Texas 2019 - 86th Regular

Texas Senate Bill SB1383 Compare Versions

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

Old	New	Differences
1	1	86R7063 MCK-D
2	2	By: Rodríguez S.B. No. 1383
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to prohibited nonconsensual genital surgery on certain
8	8	minors with intersex traits.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Sections 266.001 through 266.013, Family Code,
11	11	are designated as Subchapter A, Chapter 266, Family Code, and a
12	12	heading is added to Subchapter A to read as follows:
13	13	SUBCHAPTER A. GENERAL PROVISIONS; EDUCATIONAL SERVICES; MEDICAL
14	14	CARE
15	15	SECTION 2. Chapter 266, Family Code, is amended by adding
16	16	Subchapter B to read as follows:
17	17	SUBCHAPTER B. MEDICAL PROCEDURES AND TREATMENTS RELATED TO
18	18	INTERSEX TRAITS
19	19	Sec. 266.051. DEFINITIONS. In this subchapter:
20	20	(1) "Intersex child" means an individual who is
21	21	younger than 18 years of age and either:
22	22	(A) has inborn chromosomal, gonadal, genital, or
23	23	endocrine characteristics, or a combination of those
24	24	characteristics, that are not suited to the typical definition of
25	25	male or female or are atypical for the sex assigned; or
26	26	(B) is considered by a medical professional to
27	27	have inborn chromosomal, gonadal, genital, or endocrine
28	28	characteristics that are ambiguous or atypical for the sex
29	29	assigned.
30	30	(2) "Medical procedure or treatment related to an
31	31	intersex trait" includes:
32	32	(A) hormonal treatment to treat or modify an
33	33	intersex trait; or
34	34	(B) genital surgery, including:
35	35	(i) clitorectomy, clitoroplasty, clitoral
36	36	reduction, and clitoral recession, including corporal-sparing
37	37	procedures;
38	38	(ii) vaginoplasty, introitoplasty, vaginal
39	39	exteriorization, and partial or total urogenital sinus
40	40	mobilization;
41	41	(iii) labiaplasty and labial reduction;
42	42	(iv) hypospadias surgery, relocation of the
43	43	urethral meatus, and chordee release;
44	44	(v) phalloplasty; and
45	45	(vi) gonadectomy, including of testes,
46	46	ovaries, ovotestes, or streak gonads.
47	47	(3) "Medically necessary" means a medical procedure or
48	48	treatment immediately necessary to treat an injury, illness,
49	49	disease, or condition affecting the intersex child's health that if
50	50	delayed would adversely affect the intersex child's physical
51	51	health.
52	52	Sec. 266.052. REQUIREMENTS FOR CERTAIN MEDICAL PROCEDURES
53	53	OR TREATMENTS. A physician may not perform a medical procedure or
54	54	treatment related to an intersex trait on a foster child unless:
55	55	(1) the procedure or treatment is medically necessary
56	56	for the physical health of the child and the child consents to the
57	57	procedure or treatment; or
58	58	(2) the procedure or treatment is not medically
59	59	necessary for the physical health of the child, the child consents
60	60	to the procedure or treatment, and a court authorizes the procedure
61	61	or treatment as provided under this subchapter.
62	62	Sec. 266.053. INFORMED CONSENT. (a) Consent to a medical
63	63	procedure or treatment related to an intersex trait is voluntary
64	64	and informed only if:
65	65	(1) the child and the child's caregivers are provided
66	66	with the information necessary for the child to provide voluntary
67	67	and informed consent to the procedure or treatment, including:
68	68	(A) the nature of the proposed procedure or
69	69	treatment, including whether and the extent to which the procedure
70	70	is irreversible;
71	71	(B) the goals of the procedure or treatment,
72	72	including whether the benefits of the proposed procedure or
73	73	treatment are medical, psychological, or social, and the strength
74	74	of the evidence supporting claims that the procedure provides each
75	75	of those benefits;
76	76	(C) the possible risks associated with the
77	77	procedure or treatment, including, if applicable, risk from
78	78	anesthesia, loss of reproductive capacity, and loss of sexual
79	79	function or sensation; and
80	80	(D) the alternatives to the proposed procedure or
81	81	treatment, including delay of the procedure or treatment;
82	82	(2) the child and the child's caregivers are evaluated
83	83	on at least two separate occasions by a mental health professional
84	84	with previous experience treating individuals with intersex traits
85	85	to ensure the child:
86	86	(A) does not have an undiagnosed mental health
87	87	condition; and
88	88	(B) has capacity to understand the procedure or
89	89	treatment and is providing voluntary and informed consent absent
90	90	coercion from family members or medical staff; and
91	91	(3) the consent is in writing and includes the
92	92	following statements:
93	93	(A) "I (name of child) certify that I understand
94	94	(reprint of Subdivisions (1)(A)-(D)) and consent to (description of
95	95	medical procedure or treatment) to be performed or provided by
96	96	(name of physician) on (date the medical procedure or treatment is
97	97	to be performed or provided on the child).";
98	98	(B) "I (name of physician performing the
99	99	procedure or providing the treatment) certify that I have discussed
100	100	with (name of child and names of child's caregivers) (reprint of
101	101	Subdivisions (1)(A)-(D)) on (date the information was provided).";
102	102	and
103	103	(C) "I (name of mental health professional)
104	104	certify that I have discussed with (name of child and names of
105	105	child's caregivers) (reprint of Subdivisions (1)(A)-(D)) on (date
106	106	the information was provided). It is my professional opinion that
107	107	(name of child) actively desires (name of procedure or treatment)
108	108	and is capable of providing informed consent."
109	109	(b) The child's physician shall retain the original consent
110	110	in the child's medical record and provide a copy of the consent to
111	111	the child and the child's caregivers.
112	112	Sec. 266.054. COURT APPROVAL OF CERTAIN MEDICAL PROCEDURES
113	113	OR TREATMENTS. (a) If the department wants an intersex child to
114	114	undergo a medical procedure or treatment related to an intersex
115	115	trait that is not medically necessary or the child wants to undergo
116	116	the procedure or treatment, the department or child may file a
117	117	petition with the court having continuing jurisdiction over the
118	118	intersex child seeking court approval of the procedure or
119	119	treatment.
120	120	(b) The court shall hold a hearing to determine whether the
121	121	proposed medical procedure or treatment related to an intersex
122	122	trait is in the child's best interest.
123	123	(c) The child must be represented by an attorney at the
124	124	hearing. The attorney for the child must:
125	125	(1) possess adequate knowledge of intersex traits, the
126	126	intersex population, and the range of medical procedures or
127	127	treatments that may be pursued in connection with the child's
128	128	intersex trait, including the option to delay any procedure or
129	129	treatment;
130	130	(2) communicate with the child, to the extent possible
131	131	given the child's age, regarding:
132	132	(A) the nature of the proposed medical procedure
133	133	or treatment;
134	134	(B) whether and the extent to which the proposed
135	135	medical procedure or treatment is irreversible; and
136	136	(C) the projected outcome of, the possible risks
137	137	associated with, and the alternatives, including delay, to the
138	138	proposed medical procedure or treatment;
139	139	(3) interview the child, to the extent possible given
140	140	the child's age, to determine the child's wishes regarding the
141	141	pursuit or delay of any proposed medical procedure or treatment;
142	142	(4) assist the child, to the extent possible given the
143	143	child's age, in assessing the child's desires related to the child's
144	144	medical care and in communicating the child's desires to the court;
145	145	and
146	146	(5) for a child younger than 12 years of age, argue
147	147	against a proposed medical procedure or treatment that is not
148	148	medically necessary.
149	149	(d) Any party to the suit may submit to the court a report or
150	150	introduce evidence from a qualified expert on:
151	151	(1) intersex traits and the intersex population in
152	152	general;
153	153	(2) the child's specific intersex traits;
154	154	(3) the range of medical procedures and treatments
155	155	that may be pursued in connection with the child's intersex traits,
156	156	including delay;
157	157	(4) the specific medical procedure or treatment
158	158	proposed for the child, including the risks and anticipated
159	159	benefits associated with the procedure or treatment and the
160	160	possibility that the child's ultimate gender identity may differ
161	161	from the sex assigned;
162	162	(5) whether and the extent to which the medical
163	163	procedure or treatment:
164	164	(A) is irreversible; and
165	165	(B) may safely be delayed until the child is of an
166	166	age to participate in the decision-making process;
167	167	(6) the physician's responsibilities to obtain
168	168	informed consent from the child and the child's parent or guardian
169	169	and whether those responsibilities have been adequately
170	170	discharged; and
171	171	(7) the public statements of intersex individuals or
172	172	patient advocates regarding Subdivisions (1)-(6).
173	173	(e) Following the hearing, the court shall determine
174	174	whether the proposed medical procedure or treatment related to an
175	175	intersex trait is in the child's best interest and render an order
176	176	with specific findings on:
177	177	(1) whether clear and convincing evidence establishes
178	178	that the short-term or long-term physical benefits of the proposed
179	179	medical procedure or treatment outweigh the short-term or long-term
180	180	physical risks;
181	181	(2) whether clear and convincing evidence establishes
182	182	that the short-term and long-term psychological benefits of the
183	183	proposed medical procedure or treatment outweigh the short-term or
184	184	long-term psychological risks;
185	185	(3) the extent to which the proposed medical procedure
186	186	or treatment would limit the child's future options for:
187	187	(A) fertility;
188	188	(B) development or construction of
189	189	female-typical characteristics;
190	190	(C) development or construction of male-typical
191	191	characteristics; and
192	192	(D) preservation of body characteristics
193	193	unaltered by decisions the child did not initiate; and
194	194	(4) whether clear and convincing evidence establishes
195	195	that any limitation identified under Subdivision (3) is justified
196	196	by an urgent need for the proposed medical procedure or treatment.
197	197	(f) If the requirements of Section 266.053 are satisfied,
198	198	the court may consider the child's consent to the proposed medical
199	199	procedure or treatment related to an intersex trait as clear and
200	200	convincing evidence for purposes of the court's best-interest
201	201	determination under Subsection (e).
202	202	Sec. 266.055. FOSTER CHILD'S CONSENT TO MEDICAL PROCEDURE
203	203	OR TREATMENT. Notwithstanding Section 32.003 or 266.004 or other
204	204	law, a foster child may consent to a medical procedure or treatment
205	205	related to an intersex trait if the child provides voluntary and
206	206	informed consent to the proposed medical procedure or treatment in
207	207	accordance with Section 266.053.
208	208	SECTION 3. This Act takes effect immediately if it receives
209	209	a vote of two-thirds of all the members elected to each house, as
210	210	provided by Section 39, Article III, Texas Constitution. If this
211	211	Act does not receive the vote necessary for immediate effect, this
212	212	Act takes effect September 1, 2019.