76	76	decisions for myself and am expected to die without life-sustaining
77	77	treatment provided in accordance with prevailing standards of care:
78	78	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR __________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
79	79	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
80	80	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.) __________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
81	81	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
82	82	Additional requests: (After discussion with your physician,
83	83	you may wish to consider listing particular treatments in this
84	84	space that you do or do not want in specific circumstances, such as
85	85	artificial nutrition and fluids, intravenous antibiotics, etc. Be
86	86	sure to state whether you do or do not want the particular
87	87	treatment.)
88	88	________________________________________________________________ ________________________________________________________________
89	89	________________________________________________________________
90	90	________________________________________________________________ ________________________________________________________________
91	91	________________________________________________________________
92	92	________________________________________________________________ ________________________________________________________________
93	93	________________________________________________________________
94	94	After signing this directive, if my representative or I elect
95	95	hospice care, I understand and agree that only those treatments
96	96	needed to keep me comfortable would be provided and I would not be
97	97	given available life-sustaining treatments.
98	98	If I do not have a Medical Power of Attorney, and I am unable
99	99	to make my wishes known, I designate the following person(s) to make
100	100	treatment decisions with my physician compatible with my personal
101	101	values:
102	102	1. __________ 1. __________
103	103	1. __________
104	104	2. __________ 2. __________
105	105	2. __________
106	106	(If a Medical Power of Attorney has been executed, then an
107	107	agent already has been named and you should not list additional
108	108	names in this document.)
109	109	If the above persons are not available, or if I have not
110	110	designated a spokesperson, I understand that a spokesperson will be
111	111	chosen for me following standards specified in the laws of Texas.
112	112	If, in the judgment of my physician, my death is imminent within
113	113	minutes to hours, even with the use of all available medical
114	114	treatment provided within the prevailing standard of care, I
115	115	acknowledge that all treatments may be withheld or removed except
116	116	those needed to maintain my comfort. I understand that under Texas
117	117	law this directive has no effect if I have been diagnosed as
118	118	pregnant. This directive will remain in effect until I revoke it.
119	119	No other person may do so.
120	120	Signed__________ Date__________ City, County, State of
121	121	Residence __________
122	122	Two competent adult witnesses must sign below, acknowledging
123	123	the signature of the declarant. The witness designated as Witness 1
124	124	may not be a person designated to make a treatment decision for the
125	125	patient and may not be related to the patient by blood or marriage.
126	126	This witness may not be entitled to any part of the estate and may
127	127	not have a claim against the estate of the patient. This witness
128	128	may not be the attending physician or an employee of the attending
129	129	physician. If this witness is an employee of a health care facility
130	130	in which the patient is being cared for, this witness may not be
131	131	involved in providing direct patient care to the patient. This
132	132	witness may not be an officer, director, partner, or business
133	133	office employee of a health care facility in which the patient is
134	134	being cared for or of any parent organization of the health care
135	135	facility.
136	136	Witness 1 __________ Witness 2 __________
137	137	Definitions:
138	138	"Artificial nutrition and hydration" means the provision of
139	139	nutrients or fluids by a tube inserted in a vein, under the skin in
140	140	the subcutaneous tissues, or in the stomach (gastrointestinal
141	141	tract).
142	142	"Irreversible condition" means a condition, injury, or
143	143	illness:
144	144	(1) that may be treated, but is never cured or
145	145	eliminated;
146	146	(2) that leaves a person unable to care for or make
147	147	decisions for the person's own self; and
148	148	(3) that, without life-sustaining treatment provided
149	149	in accordance with the prevailing standard of medical care, is
150	150	fatal.
151	151	Explanation: Many serious illnesses such as cancer, failure
152	152	of major organs (kidney, heart, liver, or lung), and serious brain
153	153	disease such as Alzheimer's dementia may be considered irreversible
154	154	early on. There is no cure, but the patient may be kept alive for
155	155	prolonged periods of time if the patient receives life-sustaining
156	156	treatments. Late in the course of the same illness, the disease may
157	157	be considered terminal when, even with treatment, the patient is
158	158	expected to die. You may wish to consider which burdens of
159	159	treatment you would be willing to accept in an effort to achieve a
160	160	particular outcome. This is a very personal decision that you may
161	161	wish to discuss with your physician, family, or other important
162	162	persons in your life.
163	163	"Life-sustaining treatment" means treatment that, based on
164	164	reasonable medical judgment, sustains the life of a patient and
165	165	without which the patient will die. The term includes both
166	166	life-sustaining medications and artificial life support such as
167	167	mechanical breathing machines, kidney dialysis treatment, and
168	168	artificial hydration and nutrition. The term does not include the
169	169	administration of pain management medication, the performance of a
170	170	medical procedure necessary to provide comfort care, or any other
171	171	medical care provided to alleviate a patient's pain.
172	172	"Terminal condition" means an incurable condition caused by
173	173	injury, disease, or illness that according to reasonable medical
174	174	judgment will produce death within six months, even with available
175	175	life-sustaining treatment provided in accordance with the
176	176	prevailing standard of medical care.
177	177	Explanation: Many serious illnesses may be considered
178	178	irreversible early in the course of the illness, but they may not be
179	179	considered terminal until the disease is fairly advanced. In
180	180	thinking about terminal illness and its treatment, you again may
181	181	wish to consider the relative benefits and burdens of treatment and
182	182	discuss your wishes with your physician, family, or other important
183	183	persons in your life.
184	184	SECTION 3. Section 166.039, Health and Safety Code, is
185	185	amended by amending Subsections (b), (e), and (g) and adding
186	186	Subsections (e-1), (e-2), and (e-3) to read as follows:
187	187	(b) If the patient does not have a legal guardian, [or] an
188	188	agent under a medical power of attorney, or an advance directive,
189	189	the attending physician and one person[, if available,] from one of
190	190	the following categories, in the following priority, may make a
191	191	treatment decision that may include a decision to withhold or
192	192	withdraw life-sustaining treatment:
193	193	(1) the patient's spouse;
194	194	(2) the patient's reasonably available adult children;
195	195	(3) the patient's parents; or
196	196	(4) the patient's nearest living relative.
197	197	(e) If the patient does not have a legal guardian and a
198	198	person listed in Subsection (b) is not available, in order for a
199	199	treatment decision under Subsection (b) to be made, the health care
200	200	facility must file an application for temporary guardianship under
201	201	Chapter 1251, Estates Code, for the appointment of a person who is
202	202	not involved in the treatment of the patient or associated with or
203	203	employed by the health care facility to serve as a temporary
204	204	guardian for the patient for the limited purpose of making a
205	205	treatment decision [made] under Subsection (b) [must be concurred
206	206	in by another physician who is not involved in the treatment of the
207	207	patient or who is a representative of an ethics or medical committee
208	208	of the health care facility in which the person is a patient].
209	209	(e-1) The term of a temporary guardian appointed under a
210	210	temporary guardianship created pursuant to Subsection (e) expires
211	211	on the date a court enters an order finding that the patient's legal
212	212	guardian or a person listed in Subsection (b) is available to make a
213	213	treatment decision under this section. When the patient's legal
214	214	guardian or a person listed in Subsection (b) becomes available,
215	215	that person may make a treatment decision according to Subsection
216	216	(b).
217	217	(e-2) If a person listed in Subsection (b) is not
218	218	immediately available to make a treatment decision under this
219	219	section, the attending physician or the attending physician's
220	220	designee shall notify each person listed in Subsection (b) of the
221	221	need for a qualified person to make a treatment decision under this
222	222	section by:
223	223	(1) personally delivering notice to the person; or
224	224	(2) providing written notice sent by certified mail,
225	225	restricted delivery, return receipt requested, to the last known
226	226	address of the person.
227	227	(e-3) A person is considered not available for the purposes
228	228	of Subsection (e) if 48 hours have elapsed since personal notice was
229	229	provided under Subsection (e-2)(1), or 72 hours have elapsed since
230	230	the return receipt for the written notice was received under
231	231	Subsection (e-2)(2), and the person who was notified remains
232	232	unavailable to make a treatment decision under this section.
233	233	(g) A person listed in Subsection (b) who wishes to
234	234	challenge a treatment decision made under this section may [must]
235	235	apply for temporary guardianship under Chapter 1251, Estates
236	236	[Section 875, Texas Probate] Code. The court may waive applicable
237	237	fees in that proceeding.
238	238	SECTION 4. Subchapter B, Chapter 166, Health and Safety
239	239	Code, is amended by adding Section 166.054 to read as follows:
240	240	Sec. 166.054. APPLICABILITY OF SUBCHAPTER. This subchapter
241	241	applies to facilities licensed under Chapter 142.
242	242	SECTION 5. The heading to Subchapter C, Chapter 166, Health
243	243	and Safety Code, is amended to read as follows:
244	244	SUBCHAPTER C. [OUT-OF-HOSPITAL] DO-NOT-RESUSCITATE ORDERS
245	245	SECTION 6. Sections 166.081(2), (6), (9), and (10), Health
246	246	and Safety Code, are amended to read as follows:
247	247	(2) "DNR identification device" means an
248	248	identification device specified by department rule [the board]
249	249	under Section 166.101 that is worn for the purpose of identifying a
250	250	person who has executed or issued a [an out-of-hospital] DNR order
251	251	or on whose behalf a [an out-of-hospital] DNR order has been
252	252	executed or issued under this subchapter.
253	253	(6) "[Out-of-hospital] DNR order":
254	254	(A) means a legally binding [out-of-hospital]
255	255	do-not-resuscitate order, in the form specified by department rule
256	256	[the board] under Section 166.083, prepared and signed in
257	257	accordance with Section 166.082, 166.084, 166.085, or 166.0855 [by
258	258	the attending physician of a person], that documents the
259	259	instructions of a person or the person's legally authorized
260	260	representative and directs health care professionals to withhold or
261	261	withdraw one or more of [acting in an out-of-hospital setting not to
262	262	initiate or continue] the following treatments [life-sustaining
263	263	treatment]:
264	264	(i) cardiopulmonary resuscitation;
265	265	(ii) [advanced airway management;
266	266	[(iii) artificial ventilation;
267	267	[(iv)] defibrillation; and
268	268	(iii) [(v)] transcutaneous cardiac
269	269	pacing[; and
270	270	[(vi) other life-sustaining treatment
271	271	specified by the board under Section 166.101(a)]; and
272	272	(B) does not include authorization to withhold or
273	273	withdraw:
274	274	(i) medical interventions or therapies
275	275	[considered] necessary to provide comfort care or to alleviate
276	276	pain; or
277	277	(ii) fluids [to provide water] or
278	278	nutrition, including fluids or nutrition by mouth or by nasogastric
279	279	tube or artificial nutrition and hydration.
280	280	(9) "Qualified relatives" means those persons
281	281	authorized to execute or issue a [an out-of-hospital] DNR order on
282	282	behalf of a person who is incompetent or otherwise mentally or
283	283	physically incapable of communication under Section 166.088.
284	284	(10) "Statewide [out-of-hospital] DNR protocol" means
285	285	a set of statewide standardized procedures adopted by the executive
286	286	commissioner [board] under Section 166.101(a) for withholding or
287	287	withdrawing cardiopulmonary resuscitation and certain other
288	288	treatments listed in Subdivision (6) [life-sustaining treatment]
289	289	by health care professionals [acting in out-of-hospital settings].
290	290	SECTION 7. Sections 166.082, 166.083, 166.084, and 166.085,
291	291	Health and Safety Code, are amended to read as follows:
292	292	Sec. 166.082. [OUT-OF-HOSPITAL] DNR ORDER; DIRECTIVE TO
293	293	PHYSICIANS. (a) A competent person may at any time execute a
294	294	written [out-of-hospital] DNR order directing health care
295	295	professionals [acting in an out-of-hospital setting] to withhold
296	296	cardiopulmonary resuscitation and certain other treatments listed
297	297	in Section 166.081(6) [life-sustaining treatment designated by the
298	298	board].
299	299	(b) Except as provided by this subsection, the declarant
300	300	must sign the [out-of-hospital] DNR order in the presence of two
301	301	witnesses who qualify under Section 166.003, at least one of whom
302	302	must be a witness who qualifies under Section 166.003(2). The
303	303	witnesses must sign the order. The attending physician of the
304	304	declarant must sign the order and shall make the fact of the
305	305	existence of the order and the reasons for execution of the order a
306	306	part of the declarant's medical record. The declarant, in lieu of
307	307	signing in the presence of witnesses, may sign the
308	308	[out-of-hospital] DNR order and have the signature acknowledged
309	309	before a notary public.
310	310	(c) If the person is incompetent but previously executed or
311	311	issued a directive to physicians in accordance with Subchapter B,
312	312	the physician may rely on the directive as the person's
313	313	instructions to issue a [an out-of-hospital] DNR order and shall
314	314	place a copy of the directive in the person's medical record. The
315	315	physician shall sign the order in lieu of the person signing under
316	316	Subsection (b) and may use a digital or electronic signature
317	317	authorized under Section 166.011.
318	318	(d) If the person is incompetent but previously executed or
319	319	issued a directive to physicians in accordance with Subchapter B
320	320	designating a proxy, the proxy may make any decisions required of
321	321	the designating person as to a [an out-of-hospital] DNR order and
322	322	shall sign the order in lieu of the person signing under Subsection
323	323	(b).
324	324	(e) If the person is now incompetent but previously executed
325	325	or issued a medical power of attorney designating an agent, the
326	326	agent may make any decisions required of the designating person as
327	327	to a [an out-of-hospital] DNR order and shall sign the order in lieu
328	328	of the person signing under Subsection (b).
329	329	(f) The executive commissioner [board], on the
330	330	recommendation of the department, shall by rule adopt procedures
331	331	for the disposition and maintenance of records of an original
332	332	[out-of-hospital] DNR order and any copies of the order.
333	333	(g) A [An out-of-hospital] DNR order is effective on its
334	334	execution.
335	335	Sec. 166.083. FORM OF [OUT-OF-HOSPITAL] DNR ORDER. (a) A
336	336	written [out-of-hospital] DNR order shall be in the standard form
337	337	that complies with this subchapter specified by department [board]
338	338	rule as recommended by the department.
339	339	(b) The standard form of a [an out-of-hospital] DNR order
340	340	specified by department rule [the board] must, at a minimum,
341	341	contain the following:
342	342	(1) a distinctive single-page format that readily
343	343	identifies the document as a [an out-of-hospital] DNR order;
344	344	(2) a title that readily identifies the document as a
345	345	[an out-of-hospital] DNR order;
346	346	(3) the printed or typed name of the person;
347	347	(4) a statement that the physician signing the
348	348	document is the attending physician of the person and that the
349	349	physician is directing health care professionals to withhold or
350	350	withdraw [acting in out-of-hospital settings, including a hospital
351	351	emergency department, not to initiate or continue] certain
352	352	treatments listed in Section 166.081(6) [life-sustaining
353	353	treatment] on behalf of the person, and a listing of those
354	354	procedures the patient has decided should be withheld or withdrawn
355	355	[not to be initiated or continued];
356	356	(5) a statement that the person understands that the
357	357	person may revoke the [out-of-hospital] DNR order at any time by
358	358	destroying the order and removing the DNR identification device, if
359	359	any, or by communicating to health care professionals [at the
360	360	scene] the person's desire to revoke the [out-of-hospital] DNR
361	361	order;
362	362	(6) places for the printed names and signatures of the
363	363	witnesses or the notary public's acknowledgment and for the printed
364	364	name and signature of the attending physician of the person and the
365	365	medical license number of the attending physician;
366	366	(7) a separate section for execution of the document
367	367	by the legal guardian of the person, the person's proxy, an agent of
368	368	the person having a medical power of attorney, or the attending
369	369	physician attesting to the issuance of a [an out-of-hospital] DNR
370	370	order by nonwritten means of communication or acting in accordance
371	371	with a previously executed or previously issued directive to
372	372	physicians under Section 166.082(c) that includes the following:
373	373	(A) a statement that the legal guardian, the
374	374	proxy, the agent, or the person by nonwritten means of
375	375	communication[, or the physician] directs that one or more of the
376	376	treatments listed in Section 166.081(6) [each listed
377	377	life-sustaining treatment] should [not] be withheld or withdrawn on
378	378	[initiated or continued in] behalf of the person; and
379	379	(B) places for the printed names and signatures
380	380	of the witnesses and, as applicable, the legal guardian, proxy, or
381	381	agent[, or physician];
382	382	(8) a separate section for execution of the document
383	383	by at least one qualified relative of the person when the person
384	384	does not have a legal guardian, proxy, or agent having a medical
385	385	power of attorney and is incompetent or otherwise mentally or
386	386	physically incapable of communication, including:
387	387	(A) a statement that the relative of the person
388	388	is qualified to make a treatment decision under Section 166.088 to
389	389	withhold or withdraw cardiopulmonary resuscitation and certain
390	390	other designated treatments listed in Section 166.081(6)
391	391	[life-sustaining treatment under Section 166.088] and, based on the
392	392	known desires of the person or a determination of the best interest
393	393	of the person, directs that one or more of the treatments listed in
394	394	Section 166.081(6) [each listed life-sustaining treatment] should
395	395	[not] be withheld or withdrawn on [initiated or continued in]
396	396	behalf of the person; and
397	397	(B) places for the printed names and signatures
398	398	of the witnesses and qualified relative of the person;
399	399	(9) a place for entry of the date of execution of the
400	400	document;
401	401	(10) a statement that the document is in effect on the
402	402	date of its execution and remains in effect until the death of the
403	403	person or until the document is revoked;
404	404	(11) a statement that the document must accompany the
405	405	person during transport;
406	406	(12) a statement regarding the proper disposition of
407	407	the document or copies of the document, as the executive
408	408	commissioner [board] determines appropriate; and
409	409	(13) a statement at the bottom of the document, with
410	410	places for the signature of each person executing the document,
411	411	that the document has been properly completed.
412	412	(b-1) Except as provided by Subsection (b-2), a written DNR
413	413	order may be executed based on the oral instructions of a person,
414	414	provided the order complies with Section 166.0855.
415	415	(b-2) A DNR order by a physician must be in writing and
416	416	comply with the requirements of Section 166.0855.
417	417	(c) The executive commissioner [board] may, by rule and as
418	418	recommended by the department, modify the standard form of the
419	419	[out-of-hospital] DNR order described by Subsection (b) in order to
420	420	accomplish the provisions and purposes of this subchapter.
421	421	(d) A photocopy or other complete facsimile of the original
422	422	written [out-of-hospital] DNR order executed under this subchapter
423	423	may be used for any purpose for which the original written order may
424	424	be used under this subchapter.
425	425	Sec. 166.084. ISSUANCE OF [OUT-OF-HOSPITAL] DNR ORDER BY
426	426	NONWRITTEN COMMUNICATION. (a) A competent person who is an adult
427	427	may issue a [an out-of-hospital] DNR order by nonwritten
428	428	communication.
429	429	(b) A declarant must issue the nonwritten [out-of-hospital]
430	430	DNR order in the presence of the attending physician and two
431	431	witnesses who qualify under Section 166.003, at least one of whom
432	432	must be a witness who qualifies under Section 166.003(2).
433	433	(c) The attending physician and witnesses shall sign the
434	434	[out-of-hospital] DNR order in the place of the document provided
435	435	by Section 166.083(b)(7) and the attending physician shall sign the
436	436	document in the place required by Section 166.083(b)(13). The
437	437	physician shall make the fact of the existence of the
438	438	[out-of-hospital] DNR order a part of the patient's [declarant's]
439	439	medical record and the names of the witnesses shall be entered in
440	440	the medical record.
441	441	(d) A [An out-of-hospital] DNR order issued in the manner
442	442	provided by this section is valid and shall be honored by responding
443	443	health care professionals as if executed in the manner provided by
444	444	Section 166.082.
445	445	Sec. 166.085. EXECUTION OF [OUT-OF-HOSPITAL] DNR ORDER ON
446	446	BEHALF OF [OR A] MINOR. (a) The following persons may execute a [an
447	447	out-of-hospital] DNR order on behalf of a minor:
448	448	(1) the minor's parents;
449	449	(2) the minor's legal guardian; or
450	450	(3) the minor's managing conservator.
451	451	(b) A person listed under Subsection (a) may not execute a
452	452	[an out-of-hospital] DNR order unless the minor has been diagnosed
453	453	by a physician as suffering from a terminal or irreversible
454	454	condition.
455	455	SECTION 8. Subchapter C, Chapter 166, Health and Safety
456	456	Code, is amended by adding Section 166.0855 to read as follows:
457	457	Sec. 166.0855. DNR ORDERS APPLICABLE. A DNR order is valid
458	458	only if it is issued in compliance with:
459	459	(1) the directions of the patient, if competent, given
460	460	orally or otherwise in the presence of a person authorized to make a
461	461	treatment decision under Section 166.039;
462	462	(2) the directions in an advance directive enforceable
463	463	in accordance with Section 166.005 or executed in accordance with
464	464	Section 166.032, 166.034, or 166.035;
465	465	(3) the directions of the patient's legal guardian or
466	466	agent under a medical power of attorney acting in compliance with
467	467	Subchapter D;
468	468	(4) a treatment decision made in accordance with
469	469	Section 166.039; or
470	470	(5) the reasonable medical judgment of the patient's
471	471	attending physician that the patient's death is imminent within 24
472	472	hours even if cardiopulmonary resuscitation is provided.
473	473	SECTION 9. Sections 166.086, 166.087, 166.088, 166.089,
474	474	166.090, 166.091, 166.092, 166.093, 166.094, 166.095, 166.096, and
475	475	166.097, Health and Safety Code, are amended to read as follows:
476	476	Sec. 166.086. DESIRE OF PERSON SUPERSEDES
477	477	[OUT-OF-HOSPITAL] DNR ORDER. The desire of a competent person,
478	478	including a competent minor, supersedes the effect of a [an
479	479	out-of-hospital] DNR order executed or issued by or on behalf of the
480	480	person when the desire is communicated to responding health care
481	481	professionals as provided by this subchapter.
482	482	Sec. 166.087. PROCEDURE WHEN DECLARANT IS INCOMPETENT OR
483	483	INCAPABLE OF COMMUNICATION. (a) This section applies when a person
484	484	18 years of age or older has executed or issued a [an
485	485	out-of-hospital] DNR order and subsequently becomes incompetent or
486	486	otherwise mentally or physically incapable of communication.
487	487	(b) If the adult person has designated a person to make a
488	488	treatment decision as authorized by Section 166.032(c), the
489	489	attending physician and the designated person shall comply with the
490	490	[out-of-hospital] DNR order.
491	491	(c) If the adult person has not designated a person to make a
492	492	treatment decision as authorized by Section 166.032(c), the
493	493	attending physician shall comply with the [out-of-hospital] DNR
494	494	order unless the physician believes that the order does not reflect
495	495	the person's present desire.
496	496	Sec. 166.088. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR
497	497	ISSUED [OUT-OF-HOSPITAL] DNR ORDER AND IS INCOMPETENT OR INCAPABLE
498	498	OF COMMUNICATION. (a) If an adult person has not executed or
499	499	issued a [an out-of-hospital] DNR order and is incompetent or
500	500	otherwise mentally or physically incapable of communication, the
501	501	attending physician and the person's legal guardian, proxy, or
502	502	agent having a medical power of attorney may execute a [an
503	503	out-of-hospital] DNR order on behalf of the person.
504	504	(b) If the person does not have a legal guardian, proxy, or
505	505	agent under a medical power of attorney, the attending physician
506	506	and at least one qualified relative from a category listed by
507	507	Section 166.039(b), subject to the priority established under that
508	508	subsection, may execute a [an out-of-hospital] DNR order in the
509	509	same manner as a treatment decision made under Section 166.039(b).
510	510	(c) A decision to execute a [an out-of-hospital] DNR order
511	511	made under Subsection (a) or (b) must be based on knowledge of what
512	512	the person would desire, if known.
513	513	(d) A [An out-of-hospital] DNR order executed under
514	514	Subsection (b) must be made in the presence of at least two
515	515	witnesses who qualify under Section 166.003, at least one of whom
516	516	must be a witness who qualifies under Section 166.003(2).
517	517	(e) The fact that an adult person has not executed or issued
518	518	a [an out-of-hospital] DNR order does not create a presumption that
519	519	the person does not want a treatment decision made to withhold or
520	520	withdraw cardiopulmonary resuscitation and certain other
521	521	designated treatments listed in Section 166.081(6)
522	522	[life-sustaining treatment designated by the board].
523	523	(f) If there is not a qualified relative available to act
524	524	for the person under Subsection (b), in order for a decision to be
525	525	made to execute a DNR order under Subsection (a) or (b), the health
526	526	care facility must file an application for temporary guardianship
527	527	under Chapter 1251, Estates Code, for the appointment of a person
528	528	who is not involved in the treatment of the patient or associated
529	529	with or employed by the health care facility to serve as a temporary
530	530	guardian for the patient for the limited purpose of making a
531	531	decision about a [an out-of-hospital] DNR order [must be concurred
532	532	in by another physician who is not involved in the treatment of the
533	533	patient or who is a representative of the ethics or medical
534	534	committee of the health care facility in which the person is a
535	535	patient].
536	536	(f-1) The term of a temporary guardian appointed under a
537	537	temporary guardianship created pursuant to Subsection (f) expires
538	538	on the date a court enters an order finding that a qualified
539	539	relative is available to make a decision about a DNR order. When the
540	540	patient's legal guardian or a person listed in Subsection (b)
541	541	becomes available, that person may make a treatment decision
542	542	according to Subsection (a) or (b).
543	543	(f-2) If a qualified relative is not immediately available
544	544	to make a treatment decision under Subsection (b), the attending
545	545	physician or the attending physician's designee shall notify each
546	546	qualified relative of the need for a qualified relative to make a
547	547	treatment decision under this section by:
548	548	(1) personally delivering notice to the person; or
549	549	(2) providing written notice sent by certified mail,
550	550	restricted delivery, return receipt requested, to the last known
551	551	address of the person.
552	552	(f-3) A qualified relative is considered not available for
553	553	the purposes of Subsection (f) only if 48 hours have elapsed since
554	554	personal notice was provided under Subsection (f-2)(1), or 72 hours
555	555	have elapsed since the return receipt for the written notice was
556	556	received under Subsection (f-2)(2), and the qualified relative who
557	557	was notified remains unavailable to make a treatment decision under
558	558	this section.
559	559	(g) A person listed in Section 166.039(b) who wishes to
560	560	challenge a decision made under this section must apply for
561	561	temporary guardianship under Chapter 1251, Estates [Section 875,
562	562	Texas Probate] Code. The court may waive applicable fees in that
563	563	proceeding.
564	564	Sec. 166.089. COMPLIANCE WITH [OUT-OF-HOSPITAL] DNR ORDER.
565	565	(a) When responding to a call for assistance in an out-of-hospital
566	566	setting, health care professionals shall honor a [an
567	567	out-of-hospital] DNR order in accordance with the statewide
568	568	[out-of-hospital] DNR protocol and, where applicable, locally
569	569	adopted [out-of-hospital] DNR protocols not in conflict with the
570	570	statewide protocol if:
571	571	(1) the responding health care professionals discover
572	572	an executed or issued [out-of-hospital] DNR order form on their
573	573	arrival at the scene; and
574	574	(2) the responding health care professionals comply
575	575	with this section.
576	576	(b) If the person is wearing a DNR identification device,
577	577	the responding health care professionals must comply with Section
578	578	166.090.
579	579	(c) The responding health care professionals must establish
580	580	the identity of the person as the person who executed or issued the
581	581	[out-of-hospital] DNR order or for whom the [out-of-hospital] DNR
582	582	order was executed or issued.
583	583	(d) The responding health care professionals must determine
584	584	that the [out-of-hospital] DNR order form appears to be valid in
585	585	that it includes:
586	586	(1) written responses in the places designated on the
587	587	form for the names, signatures, and other information required of
588	588	persons executing or issuing, or witnessing or acknowledging as
589	589	applicable, the execution or issuance of, the order;
590	590	(2) a date in the place designated on the form for the
591	591	date the order was executed or issued; and
592	592	(3) the signature or digital or electronic signature
593	593	of the declarant or persons executing or issuing the order and the
594	594	attending physician in the appropriate places designated on the
595	595	form for indicating that the order form has been properly
596	596	completed.
597	597	(e) If the conditions prescribed by Subsections (a) through
598	598	(d) are not determined to apply by the responding health care
599	599	professionals at the scene, the [out-of-hospital] DNR order may not
600	600	be honored and life-sustaining procedures otherwise required by law
601	601	or local emergency medical services protocols shall be initiated or
602	602	continued. Health care professionals acting in out-of-hospital
603	603	settings are not required to accept or interpret a [an
604	604	out-of-hospital] DNR order that does not meet the requirements of
605	605	this subchapter.
606	606	(f) The [out-of-hospital] DNR order form or a copy of the
607	607	form, when available, must accompany the person during transport.
608	608	(g) A record shall be made and maintained of the
609	609	circumstances of each emergency medical services response in which
610	610	a [an out-of-hospital] DNR order or DNR identification device is
611	611	encountered, in accordance with the statewide [out-of-hospital]
612	612	DNR protocol and any applicable local [out-of-hospital] DNR
613	613	protocol not in conflict with the statewide protocol.
614	614	(h) A [An out-of-hospital] DNR order executed or issued and
615	615	documented or evidenced in the manner prescribed by this subchapter
616	616	is valid and shall be honored by responding health care
617	617	professionals in an out-of-hospital setting unless the person or
618	618	persons found at the scene:
619	619	(1) identify themselves as the declarant or as the
620	620	attending physician, legal guardian, qualified relative, or agent
621	621	of the person having a medical power of attorney who executed or
622	622	issued the [out-of-hospital] DNR order on behalf of the person; and
623	623	(2) request that cardiopulmonary resuscitation or
624	624	certain other treatments listed in Section 166.081(6)
625	625	[life-sustaining treatment designated by the board] be initiated or
626	626	continued.
627	627	(i) If the policies of a health care facility preclude
628	628	compliance with the [out-of-hospital] DNR order of a person or a [an
629	629	out-of-hospital] DNR order issued by an attending physician on
630	630	behalf of a person who is admitted to or a resident of the facility,
631	631	or if the facility is unwilling to accept DNR identification
632	632	devices as evidence of the existence of a [an out-of-hospital] DNR
633	633	order, that facility shall take all reasonable steps to notify the
634	634	person or, if the person is incompetent, the person's guardian or
635	635	the person or persons having authority to make health care
636	636	treatment decisions on behalf of the person, of the facility's
637	637	policy and shall take all reasonable steps to effect the transfer of
638	638	the person to the person's home or to a facility where the
639	639	provisions of this subchapter can be carried out.
640	640	Sec. 166.090. DNR IDENTIFICATION DEVICE. (a) A person who
641	641	has a valid [out-of-hospital] DNR order under this subchapter and
642	642	has chosen to have all treatments listed in Section 166.081(6)
643	643	withheld or withdrawn may wear a DNR identification device around
644	644	the neck or on the wrist as prescribed by department [board] rule
645	645	adopted under Section 166.101.
646	646	(b) The presence of a DNR identification device on the body
647	647	of a person is conclusive evidence that the person has executed or
648	648	issued a valid [out-of-hospital] DNR order or has a valid
649	649	[out-of-hospital] DNR order executed or issued on the person's
650	650	behalf. Responding health care professionals shall honor the DNR
651	651	identification device as if a valid [out-of-hospital] DNR order
652	652	form executed or issued by the person, which indicated the choice
653	653	for all treatments listed in Section 166.081(6) to be withheld or
654	654	withdrawn, were found in the possession of the person.
655	655	Sec. 166.091. DURATION OF [OUT-OF-HOSPITAL] DNR ORDER. A
656	656	[An out-of-hospital] DNR order is effective until it is revoked as
657	657	prescribed by Section 166.092.
658	658	Sec. 166.092. REVOCATION OF [OUT-OF-HOSPITAL] DNR ORDER.
659	659	(a) A patient or other declarant, without regard to the patient's
660	660	or other declarant's mental state or competency, or another person
661	661	authorized to make a treatment decision in Section 166.039 may
662	662	revoke a [an out-of-hospital] DNR order at any time [without regard
663	663	to the declarant's mental state or competency]. An order may be
664	664	revoked by[:
665	665	[(1) the declarant or someone in the declarant's
666	666	presence and at the declarant's direction destroying the order form
667	667	and removing the DNR identification device, if any;
668	668	[(2) a person who identifies himself or herself as the
669	669	legal guardian, as a qualified relative, or as the agent of the
670	670	declarant having a medical power of attorney who executed the
671	671	out-of-hospital DNR order or another person in the person's
672	672	presence and at the person's direction destroying the order form
673	673	and removing the DNR identification device, if any;
674	674	[(3)] the patient or other declarant, or a person who
675	675	identifies himself or herself as the legal guardian, a qualified
676	676	relative, or the agent of the patient having a medical power of
677	677	attorney, communicating orally or in another manner the person's
678	678	[declarant's] intent to revoke the order[; or
679	679	[(4) a person who identifies himself or herself as the
680	680	legal guardian, a qualified relative, or the agent of the declarant
681	681	having a medical power of attorney who executed the out-of-hospital
682	682	DNR order orally stating the person's intent to revoke the order].
683	683	(b) A [An oral] revocation of a DNR order under Subsection
684	684	(a) [(a)(3) or (a)(4)] takes effect only when the patient or other
685	685	declarant or a person who identifies himself or herself as the legal
686	686	guardian, a qualified relative, or the agent of the patient
687	687	[declarant] having a medical power of attorney [who executed the
688	688	out-of-hospital DNR order] communicates the intent to revoke the
689	689	order to the responding health care professionals or the attending
690	690	physician [at the scene]. The responding health care professionals
691	691	shall record the time, date, and place of the revocation in
692	692	accordance with the statewide [out-of-hospital] DNR protocol and
693	693	rules adopted by the executive commissioner [board] and any
694	694	applicable local [out-of-hospital] DNR protocol. The attending
695	695	physician or the physician's designee shall record in the person's
696	696	medical record the time, date, and place of the revocation and, if
697	697	different, the time, date, and place that the physician received
698	698	notice of the revocation. The attending physician or the
699	699	physician's designee shall also enter the word "VOID" on each page
700	700	of the copy of the order in the person's medical record and enter
701	701	and note the revocation in all relevant electronic medical records
702	702	of the patient.
703	703	(c) Except as otherwise provided by this subchapter, a
704	704	person is not civilly or criminally liable for failure to act on a
705	705	revocation made under this section unless the person has actual
706	706	knowledge of the revocation.
707	707	(d) If a licensed health care professional does not comply
708	708	with a revocation under Subsection (a), the patient or other
709	709	declarant, the legal guardian, a qualified relative, or an agent of
710	710	the patient having medical power of attorney may bring an action to
711	711	obtain an injunction to enforce the revocation from a court of
712	712	competent jurisdiction.
713	713	(e) A person who seeks an injunction under Subsection (d)
714	714	must:
715	715	(1) prove that the person is authorized to make a
716	716	treatment decision on behalf of the patient under Section 166.039;
717	717	and
718	718	(2) express a desire to revoke the DNR order.
719	719	(f) A court considering a request for an injunction under
720	720	Subsection (d) may not require a person seeking an injunction under
721	721	Subsection (d) to:
722	722	(1) pay the attorney's fees of an opposing party;
723	723	(2) provide expert testimony in support of the
724	724	injunction; or
725	725	(3) establish irreparable harm.
726	726	Sec. 166.093. REEXECUTION OF [OUT-OF-HOSPITAL] DNR ORDER.
727	727	A declarant may at any time reexecute or reissue a [an
728	728	out-of-hospital] DNR order in accordance with the procedures
729	729	prescribed by Section 166.082, including reexecution or reissuance
730	730	after the declarant is diagnosed as having a terminal or
731	731	irreversible condition.
732	732	Sec. 166.094. LIMITATION ON LIABILITY FOR WITHHOLDING OR
733	733	WITHDRAWING CARDIOPULMONARY RESUSCITATION AND CERTAIN OTHER
734	734	[LIFE-SUSTAINING] PROCEDURES. (a) A health care professional or
735	735	health care facility or entity that in good faith causes
736	736	cardiopulmonary resuscitation or certain other treatments listed
737	737	in Section 166.081(6) [life-sustaining treatment designated by the
738	738	board] to be withheld or withdrawn from a person in accordance with
739	739	this subchapter is not civilly liable for that action.
740	740	(b) A health care professional or health care facility or
741	741	entity that in good faith participates in withholding or
742	742	withdrawing cardiopulmonary resuscitation or certain other
743	743	treatments listed in Section 166.081(6) [life-sustaining treatment
744	744	designated by the board] from a person in accordance with this
745	745	subchapter is not civilly liable for that action.
746	746	(c) A health care professional or health care facility or
747	747	entity that in good faith participates in withholding or
748	748	withdrawing cardiopulmonary resuscitation or certain other
749	749	treatments listed in Section 166.081(6) [life-sustaining treatment
750	750	designated by the board] from a person in accordance with this
751	751	subchapter is not criminally liable or guilty of unprofessional
752	752	conduct as a result of that action.
753	753	(d) A health care professional or health care facility or
754	754	entity that in good faith causes or participates in withholding or
755	755	withdrawing cardiopulmonary resuscitation or certain other
756	756	treatments listed in Section 166.081(6) [life-sustaining treatment
757	757	designated by the board] from a person in accordance with this
758	758	subchapter and rules adopted under this subchapter is not in
759	759	violation of any other licensing or regulatory laws or rules of this
760	760	state and is not subject to any disciplinary action or sanction by
761	761	any licensing or regulatory agency of this state as a result of that
762	762	action.
763	763	Sec. 166.095. LIMITATION ON LIABILITY FOR FAILURE TO
764	764	EFFECTUATE [OUT-OF-HOSPITAL] DNR ORDER. (a) A health care
765	765	professional or health care facility or entity that has no actual
766	766	knowledge of a [an out-of-hospital] DNR order is not civilly or
767	767	criminally liable for failing to act in accordance with the order.
768	768	(b) A health care professional or health care facility or
769	769	entity is not subject to review and disciplinary action by the
770	770	appropriate licensing board for failing to effectuate a [an
771	771	out-of-hospital] DNR order if the decision was made in good faith.
772	772	This subsection does not limit remedies available under other laws
773	773	of this state.
774	774	(c) If an attending physician refuses to execute or comply
775	775	with a [an out-of-hospital] DNR order, the physician shall inform
776	776	the person, the legal guardian or qualified relatives of the
777	777	person, or the agent of the person having a medical power of
778	778	attorney and, if the person or another authorized to act on behalf
779	779	of the person so directs, shall make a reasonable effort to transfer
780	780	the person to another physician who is willing to execute or comply
781	781	with a [an out-of-hospital] DNR order.
782	782	Sec. 166.096. HONORING [OUT-OF-HOSPITAL] DNR ORDER DOES NOT
783	783	CONSTITUTE OFFENSE OF AIDING SUICIDE. A person does not commit an
784	784	offense under Section 22.08, Penal Code, by withholding
785	785	cardiopulmonary resuscitation or certain other treatments listed
786	786	in Section 166.081(6) [life-sustaining treatment designated by the
787	787	board] from a person in accordance with this subchapter.
788	788	Sec. 166.097. CRIMINAL PENALTY; PROSECUTION. (a) A person
789	789	commits an offense if the person intentionally conceals, cancels,
790	790	defaces, obliterates, or damages another person's
791	791	[out-of-hospital] DNR order or DNR identification device without
792	792	that person's consent or the consent of the person or persons
793	793	authorized to execute or issue a [an out-of-hospital] DNR order on
794	794	behalf of the person under this subchapter. An offense under this
795	795	subsection is a Class A misdemeanor.
796	796	(b) A person is subject to prosecution for criminal homicide
797	797	under Chapter 19, Penal Code, if the person, with the intent to
798	798	cause cardiopulmonary resuscitation or certain other treatments
799	799	listed in Section 166.081(6) [life-sustaining treatment designated
800	800	by the board] to be withheld or withdrawn from another person
801	801	contrary to the other person's desires, falsifies or forges a [an
802	802	out-of-hospital] DNR order or intentionally conceals or withholds
803	803	personal knowledge of a revocation and thereby directly causes
804	804	cardiopulmonary resuscitation and certain other treatments listed
805	805	in Section 166.081(6) [life-sustaining treatment designated by the
806	806	board] to be withheld or withdrawn from the other person with the
807	807	result that the other person's death is hastened.
808	808	(c) A health care professional commits an offense if the
809	809	person knowingly executes a DNR order that is not in compliance with
810	810	the provisions of this subchapter. An offense under this subsection
811	811	is a felony of the third degree.
812	812	SECTION 10. Subchapter C, Chapter 166, Health and Safety
813	813	Code, is amended by adding Section 166.0975 to read as follows:
814	814	Sec. 166.0975. DISCIPLINARY ACTION. The Texas Medical
815	815	Board shall take disciplinary action under Chapter 164, Occupations
816	816	Code, against a person who violates this chapter.
817	817	SECTION 11. Sections 166.098, 166.100, 166.101, and
818	818	166.102, Health and Safety Code, are amended to read as follows:
819	819	Sec. 166.098. PREGNANT PERSONS. A person may not withhold
820	820	or withdraw cardiopulmonary resuscitation or certain treatments
821	821	listed in Section 166.081(6) [other life-sustaining treatment
822	822	designated by the board] under this subchapter from a person known
823	823	by the responding health care professionals to be pregnant.
824	824	Sec. 166.100. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
825	825	This subchapter does not impair or supersede any legal right or
826	826	responsibility a patient or other person authorized to make a
827	827	treatment decision under Section 166.039 may have under a
828	828	constitution, other statute, regulation, or court decision to
829	829	effect the withholding or withdrawing of cardiopulmonary
830	830	resuscitation or certain other treatments listed in Section
831	831	166.081(6) from himself or herself or the patient for whom the
832	832	person has been authorized to make a treatment decision under
833	833	Section 166.039 [life-sustaining treatment designated by the
834	834	board].
835	835	Sec. 166.101. DUTIES OF DEPARTMENT AND EXECUTIVE
836	836	COMMISSIONER [BOARD]. (a) The executive commissioner [board]
837	837	shall, on the recommendation of the department, adopt all
838	838	reasonable and necessary rules to carry out the provisions and
839	839	purposes of this subchapter, including rules:
840	840	(1) adopting a statewide [out-of-hospital] DNR order
841	841	protocol that sets out standard procedures for the withholding or
842	842	withdrawing of cardiopulmonary resuscitation and certain other
843	843	treatments listed in Section 166.081(6) [life-sustaining
844	844	treatment] by health care professionals that addresses each of the
845	845	methods for executing the DNR order described in Section 166.082,
846	846	subject to Sections 166.084, 166.085, and 166.092 [acting in
847	847	out-of-hospital settings];
848	848	(2) [designating life-sustaining treatment that may
849	849	be included in an out-of-hospital DNR order, including all
850	850	procedures listed in Sections 166.081(6)(A)(i) through (v); and
851	851	[(3)] governing recordkeeping in circumstances in
852	852	which a [an out-of-hospital] DNR order or DNR identification device
853	853	is encountered by responding health care professionals; and
854	854	(3) explicitly specifying that a DNR order may be
855	855	issued by a physician only in compliance with the methods for
856	856	executing the DNR order described in Section 166.082, subject to
857	857	Sections 166.084, 166.085, and 166.0855.
858	858	(b) The rules adopted [by the board] under Subsection (a)
859	859	are not effective until approved by the Texas Medical [State] Board
860	860	[of Medical Examiners].
861	861	(c) Local emergency medical services authorities may adopt
862	862	local [out-of-hospital] DNR order protocols if the local protocols
863	863	do not conflict with the statewide [out-of-hospital] DNR order
864	864	protocol adopted by the executive commissioner [board].
865	865	(d) The executive commissioner [board] by rule shall
866	866	specify a distinctive standard design for a necklace and a bracelet
867	867	DNR identification device that signifies, when worn by a person,
868	868	that the possessor has executed or issued a valid [out-of-hospital]
869	869	DNR order under this subchapter or is a person for whom a valid
870	870	[out-of-hospital] DNR order has been executed or issued.
871	871	(e) The department shall report to the executive
872	872	commissioner [board] from time to time regarding issues identified
873	873	in emergency medical services responses in which a [an
874	874	out-of-hospital] DNR order or DNR identification device is
875	875	encountered. The report may contain recommendations to the
876	876	executive commissioner [board] for necessary modifications to the
877	877	form of the standard [out-of-hospital] DNR order or the designated
878	878	[life-sustaining] procedures listed in the standard
879	879	[out-of-hospital] DNR order, the statewide [out-of-hospital] DNR
880	880	order protocol, or the DNR identification devices.
881	881	Sec. 166.102. DUTY OF [PHYSICIAN'S DNR ORDER MAY BE HONORED
882	882	BY HEALTH CARE PERSONNEL OTHER THAN] EMERGENCY MEDICAL SERVICES
883	883	PERSONNEL RESPONDING TO CALL. [(a) Except as provided by
884	884	Subsection (b), a licensed nurse or person providing health care
885	885	services in an out-of-hospital setting may honor a physician's
886	886	do-not-resuscitate order.
887	887	[(b)] When responding to a call for assistance, emergency
888	888	medical services personnel:
889	889	(1) shall honor only a properly executed or issued
890	890	[out-of-hospital] DNR order or prescribed DNR identification
891	891	device in accordance with this subchapter; and
892	892	(2) have no duty to review, examine, interpret, or
893	893	honor a person's other written directive, including a written
894	894	directive in the form prescribed by Section 166.033.
895	895	SECTION 12. Subchapter C, Chapter 166, Health and Safety
896	896	Code, is amended by adding Section 166.103 to read as follows:
897	897	Sec. 166.103. APPLICABILITY OF SUBCHAPTER. This subchapter
898	898	applies to facilities licensed under Chapter 142.
899	899	SECTION 13. Not later than December 1, 2015, the executive
900	900	commissioner of the Health and Human Services Commission shall
901	901	adopt the rules required by Section 166.101(a), Health and Safety
902	902	Code, as amended by this Act.
903	903	SECTION 14. (a) Except as provided by Subsection (b) of
904	904	this section, the changes in law made by this Act apply to a
905	905	do-not-resuscitate order on or after the effective date of this
906	906	Act, regardless of whether the order was issued before, on, or after
907	907	the effective date of this Act.
908	908	(b) Section 166.083, Health and Safety Code, as amended by
909	909	this Act, and Section 166.0855, Health and Safety Code, as added by
910	910	this Act, apply only to a do-not-resuscitate order that is issued on
911	911	or after the effective date of this Act.
912	912	SECTION 15. This Act takes effect September 1, 2015.
913	913
914	914	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
915	915
916	916	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
917	917
918	918	__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
919	919
920	920	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
921	921
922	922	________________________________________________________________
923	923
924	924	________________________________________________________________
925	925
926	926	________________________________________________________________
927	927
928	928	1. __________
929	929
930	930	2. __________