By: Hughes H.B. No. 2984
A BILL TO BE ENTITLED
AN ACT
relating to advance directives or health care or treatment
decisions made by or on behalf of patients.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. This Act may be cited as the Patient and Family
Treatment Choice Rights Act of 2015.
SECTION 2. The purpose of this Act is to protect the right
of patients and their families to decide whether and under what
circumstances to choose or reject life-sustaining treatment. This
Act amends the applicable provisions of the Advance Directives Act
(Chapter 166, Health and Safety Code) to ensure that, when an
attending physician is unwilling to respect a patient's advance
directive or a patient's or family's decision to choose the
treatment necessary to prevent the patient's death,
life-sustaining medical treatment will be provided until the
patient can be transferred to a health care provider willing to
honor the directive or treatment decision.
SECTION 3. Section 166.045(c), Health and Safety Code, is
amended to read as follows:
(c) If an attending physician refuses to comply with a
directive or treatment decision to provide life-sustaining
treatment to a patient and does not wish to follow the procedure
established under Section 166.046, life-sustaining treatment shall
be provided to the patient[, but only] until [a reasonable
opportunity has been afforded for the transfer of] the patient is
transferred to another physician or health care facility willing to
comply with the directive or treatment decision.
SECTION 4. Sections 166.046(a) and (e), Health and Safety
Code, are amended to read as follows:
(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, other than a directive or decision to
provide artificial nutrition and hydration to the 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.
(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 after the 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 unless ordered to do so under Subsection (g).]
SECTION 5. Section 166.051, Health and Safety Code, is
amended to read as follows:
Sec. 166.051. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
This subchapter does not impair or supersede any legal right or
responsibility a person may have to effect the withholding or
withdrawal of life-sustaining treatment in a lawful manner,
provided that if an attending physician or health care facility is
unwilling to honor a patient's advance directive or a treatment
decision to provide life-sustaining treatment, life-sustaining
treatment must [is required to] be provided to the patient in
accordance with this chapter[, but only until a reasonable
opportunity has been afforded for transfer of the patient to
another physician or health care facility willing to comply with
the advance directive or treatment decision].
SECTION 6. 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, other than a directive or
decision to provide artificial nutrition and hydration, 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,* other than artificial
nutrition and hydration, 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, other
than artificial nutrition and hydration, 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.
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 finding [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 Health
Services [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.
(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:
When There Is A Disagreement About Medical Treatment: The
Physician Recommends Life-Sustaining Treatment That You Wish To
Stop
You have been given this information because you have
requested the withdrawal or withholding of life-sustaining
treatment*, other than artificial nutrition and hydration, 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 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.
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 finding [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 Health
Services [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.
*"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 7. Section 25.0021(b), Government Code, is amended
to read as follows:
(b) A statutory probate court as that term is defined in
Section 3(ii), Texas Probate Code, has:
(1) the general jurisdiction of a probate court as
provided by the Texas Probate Code; and
(2) the jurisdiction provided by law for a county
court to hear and determine actions, cases, matters, or proceedings
instituted under:
(A) Section[166.046,]192.027,193.007, 552.015,
552.019, 711.004, or 714.003, Health and Safety Code;
(B) Chapter 462, Health and Safety Code; or
(C) Subtitle C or D, Title 7, Health and Safety
Code.
SECTION 8. Sections 166.046(f) and (g), Health and Safety
Code, are repealed.
SECTION 9. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2015.