Texas 2019 - 86th Regular

Texas House Bill HB1071 Compare Versions

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

Old	New	Differences
1	1	86R1950 SCL-D
2	2	By: Hinojosa H.B. No. 1071
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to an advance directive and do-not-resuscitate order of a
8	8	pregnant woman and information provided for an advance directive.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 166.033, Health and Safety Code, is
11	11	amended to read as follows:
12	12	Sec. 166.033. FORM OF WRITTEN DIRECTIVE. A written
13	13	directive may be in the following form:
14	14	DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
15	15	Instructions for completing this document:
16	16	This is an important legal document known as an Advance
17	17	Directive. It is designed to help you communicate your wishes about
18	18	medical treatment at some time in the future when you are unable to
19	19	make your wishes known because of illness or injury. These wishes
20	20	are usually based on personal values. In particular, you may want
21	21	to consider what burdens or hardships of treatment you would be
22	22	willing to accept for a particular amount of benefit obtained if you
23	23	were seriously ill.
24	24	You are encouraged to discuss your values and wishes with
25	25	your family or chosen spokesperson, as well as your physician. Your
26	26	physician, other health care provider, or medical institution may
27	27	provide you with various resources to assist you in completing your
28	28	advance directive. Brief definitions are listed below and may aid
29	29	you in your discussions and advance planning. Initial the
30	30	treatment choices that best reflect your personal preferences.
31	31	Provide a copy of your directive to your physician, usual hospital,
32	32	and family or spokesperson. Consider a periodic review of this
33	33	document. By periodic review, you can best assure that the
34	34	directive reflects your preferences.
35	35	In addition to this advance directive, Texas law provides for
36	36	three [two] other types of directives that can be important during a
37	37	serious illness. These are the Medical Power of Attorney, [and] the
38	38	Out-of-Hospital Do-Not-Resuscitate Order, and the Health Care
39	39	Facility Do-Not-Resuscitate Order. You may wish to discuss these
40	40	with your physician, family, hospital representative, or other
41	41	advisers. You may also wish to complete a directive related to the
42	42	donation of organs and tissues.
43	43	DIRECTIVE
44	44	I, __________, recognize that the best health care is based
45	45	upon a partnership of trust and communication with my physician. My
46	46	physician and I will make health care or treatment decisions
47	47	together as long as I am of sound mind and able to make my wishes
48	48	known. If there comes a time that I am unable to make medical
49	49	decisions about myself because of illness or injury, I direct that
50	50	the following treatment preferences be honored:
51	51	If, in the judgment of my physician, I am suffering with a
52	52	terminal condition from which I am expected to die within six
53	53	months, even with available life-sustaining treatment provided in
54	54	accordance with prevailing standards of medical care:
55	55	__________ 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
56	56	__________ 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
57	57	__________ 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.)
58	58	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
59	59	If, in the judgment of my physician, I am suffering with an
60	60	irreversible condition so that I cannot care for myself or make
61	61	decisions for myself and am expected to die without life-sustaining
62	62	treatment provided in accordance with prevailing standards of care:
63	63	__________ 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
64	64	__________ 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
65	65	__________ 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.)
66	66	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
67	67	In case of pregnancy:
68	68	If I am pregnant, my decision concerning life-sustaining
69	69	treatment is modified as follows:
70	70	________________________________________________________________ ________________________________________________________________
71	71	________________________________________________________________
72	72	________________________________________________________________ ________________________________________________________________
73	73	________________________________________________________________
74	74	________________________________________________________________ ________________________________________________________________
75	75	________________________________________________________________
76	76	(THIS SECTION IS OPTIONAL, IS ONLY FOR WOMEN OF CHILD-BEARING AGE,
77	77	AND DOES NOT AFFECT THE VALIDITY OF THIS FORM IF LEFT BLANK.)
78	78	Additional requests: (After discussion with your physician,
79	79	you may wish to consider listing particular treatments in this
80	80	space that you do or do not want in specific circumstances, such as
81	81	artificially administered nutrition and hydration, intravenous
82	82	antibiotics, etc. Be sure to state whether you do or do not want the
83	83	particular treatment.)
84	84	After signing this directive, if my representative or I elect
85	85	hospice care, I understand and agree that only those treatments
86	86	needed to keep me comfortable would be provided and I would not be
87	87	given available life-sustaining treatments.
88	88	If I do not have a Medical Power of Attorney, and I am unable
89	89	to make my wishes known, I designate the following person(s) to make
90	90	health care or treatment decisions with my physician compatible
91	91	with my personal values:
92	92	1. __________
93	93	2. __________
94	94	(If a Medical Power of Attorney has been executed, then an
95	95	agent already has been named and you should not list additional
96	96	names in this document.)
97	97	If the above persons are not available, or if I have not
98	98	designated a spokesperson, I understand that a spokesperson will be
99	99	chosen for me following standards specified in the laws of Texas.
100	100	If, in the judgment of my physician, my death is imminent within
101	101	minutes to hours, even with the use of all available medical
102	102	treatment provided within the prevailing standard of care, I
103	103	acknowledge that all treatments may be withheld or removed except
104	104	those needed to maintain my comfort. [I understand that under Texas
105	105	law this directive has no effect if I have been diagnosed as
106	106	pregnant.] This directive will remain in effect until I revoke it.
107	107	No other person may do so.
108	108	Signed__________ Date__________ City, County, State of
109	109	Residence __________
110	110	Two competent adult witnesses must sign below, acknowledging
111	111	the signature of the declarant. The witness designated as Witness 1
112	112	may not be a person designated to make a health care or treatment
113	113	decision for the patient and may not be related to the patient by
114	114	blood or marriage. This witness may not be entitled to any part of
115	115	the estate and may not have a claim against the estate of the
116	116	patient. This witness may not be the attending physician or an
117	117	employee of the attending physician. If this witness is an employee
118	118	of a health care facility in which the patient is being cared for,
119	119	this witness may not be involved in providing direct patient care to
120	120	the patient. This witness may not be an officer, director, partner,
121	121	or business office employee of a health care facility in which the
122	122	patient is being cared for or of any parent organization of the
123	123	health care facility.
124	124	Witness 1 __________ Witness 2 __________
125	125	Definitions:
126	126	"Artificially administered nutrition and hydration" means
127	127	the provision of nutrients or fluids by a tube inserted in a vein,
128	128	under the skin in the subcutaneous tissues, or in the
129	129	gastrointestinal tract.
130	130	"Irreversible condition" means a condition, injury, or
131	131	illness:
132	132	(1) that may be treated, but is never cured or
133	133	eliminated;
134	134	(2) that leaves a person unable to care for or make
135	135	decisions for the person's own self; and
136	136	(3) that, without life-sustaining treatment provided
137	137	in accordance with the prevailing standard of medical care, is
138	138	fatal.
139	139	Explanation: Many serious illnesses such as cancer, failure
140	140	of major organs (kidney, heart, liver, or lung), and serious brain
141	141	disease such as Alzheimer's dementia may be considered irreversible
142	142	early on. There is no cure, but the patient may be kept alive for
143	143	prolonged periods of time if the patient receives life-sustaining
144	144	treatments. Late in the course of the same illness, the disease may
145	145	be considered terminal when, even with treatment, the patient is
146	146	expected to die. You may wish to consider which burdens of
147	147	treatment you would be willing to accept in an effort to achieve a
148	148	particular outcome. This is a very personal decision that you may
149	149	wish to discuss with your physician, family, or other important
150	150	persons in your life.
151	151	"Life-sustaining treatment" means treatment that, based on
152	152	reasonable medical judgment, sustains the life of a patient and
153	153	without which the patient will die. The term includes both
154	154	life-sustaining medications and artificial life support such as
155	155	mechanical breathing machines, kidney dialysis treatment, and
156	156	artificially administered nutrition and hydration. The term does
157	157	not include the administration of pain management medication, the
158	158	performance of a medical procedure necessary to provide comfort
159	159	care, or any other medical care provided to alleviate a patient's
160	160	pain.
161	161	"Terminal condition" means an incurable condition caused by
162	162	injury, disease, or illness that according to reasonable medical
163	163	judgment will produce death within six months, even with available
164	164	life-sustaining treatment provided in accordance with the
165	165	prevailing standard of medical care.
166	166	Explanation: Many serious illnesses may be considered
167	167	irreversible early in the course of the illness, but they may not be
168	168	considered terminal until the disease is fairly advanced. In
169	169	thinking about terminal illness and its treatment, you again may
170	170	wish to consider the relative benefits and burdens of treatment and
171	171	discuss your wishes with your physician, family, or other important
172	172	persons in your life.
173	173	SECTION 2. Section 166.049, Health and Safety Code, is
174	174	amended to read as follows:
175	175	Sec. 166.049. PREGNANT WOMAN [PATIENTS]. A woman of
176	176	child-bearing age may specify in an advance directive executed by
177	177	the woman the effect the woman's pregnancy has on the advance
178	178	directive [A person may not withdraw or withhold life-sustaining
179	179	treatment under this subchapter from a pregnant patient].
180	180	SECTION 3. Section 166.083(b), Health and Safety Code, is
181	181	amended to read as follows:
182	182	(b) The standard form of an out-of-hospital DNR order
183	183	specified by department rule must, at a minimum, contain the
184	184	following:
185	185	(1) a distinctive single-page format that readily
186	186	identifies the document as an out-of-hospital DNR order;
187	187	(2) a title that readily identifies the document as an
188	188	out-of-hospital DNR order;
189	189	(3) the printed or typed name of the person;
190	190	(4) a statement that the physician signing the
191	191	document is the attending physician of the person and that the
192	192	physician is directing health care professionals acting in
193	193	out-of-hospital settings, including a hospital emergency
194	194	department, not to initiate or continue certain life-sustaining
195	195	treatment on behalf of the person, and a listing of those procedures
196	196	not to be initiated or continued;
197	197	(5) a statement that the person understands that the
198	198	person may revoke the out-of-hospital DNR order at any time by
199	199	destroying the order and removing the DNR identification device, if
200	200	any, or by communicating to health care professionals at the scene
201	201	the person's desire to revoke the out-of-hospital DNR order;
202	202	(6) a statement that the person, if a woman of
203	203	child-bearing age, may specify in the form the effect the woman's
204	204	pregnancy has on the out-of-hospital DNR order;
205	205	(7) places for the printed names and signatures of the
206	206	witnesses or the notary public's acknowledgment and for the printed
207	207	name and signature of the attending physician of the person and the
208	208	medical license number of the attending physician;
209	209	(8) [(7)] a separate section for execution of the
210	210	document by the legal guardian of the person, the person's proxy, an
211	211	agent of the person having a medical power of attorney, or the
212	212	attending physician attesting to the issuance of an out-of-hospital
213	213	DNR order by nonwritten means of communication or acting in
214	214	accordance with a previously executed or previously issued
215	215	directive to physicians under Section 166.082(c) that includes the
216	216	following:
217	217	(A) a statement that the legal guardian, the
218	218	proxy, the agent, the person by nonwritten means of communication,
219	219	or the physician directs that each listed life-sustaining treatment
220	220	should not be initiated or continued in behalf of the person; and
221	221	(B) places for the printed names and signatures
222	222	of the witnesses and, as applicable, the legal guardian, proxy,
223	223	agent, or physician;
224	224	(9) [(8)] a separate section for execution of the
225	225	document by at least one qualified relative of the person when the
226	226	person does not have a legal guardian, proxy, or agent having a
227	227	medical power of attorney and is incompetent or otherwise mentally
228	228	or physically incapable of communication, including:
229	229	(A) a statement that the relative of the person
230	230	is qualified to make a treatment decision to withhold
231	231	cardiopulmonary resuscitation and certain other designated
232	232	life-sustaining treatment under Section 166.088 and, based on the
233	233	known desires of the person or a determination of the best interest
234	234	of the person, directs that each listed life-sustaining treatment
235	235	should not be initiated or continued in behalf of the person; and
236	236	(B) places for the printed names and signatures
237	237	of the witnesses and qualified relative of the person;
238	238	(10) [(9)] a place for entry of the date of execution
239	239	of the document;
240	240	(11) [(10)] a statement that the document is in effect
241	241	on the date of its execution and remains in effect until the death
242	242	of the person or until the document is revoked;
243	243	(12) [(11)] a statement that the document must
244	244	accompany the person during transport;
245	245	(13) [(12)] a statement regarding the proper
246	246	disposition of the document or copies of the document, as the
247	247	executive commissioner determines appropriate; and
248	248	(14) [(13)] a statement at the bottom of the document,
249	249	with places for the signature of each person executing the
250	250	document, that the document has been properly completed.
251	251	SECTION 4. Section 166.084(c), Health and Safety Code, is
252	252	amended to read as follows:
253	253	(c) The attending physician and witnesses shall sign the
254	254	out-of-hospital DNR order in the place of the document provided by
255	255	Section 166.083(b)(8) [166.083(b)(7)] and the attending physician
256	256	shall sign the document in the place required by Section
257	257	166.083(b)(14) [166.083(b)(13)]. The physician shall make the fact
258	258	of the existence of the out-of-hospital DNR order a part of the
259	259	declarant's medical record and the names of the witnesses shall be
260	260	entered in the medical record.
261	261	SECTION 5. Section 166.098, Health and Safety Code, is
262	262	amended to read as follows:
263	263	Sec. 166.098. PREGNANT WOMAN [PERSONS]. A woman of
264	264	child-bearing age may specify in an out-of-hospital DNR order
265	265	executed by the woman the effect the woman's pregnancy has on the
266	266	order [A person may not withhold cardiopulmonary resuscitation or
267	267	certain other life-sustaining treatment designated by department
268	268	rule under this subchapter from a person known by the responding
269	269	health care professionals to be pregnant].
270	270	SECTION 6. This Act takes effect September 1, 2019.
271	271
272	272	__________ 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
273	273
274	274	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
275	275
276	276	__________ 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
277	277
278	278	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
279	279
280	280	________________________________________________________________
281	281
282	282	________________________________________________________________
283	283
284	284	________________________________________________________________