84R25291 SCL-F
By: Springer, Cook, Turner of Harris, Klick, H.B. No. 3074
Wray, et al.
A BILL TO BE ENTITLED
AN ACT
relating to the provision of artificially administered nutrition
and hydration and life-sustaining treatment.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 166.002(2) and (10), Health and Safety
Code, are amended to read as follows:
(2) "Artificially administered [Artificial] nutrition
and hydration" means the provision of nutrients or fluids by a tube
inserted in a vein, under the skin in the subcutaneous tissues, or
in the [stomach (]gastrointestinal tract[)].
(10) "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
artificially administered [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 2. Section 166.003, Health and Safety Code, is
amended to read as follows:
Sec. 166.003. WITNESSES. In any circumstance in which this
chapter requires the execution of an advance directive or the
issuance of a nonwritten advance directive to be witnessed:
(1) each witness must be a competent adult; and
(2) at least one of the witnesses must be a person who
is not:
(A) a person designated by the declarant to make
a health care or treatment decision;
(B) a person related to the declarant by blood or
marriage;
(C) a person entitled to any part of the
declarant's estate after the declarant's death under a will or
codicil executed by the declarant or by operation of law;
(D) the attending physician;
(E) an employee of the attending physician;
(F) an employee of a health care facility in
which the declarant is a patient if the employee is providing direct
patient care to the declarant or is an officer, director, partner,
or business office employee of the health care facility or of any
parent organization of the health care facility; or
(G) a person who, at the time the written advance
directive is executed or, if the directive is a nonwritten
directive issued under this chapter, at the time the nonwritten
directive is issued, has a claim against any part of the declarant's
estate after the declarant's death.
SECTION 3. Section 166.032(c), Health and Safety Code, is
amended to read as follows:
(c) A declarant may include in a directive directions other
than those provided by Section 166.033 and may designate in a
directive a person to make a health care or treatment decision for
the declarant in the event the declarant becomes incompetent or
otherwise mentally or physically incapable of communication.
SECTION 4. Section 166.033, Health and Safety Code, is
amended to read as follows:
Sec. 166.033. FORM OF WRITTEN DIRECTIVE. A written
directive may be in the following form:
DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
Instructions for completing this document:
This is an important legal document known as an Advance
Directive. It is designed to help you communicate your wishes about
medical treatment at some time in the future when you are unable to
make your wishes known because of illness or injury. These wishes
are usually based on personal values. In particular, you may want
to consider what burdens or hardships of treatment you would be
willing to accept for a particular amount of benefit obtained if you
were seriously ill.
You are encouraged to discuss your values and wishes with
your family or chosen spokesperson, as well as your physician. Your
physician, other health care provider, or medical institution may
provide you with various resources to assist you in completing your
advance directive. Brief definitions are listed below and may aid
you in your discussions and advance planning. Initial the
treatment choices that best reflect your personal preferences.
Provide a copy of your directive to your physician, usual hospital,
and family or spokesperson. Consider a periodic review of this
document. By periodic review, you can best assure that the
directive reflects your preferences.
In addition to this advance directive, Texas law provides for
two other types of directives that can be important during a serious
illness. These are the Medical Power of Attorney and the
Out-of-Hospital Do-Not-Resuscitate Order. You may wish to discuss
these with your physician, family, hospital representative, or
other advisers. You may also wish to complete a directive related
to the donation of organs and tissues.
DIRECTIVE
I, __________, recognize that the best health care is based
upon a partnership of trust and communication with my physician. My
physician and I will make health care or treatment decisions
together as long as I am of sound mind and able to make my wishes
known. If there comes a time that I am unable to make medical
decisions about myself because of illness or injury, I direct that
the following treatment preferences be honored:
If, in the judgment of my physician, I am suffering with a
terminal condition from which I am expected to die within six
months, even with available life-sustaining treatment provided in
accordance with prevailing standards of medical care:
__________ 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
__________ 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 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.)
__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
If, in the judgment of my physician, I am suffering with an
irreversible condition so that I cannot care for myself or make
decisions for myself and am expected to die without life-sustaining
treatment provided in accordance with prevailing standards of care:
__________ 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
__________ 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 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.)
__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
Additional requests: (After discussion with your physician,
you may wish to consider listing particular treatments in this
space that you do or do not want in specific circumstances, such as
artificially administered [artificial] nutrition and hydration
[fluids], intravenous antibiotics, etc. Be sure to state whether
you do or do not want the particular treatment.)
After signing this directive, if my representative or I elect
hospice care, I understand and agree that only those treatments
needed to keep me comfortable would be provided and I would not be
given available life-sustaining treatments.
If I do not have a Medical Power of Attorney, and I am unable
to make my wishes known, I designate the following person(s) to make
health care or treatment decisions with my physician compatible
with my personal values:
1. __________
2. __________
(If a Medical Power of Attorney has been executed, then an
agent already has been named and you should not list additional
names in this document.)
If the above persons are not available, or if I have not
designated a spokesperson, I understand that a spokesperson will be
chosen for me following standards specified in the laws of Texas.
If, in the judgment of my physician, my death is imminent within
minutes to hours, even with the use of all available medical
treatment provided within the prevailing standard of care, I
acknowledge that all treatments may be withheld or removed except
those needed to maintain my comfort. I understand that under Texas
law this directive has no effect if I have been diagnosed as
pregnant. This directive will remain in effect until I revoke it.
No other person may do so.
Signed__________ Date__________ City, County, State of
Residence __________
Two competent adult witnesses must sign below, acknowledging
the signature of the declarant. The witness designated as Witness 1
may not be a person designated to make a health care or treatment
decision for the patient and may not be related to the patient by
blood or marriage. This witness may not be entitled to any part of
the estate and may not have a claim against the estate of the
patient. This witness may not be the attending physician or an
employee of the attending physician. If this witness is an employee
of a health care facility in which the patient is being cared for,
this witness may not be involved in providing direct patient care to
the patient. This witness may not be an officer, director, partner,
or business office employee of a health care facility in which the
patient is being cared for or of any parent organization of the
health care facility.
Witness 1 __________ Witness 2 __________
Definitions:
"Artificially administered [Artificial] nutrition and
hydration" means the provision of nutrients or fluids by a tube
inserted in a vein, under the skin in the subcutaneous tissues, or
in the [stomach (]gastrointestinal tract[)].
"Irreversible condition" means a condition, injury, or
illness:
(1) that may be treated, but is never cured or
eliminated;
(2) that leaves a person unable to care for or make
decisions for the person's own self; and
(3) that, without life-sustaining treatment provided
in accordance with the prevailing standard of medical care, is
fatal.
Explanation: Many serious illnesses such as cancer, failure
of major organs (kidney, heart, liver, or lung), and serious brain
disease such as Alzheimer's dementia may be considered irreversible
early on. There is no cure, but the patient may be kept alive for
prolonged periods of time if the patient receives life-sustaining
treatments. Late in the course of the same illness, the disease may
be considered terminal when, even with treatment, the patient is
expected to die. You may wish to consider which burdens of
treatment you would be willing to accept in an effort to achieve a
particular outcome. This is a very personal decision that you may
wish to discuss with your physician, family, or other important
persons in your life.
"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
artificially administered nutrition and [artificial] hydration
[and nutrition]. The term does not include the administration of
pain management medication, the performance of a medical procedure
necessary to provide comfort care, or any other medical care
provided to alleviate a patient's pain.
"Terminal condition" means an incurable condition caused by
injury, disease, or illness that according to reasonable medical
judgment will produce death within six months, even with available
life-sustaining treatment provided in accordance with the
prevailing standard of medical care.
Explanation: Many serious illnesses may be considered
irreversible early in the course of the illness, but they may not be
considered terminal until the disease is fairly advanced. In
thinking about terminal illness and its treatment, you again may
wish to consider the relative benefits and burdens of treatment and
discuss your wishes with your physician, family, or other important
persons in your life.
SECTION 5. Sections 166.046(b) and (e), Health and Safety
Code, as amended by S.B. 219, Acts of the 84th Legislature, Regular
Session, 2015, are amended to read as follows:
(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 under Section 166.053; and
(4) is entitled to:
(A) attend the meeting; [and]
(B) receive a written explanation of the decision
reached during the review process;
(C) receive a copy of the portion of the
patient's medical record related to the treatment received by the
patient in the facility for the lesser of:
(i) the period of the patient's current
admission to the facility; or
(ii) the preceding 30 calendar days; and
(D) receive a copy of all of the patient's
reasonably available diagnostic results and reports related to the
medical record provided under Paragraph (C).
(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 ethics
or medical committee [review process] has affirmed is medically
inappropriate treatment, the patient shall be given available
life-sustaining treatment pending transfer under Subsection (d).
This subsection does not authorize withholding or withdrawing pain
management medication, medical procedures necessary to provide
comfort, or any other health care provided to alleviate a patient's
pain. The patient is responsible for any costs incurred in
transferring the patient to another facility. The attending
physician, any other physician responsible for the care of the
patient, and the health care facility are not obligated to provide
life-sustaining treatment after the 10th day after both the written
decision and the patient's medical record required under Subsection
(b) are [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), except that artificially administered
nutrition and hydration must be provided unless, based on
reasonable medical judgment, providing artificially administered
nutrition and hydration would:
(1) hasten the patient's death;
(2) be medically contraindicated such that the
provision of the treatment seriously exacerbates life-threatening
medical problems not outweighed by the benefit of the provision of
the treatment;
(3) result in substantial irremediable physical pain
not outweighed by the benefit of the provision of the treatment;
(4) be medically ineffective in prolonging life; or
(5) be contrary to the patient's or surrogate's
clearly documented desire not to receive artificially administered
nutrition or hydration.
SECTION 6. Sections 166.052(a) and (b), Health and Safety
Code, as amended by S.B. 219, Acts of the 84th Legislature, Regular
Session, 2015, are amended to read as follows:
(a) In cases in which the attending physician refuses to
honor an advance directive or health care or treatment decision
requesting the provision 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 Against Certain Life-Sustaining Treatment
That You Wish To Continue
You have been given this information because you have
requested life-sustaining treatment[,]* for yourself as the
patient or on behalf of the patient, as applicable, which the
attending physician believes is not medically 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 medically
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 is medically 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,
licensed physicians, health care facilities, 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.
You may wish to contact providers, facilities, 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 the patient [he or she] can be transferred to a
willing provider for up to 10 days from the time you were given both
the committee's written decision that life-sustaining treatment is
not appropriate and the patient's medical record. The patient will
continue to be given after the 10-day period treatment to enhance
pain management and reduce suffering, including artificially
administered nutrition and hydration, unless, based on reasonable
medical judgment, providing artificially administered nutrition
and hydration would hasten the patient's death, be medically
contraindicated such that the provision of the treatment seriously
exacerbates life-threatening medical problems not outweighed by
the benefit of the provision of the treatment, result in
substantial irremediable physical pain not outweighed by the
benefit of the provision of the treatment, be medically ineffective
in prolonging life, or be contrary to the patient's or surrogate's
clearly documented desires.
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 you may find a physician or health care
facility willing to provide life-sustaining treatment [will be
found] if the extension is granted. Patient medical records will be
provided to the patient or surrogate in accordance with Section
241.154, Texas Health and Safety Code.
*"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
artificially administered [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* for yourself as the patient or on behalf of the patient,
as applicable, and the attending physician disagrees with and
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 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,
licensed physicians, health care facilities, 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.
You may wish to contact providers, facilities, 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
artificially administered [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. Not later than March 1, 2016, the executive
commissioner of the Health and Human Services Commission shall
adopt all rules necessary to implement this Act.
SECTION 8. The change in law made by this Act applies only
to a review, consultation, disagreement, or other action relating
to a health care or treatment decision made on or after April 1,
2016. A review, consultation, disagreement, or other action
relating to a health care or treatment decision made before April 1,
2016, is governed by the law in effect immediately before the
effective date of this Act, and that law is continued in effect for
that purpose.
SECTION 9. This Act takes effect September 1, 2015.
__________ 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 I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
__________ 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 I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)