Texas 2025 - 89th Regular

Texas House Bill HB1559 Compare Versions

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Old	New	Differences
1	1	89R5526 AMF-D
2	2	By: Hernandez H.B. No. 1559
3	3
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6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to prohibited nonconsensual medical procedures and
10	10	treatment on certain minors with intersex traits.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 266, Family Code, is amended by
13	13	designating Sections 266.001 through 266.013 as Subchapter A and
14	14	adding a subchapter heading to read as follows:
15	15	SUBCHAPTER A. GENERAL PROVISIONS; EDUCATIONAL SERVICES; MEDICAL
16	16	CARE
17	17	SECTION 2. Chapter 266, Family Code, is amended by adding
18	18	Subchapter B to read as follows:
19	19	SUBCHAPTER B. MEDICAL PROCEDURES AND TREATMENTS RELATED TO
20	20	INTERSEX TRAITS
21	21	Sec. 266.051. DEFINITIONS. In this subchapter:
22	22	(1) "Intersex trait" means an inborn chromosomal,
23	23	gonadal, genital, or endocrine characteristic, or a combination of
24	24	those characteristics, that is not suited to the typical definition
25	25	of male or female or is atypical for the sex assigned to an
26	26	individual.
27	27	(2) "Medical procedure or treatment related to an
28	28	intersex trait" includes:
29	29	(A) hormonal treatment to treat or modify an
30	30	intersex trait; or
31	31	(B) genital surgery, including:
32	32	(i) clitorectomy, clitoroplasty, clitoral
33	33	reduction, and clitoral recession, including corporal-sparing
34	34	procedures;
35	35	(ii) vaginoplasty, introitoplasty, vaginal
36	36	exteriorization, and partial or total urogenital sinus
37	37	mobilization;
38	38	(iii) labiaplasty and labial reduction;
39	39	(iv) hypospadias surgery, relocation of the
40	40	urethral meatus, and chordee release;
41	41	(v) phalloplasty; and
42	42	(vi) gonadectomy, including of testes,
43	43	ovaries, ovotestes, or streak gonads.
44	44	(3) "Medically necessary" means a medical procedure or
45	45	treatment immediately necessary to treat an injury, illness,
46	46	disease, or condition affecting a child's health that if delayed
47	47	would adversely affect the child's physical health.
48	48	Sec. 266.052. REQUIREMENTS FOR CERTAIN MEDICAL PROCEDURES
49	49	OR TREATMENTS. A physician may not perform a medical procedure or
50	50	treatment related to an intersex trait on a foster child unless:
51	51	(1) the procedure or treatment is medically necessary
52	52	and the child consents to the procedure or treatment; or
53	53	(2) for a procedure or treatment that is not medically
54	54	necessary, the child consents to the procedure or treatment and a
55	55	court authorizes the procedure or treatment as provided under this
56	56	subchapter.
57	57	Sec. 266.053. INFORMED CONSENT. (a) Consent to a medical
58	58	procedure or treatment related to an intersex trait is voluntary
59	59	and informed only if:
60	60	(1) the physician provides to the child and the child's
61	61	caregivers the information necessary for the child to provide
62	62	voluntary and informed consent to the procedure or treatment,
63	63	including:
64	64	(A) the nature of the proposed procedure or
65	65	treatment, including whether and the extent to which the procedure
66	66	is irreversible;
67	67	(B) the goals of the procedure or treatment,
68	68	including whether the benefits of the proposed procedure or
69	69	treatment are medical, psychological, or social, and the strength
70	70	of the evidence supporting claims that the procedure provides each
71	71	of those benefits;
72	72	(C) the possible risks associated with the
73	73	procedure or treatment, including, if applicable, risk from
74	74	anesthesia, loss of reproductive capacity, and loss of sexual
75	75	function or sensation; and
76	76	(D) the alternatives to the proposed procedure or
77	77	treatment, including delay of the procedure or treatment;
78	78	(2) on at least two separate occasions a mental health
79	79	professional with previous experience treating individuals with
80	80	intersex traits evaluates the child and the child's caregivers to
81	81	ensure the child has capacity to understand the procedure or
82	82	treatment and is providing voluntary and informed consent absent
83	83	coercion from family members or medical staff; and
84	84	(3) the consent is in writing and includes the
85	85	following statements:
86	86	(A) "I (name of child) certify that I understand
87	87	(reprint of Subdivisions (1)(A)-(D)) and consent to (description of
88	88	medical procedure or treatment) to be performed or provided by
89	89	(name of physician) on (date the medical procedure or treatment is
90	90	scheduled to be performed or provided on the child).";
91	91	(B) "I (name of physician performing the
92	92	procedure or providing the treatment) certify that I have discussed
93	93	with (name of child and names of child's caregivers) (reprint of
94	94	Subdivisions (1)(A)-(D)) on (date the information was provided).";
95	95	and
96	96	(C) "I (name of mental health professional)
97	97	certify that I have discussed with (name of child and names of
98	98	child's caregivers) (reprint of Subdivisions (1)(A)-(D)) on (date
99	99	the information was provided). It is my professional opinion that
100	100	(name of child) actively desires (name of procedure or treatment)
101	101	and is capable of providing informed consent."
102	102	(b) The child's physician shall retain the original consent
103	103	in the child's medical record and provide a copy of the consent to
104	104	the child and the child's caregivers.
105	105	Sec. 266.054. COURT APPROVAL OF CERTAIN MEDICAL PROCEDURES
106	106	OR TREATMENTS. (a) If the department determines a foster child
107	107	should undergo a medical procedure or treatment related to an
108	108	intersex trait that is not medically necessary or the child wants to
109	109	undergo the procedure or treatment, the department or child may
110	110	file a petition with the court having continuing jurisdiction over
111	111	the child seeking court approval for the procedure or treatment.
112	112	(b) The court shall hold a hearing to determine whether the
113	113	proposed medical procedure or treatment related to an intersex
114	114	trait is in the child's best interest.
115	115	(c) The child must be represented by an attorney at the
116	116	hearing. The attorney for the child must:
117	117	(1) possess adequate knowledge of intersex traits, the
118	118	intersex population, and the range of medical procedures or
119	119	treatments available to treat the child's intersex trait, including
120	120	the option to delay any procedure or treatment;
121	121	(2) communicate with the child, to the extent possible
122	122	given the child's age, regarding:
123	123	(A) the nature of the proposed medical procedure
124	124	or treatment;
125	125	(B) whether and the extent to which the proposed
126	126	medical procedure or treatment is irreversible; and
127	127	(C) the projected outcome of, the possible risks
128	128	associated with, and the alternatives, including delay, to the
129	129	proposed medical procedure or treatment;
130	130	(3) interview the child, to the extent possible given
131	131	the child's age, to determine the child's wishes regarding the
132	132	pursuit or delay of any proposed medical procedure or treatment;
133	133	(4) assist the child, to the extent possible given the
134	134	child's age, in assessing the child's desires related to the child's
135	135	medical care and in communicating the child's desires to the court;
136	136	and
137	137	(5) for a child younger than 12 years of age who has
138	138	not been appointed a separate guardian ad litem, argue against a
139	139	proposed medical procedure or treatment that is not medically
140	140	necessary.
141	141	(d) If a guardian ad litem has been appointed for a child
142	142	younger than 12 years of age, the guardian ad litem must argue
143	143	against a proposed medical procedure or treatment that is not
144	144	medically necessary at the hearing.
145	145	(e) Any party to the suit may submit to the court a report or
146	146	introduce evidence from a qualified expert on:
147	147	(1) intersex traits and the intersex population in
148	148	general;
149	149	(2) the child's specific intersex traits;
150	150	(3) the range of medical procedures and treatments
151	151	available to treat the child's intersex traits, including delay;
152	152	(4) the specific medical procedure or treatment
153	153	proposed for the child, including the risks and anticipated
154	154	benefits associated with the procedure or treatment and the
155	155	possibility that the child's ultimate gender identity may differ
156	156	from the sex assigned;
157	157	(5) whether and the extent to which the medical
158	158	procedure or treatment:
159	159	(A) is irreversible; and
160	160	(B) may safely be delayed until the child is of an
161	161	age to participate in the decision-making process;
162	162	(6) the physician's duty to obtain informed consent
163	163	from the child and whether the duty has been adequately discharged;
164	164	and
165	165	(7) the public statements of intersex individuals or
166	166	patient advocates regarding Subdivisions (1)-(6).
167	167	(f) Following the hearing, the court shall determine
168	168	whether the proposed medical procedure or treatment related to an
169	169	intersex trait is in the child's best interest and render an order
170	170	with specific findings on:
171	171	(1) whether clear and convincing evidence establishes
172	172	that the short-term or long-term physical benefits of the proposed
173	173	medical procedure or treatment outweigh the short-term or long-term
174	174	physical risks;
175	175	(2) whether clear and convincing evidence establishes
176	176	that the short-term and long-term psychological benefits of the
177	177	proposed medical procedure or treatment outweigh the short-term or
178	178	long-term psychological risks;
179	179	(3) the extent to which the proposed medical procedure
180	180	or treatment would limit the child's future options for:
181	181	(A) fertility;
182	182	(B) development or construction of
183	183	female-typical characteristics;
184	184	(C) development or construction of male-typical
185	185	characteristics; and
186	186	(D) preservation of body characteristics
187	187	unaltered by decisions the child did not initiate; and
188	188	(4) whether clear and convincing evidence establishes
189	189	that any limitation identified under Subdivision (3) is justified
190	190	by an urgent need for the proposed medical procedure or treatment.
191	191	(g) If the requirements of Section 266.053 are satisfied,
192	192	the court may consider the child's consent to the proposed medical
193	193	procedure or treatment related to an intersex trait as clear and
194	194	convincing evidence for purposes of the court's best-interest
195	195	determination under Subsection (f).
196	196	Sec. 266.055. FOSTER CHILD'S CONSENT TO MEDICAL PROCEDURE
197	197	OR TREATMENT. Notwithstanding Section 32.003 or 266.004 or other
198	198	law, a foster child may consent to a medical procedure or treatment
199	199	related to an intersex trait if the child provides voluntary and
200	200	informed consent to the proposed medical procedure or treatment in
201	201	accordance with Section 266.053.
202	202	SECTION 3. This Act takes effect immediately if it receives
203	203	a vote of two-thirds of all the members elected to each house, as
204	204	provided by Section 39, Article III, Texas Constitution. If this
205	205	Act does not receive the vote necessary for immediate effect, this
206	206	Act takes effect September 1, 2025.