Texas 2023 - 88th Regular

Texas Senate Bill SB2465 Compare Versions

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1	1	88R3544 LRM-D
2	2	By: Eckhardt S.B. No. 2465
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	Pregnancy directive:
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 COMPLETED ONLY FOR A PERSON OF
77	77	CHILD-BEARING AGE, AND DOES NOT AFFECT THE VALIDITY OF THIS FORM IF
78	78	LEFT BLANK.)
79	79	Additional requests: (After discussion with your physician,
80	80	you may wish to consider listing particular treatments in this
81	81	space that you do or do not want in specific circumstances, such as
82	82	artificially administered nutrition and hydration, intravenous
83	83	antibiotics, etc. Be sure to state whether you do or do not want the
84	84	particular treatment.)
85	85	After signing this directive, if my representative or I elect
86	86	hospice care, I understand and agree that only those treatments
87	87	needed to keep me comfortable would be provided and I would not be
88	88	given available life-sustaining treatments.
89	89	If I do not have a Medical Power of Attorney, and I am unable
90	90	to make my wishes known, I designate the following person(s) to make
91	91	health care or treatment decisions with my physician compatible
92	92	with my personal values:
93	93	1. __________
94	94	2. __________
95	95	(If a Medical Power of Attorney has been executed, then an
96	96	agent already has been named and you should not list additional
97	97	names in this document.)
98	98	If the above persons are not available, or if I have not
99	99	designated a spokesperson, I understand that a spokesperson will be
100	100	chosen for me following standards specified in the laws of Texas.
101	101	If, in the judgment of my physician, my death is imminent within
102	102	minutes to hours, even with the use of all available medical
103	103	treatment provided within the prevailing standard of care, I
104	104	acknowledge that all treatments may be withheld or removed except
105	105	those needed to maintain my comfort. [I understand that under Texas
106	106	law this directive has no effect if I have been diagnosed as
107	107	pregnant.] This directive will remain in effect until I revoke it.
108	108	No other person may do so.
109	109	Signed__________ Date__________ City, County, State of
110	110	Residence __________
111	111	Two competent adult witnesses must sign below, acknowledging
112	112	the signature of the declarant. The witness designated as Witness 1
113	113	may not be a person designated to make a health care or treatment
114	114	decision for the patient and may not be related to the patient by
115	115	blood or marriage. This witness may not be entitled to any part of
116	116	the estate and may not have a claim against the estate of the
117	117	patient. This witness may not be the attending physician or an
118	118	employee of the attending physician. If this witness is an employee
119	119	of a health care facility in which the patient is being cared for,
120	120	this witness may not be involved in providing direct patient care to
121	121	the patient. This witness may not be an officer, director, partner,
122	122	or business office employee of a health care facility in which the
123	123	patient is being cared for or of any parent organization of the
124	124	health care facility.
125	125	Witness 1 __________ Witness 2 __________
126	126	Definitions:
127	127	"Artificially administered nutrition and hydration" means
128	128	the provision of nutrients or fluids by a tube inserted in a vein,
129	129	under the skin in the subcutaneous tissues, or in the
130	130	gastrointestinal tract.
131	131	"Irreversible condition" means a condition, injury, or
132	132	illness:
133	133	(1) that may be treated, but is never cured or
134	134	eliminated;
135	135	(2) that leaves a person unable to care for or make
136	136	decisions for the person's own self; and
137	137	(3) that, without life-sustaining treatment provided
138	138	in accordance with the prevailing standard of medical care, is
139	139	fatal.
140	140	Explanation: Many serious illnesses such as cancer, failure
141	141	of major organs (kidney, heart, liver, or lung), and serious brain
142	142	disease such as Alzheimer's dementia may be considered irreversible
143	143	early on. There is no cure, but the patient may be kept alive for
144	144	prolonged periods of time if the patient receives life-sustaining
145	145	treatments. Late in the course of the same illness, the disease may
146	146	be considered terminal when, even with treatment, the patient is
147	147	expected to die. You may wish to consider which burdens of
148	148	treatment you would be willing to accept in an effort to achieve a
149	149	particular outcome. This is a very personal decision that you may
150	150	wish to discuss with your physician, family, or other important
151	151	persons in your life.
152	152	"Life-sustaining treatment" means treatment that, based on
153	153	reasonable medical judgment, sustains the life of a patient and
154	154	without which the patient will die. The term includes both
155	155	life-sustaining medications and artificial life support such as
156	156	mechanical breathing machines, kidney dialysis treatment, and
157	157	artificially administered nutrition and hydration. The term does
158	158	not include the administration of pain management medication, the
159	159	performance of a medical procedure necessary to provide comfort
160	160	care, or any other medical care provided to alleviate a patient's
161	161	pain.
162	162	"Terminal condition" means an incurable condition caused by
163	163	injury, disease, or illness that according to reasonable medical
164	164	judgment will produce death within six months, even with available
165	165	life-sustaining treatment provided in accordance with the
166	166	prevailing standard of medical care.
167	167	Explanation: Many serious illnesses may be considered
168	168	irreversible early in the course of the illness, but they may not be
169	169	considered terminal until the disease is fairly advanced. In
170	170	thinking about terminal illness and its treatment, you again may
171	171	wish to consider the relative benefits and burdens of treatment and
172	172	discuss your wishes with your physician, family, or other important
173	173	persons in your life.
174	174	SECTION 2. Section 166.049, Health and Safety Code, is
175	175	amended to read as follows:
176	176	Sec. 166.049. PREGNANT PERSONS [PATIENTS]. A person of
177	177	child-bearing age may specify in an advance directive the person
178	178	executes the effect the person's pregnancy has on the advance
179	179	directive [A person may not withdraw or withhold life-sustaining
180	180	treatment under this subchapter from a pregnant patient].
181	181	SECTION 3. Section 166.083(b), Health and Safety Code, is
182	182	amended to read as follows:
183	183	(b) The standard form of an out-of-hospital DNR order
184	184	specified by department rule must, at a minimum, contain the
185	185	following:
186	186	(1) a distinctive single-page format that readily
187	187	identifies the document as an out-of-hospital DNR order;
188	188	(2) a title that readily identifies the document as an
189	189	out-of-hospital DNR order;
190	190	(3) the printed or typed name of the person;
191	191	(4) a statement that the physician signing the
192	192	document is the attending physician of the person and that the
193	193	physician is directing health care professionals acting in
194	194	out-of-hospital settings, including a hospital emergency
195	195	department, not to initiate or continue certain life-sustaining
196	196	treatment on behalf of the person, and a listing of those procedures
197	197	not to be initiated or continued;
198	198	(5) a statement that the person understands that the
199	199	person may revoke the out-of-hospital DNR order at any time by
200	200	destroying the order and removing the DNR identification device, if
201	201	any, or by communicating to health care professionals at the scene
202	202	the person's desire to revoke the out-of-hospital DNR order;
203	203	(6) a statement that if the person is of child-bearing
204	204	age, the person may specify in the form the effect the person's
205	205	pregnancy has on the out-of-hospital DNR order;
206	206	(7) places for the printed names and signatures of the
207	207	witnesses or the notary public's acknowledgment and for the printed
208	208	name and signature of the attending physician of the person and the
209	209	medical license number of the attending physician;
210	210	(8) [(7)] a separate section for execution of the
211	211	document by the legal guardian of the person, the person's proxy, an
212	212	agent of the person having a medical power of attorney, or the
213	213	attending physician attesting to the issuance of an out-of-hospital
214	214	DNR order by nonwritten means of communication or acting in
215	215	accordance with a previously executed or previously issued
216	216	directive to physicians under Section 166.082(c) that includes the
217	217	following:
218	218	(A) a statement that the legal guardian, the
219	219	proxy, the agent, the person by nonwritten means of communication,
220	220	or the physician directs that each listed life-sustaining treatment
221	221	should not be initiated or continued in behalf of the person; and
222	222	(B) places for the printed names and signatures
223	223	of the witnesses and, as applicable, the legal guardian, proxy,
224	224	agent, or physician;
225	225	(9) [(8)] a separate section for execution of the
226	226	document by at least one qualified relative of the person when the
227	227	person does not have a legal guardian, proxy, or agent having a
228	228	medical power of attorney and is incompetent or otherwise mentally
229	229	or physically incapable of communication, including:
230	230	(A) a statement that the relative of the person
231	231	is qualified to make a treatment decision to withhold
232	232	cardiopulmonary resuscitation and certain other designated
233	233	life-sustaining treatment under Section 166.088 and, based on the
234	234	known desires of the person or a determination of the best interest
235	235	of the person, directs that each listed life-sustaining treatment
236	236	should not be initiated or continued in behalf of the person; and
237	237	(B) places for the printed names and signatures
238	238	of the witnesses and qualified relative of the person;
239	239	(10) [(9)] a place for entry of the date of execution
240	240	of the document;
241	241	(11) [(10)] a statement that the document is in effect
242	242	on the date of its execution and remains in effect until the death
243	243	of the person or until the document is revoked;
244	244	(12) [(11)] a statement that the document must
245	245	accompany the person during transport;
246	246	(13) [(12)] a statement regarding the proper
247	247	disposition of the document or copies of the document, as the
248	248	executive commissioner determines appropriate; and
249	249	(14) [(13)] a statement at the bottom of the document,
250	250	with places for the signature of each person executing the
251	251	document, that the document has been properly completed.
252	252	SECTION 4. Section 166.084(c), Health and Safety Code, is
253	253	amended to read as follows:
254	254	(c) The attending physician and witnesses shall sign the
255	255	out-of-hospital DNR order in the place of the document provided by
256	256	Section 166.083(b)(8) [166.083(b)(7)] and the attending physician
257	257	shall sign the document in the place required by Section
258	258	166.083(b)(14) [166.083(b)(13)]. The physician shall make the fact
259	259	of the existence of the out-of-hospital DNR order a part of the
260	260	declarant's medical record and the names of the witnesses shall be
261	261	entered in the medical record.
262	262	SECTION 5. Section 166.098, Health and Safety Code, is
263	263	amended to read as follows:
264	264	Sec. 166.098. PREGNANT PERSONS. A person of child-bearing
265	265	age may specify in an out-of-hospital DNR order executed by the
266	266	person the effect the person's pregnancy has on the order [A person
267	267	may not withhold cardiopulmonary resuscitation or certain other
268	268	life-sustaining treatment designated by department rule under this
269	269	subchapter from a person known by the responding health care
270	270	professionals to be pregnant].
271	271	SECTION 6. This Act takes effect September 1, 2023.
272	272
273	273	__________ 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
274	274
275	275	__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
276	276
277	277	__________ 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
278	278
279	279	__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
280	280
281	281	________________________________________________________________
282	282
283	283	________________________________________________________________
284	284
285	285	________________________________________________________________