Bill Text: TX HB1071 | 2019-2020 | 86th Legislature | Introduced


Bill Title: Relating to an advance directive and do-not-resuscitate order of a pregnant woman and information provided for an advance directive.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Introduced) 2019-04-15 - Failed to receive affirmative vote in comm. [HB1071 Detail]

Download: Texas-2019-HB1071-Introduced.html
  86R1950 SCL-D
 
  By: Hinojosa H.B. No. 1071
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to an advance directive and do-not-resuscitate order of a
  pregnant woman and information provided for an advance directive.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  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
  three [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, and the Health Care
  Facility 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 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 I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
         In case of pregnancy:
         If I am pregnant, my decision concerning life-sustaining
  treatment is modified as follows:
 
________________________________________________________________
 
________________________________________________________________
 
________________________________________________________________
  (THIS SECTION IS OPTIONAL, IS ONLY FOR WOMEN OF CHILD-BEARING AGE,
  AND DOES NOT AFFECT THE VALIDITY OF THIS FORM IF LEFT BLANK.)
         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 nutrition and hydration, 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 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
  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 hydration. 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 2.  Section 166.049, Health and Safety Code, is
  amended to read as follows:
         Sec. 166.049.  PREGNANT WOMAN [PATIENTS]. A woman of
  child-bearing age may specify in an advance directive executed by
  the woman the effect the woman's pregnancy has on the advance
  directive [A person may not withdraw or withhold life-sustaining
  treatment under this subchapter from a pregnant patient].
         SECTION 3.  Section 166.083(b), Health and Safety Code, is
  amended to read as follows:
         (b)  The standard form of an out-of-hospital DNR order
  specified by department rule must, at a minimum, contain the
  following:
               (1)  a distinctive single-page format that readily
  identifies the document as an out-of-hospital DNR order;
               (2)  a title that readily identifies the document as an
  out-of-hospital DNR order;
               (3)  the printed or typed name of the person;
               (4)  a statement that the physician signing the
  document is the attending physician of the person and that the
  physician is directing health care professionals acting in
  out-of-hospital settings, including a hospital emergency
  department, not to initiate or continue certain life-sustaining
  treatment on behalf of the person, and a listing of those procedures
  not to be initiated or continued;
               (5)  a statement that the person understands that the
  person may revoke the out-of-hospital DNR order at any time by
  destroying the order and removing the DNR identification device, if
  any, or by communicating to health care professionals at the scene
  the person's desire to revoke the out-of-hospital DNR order;
               (6)  a statement that the person, if a woman of
  child-bearing age, may specify in the form the effect the woman's
  pregnancy has on the out-of-hospital DNR order;
               (7)  places for the printed names and signatures of the
  witnesses or the notary public's acknowledgment and for the printed
  name and signature of the attending physician of the person and the
  medical license number of the attending physician;
               (8) [(7)]  a separate section for execution of the
  document by the legal guardian of the person, the person's proxy, an
  agent of the person having a medical power of attorney, or the
  attending physician attesting to the issuance of an out-of-hospital
  DNR order by nonwritten means of communication or acting in
  accordance with a previously executed or previously issued
  directive to physicians under Section 166.082(c) that includes the
  following:
                     (A)  a statement that the legal guardian, the
  proxy, the agent, the person by nonwritten means of communication,
  or the physician directs that each listed life-sustaining treatment
  should not be initiated or continued in behalf of the person; and
                     (B)  places for the printed names and signatures
  of the witnesses and, as applicable, the legal guardian, proxy,
  agent, or physician;
               (9) [(8)]  a separate section for execution of the
  document by at least one qualified relative of the person when the
  person does not have a legal guardian, proxy, or agent having a
  medical power of attorney and is incompetent or otherwise mentally
  or physically incapable of communication, including:
                     (A)  a statement that the relative of the person
  is qualified to make a treatment decision to withhold
  cardiopulmonary resuscitation and certain other designated
  life-sustaining treatment under Section 166.088 and, based on the
  known desires of the person or a determination of the best interest
  of the person, directs that each listed life-sustaining treatment
  should not be initiated or continued in behalf of the person; and
                     (B)  places for the printed names and signatures
  of the witnesses and qualified relative of the person;
               (10) [(9)]  a place for entry of the date of execution
  of the document;
               (11) [(10)]  a statement that the document is in effect
  on the date of its execution and remains in effect until the death
  of the person or until the document is revoked;
               (12) [(11)]  a statement that the document must
  accompany the person during transport;
               (13) [(12)]  a statement regarding the proper
  disposition of the document or copies of the document, as the
  executive commissioner determines appropriate; and
               (14) [(13)]  a statement at the bottom of the document,
  with places for the signature of each person executing the
  document, that the document has been properly completed.
         SECTION 4.  Section 166.084(c), Health and Safety Code, is
  amended to read as follows:
         (c)  The attending physician and witnesses shall sign the
  out-of-hospital DNR order in the place of the document provided by
  Section 166.083(b)(8) [166.083(b)(7)] and the attending physician
  shall sign the document in the place required by Section
  166.083(b)(14) [166.083(b)(13)]. The physician shall make the fact
  of the existence of the out-of-hospital DNR order a part of the
  declarant's medical record and the names of the witnesses shall be
  entered in the medical record.
         SECTION 5.  Section 166.098, Health and Safety Code, is
  amended to read as follows:
         Sec. 166.098.  PREGNANT WOMAN [PERSONS]. A woman of
  child-bearing age may specify in an out-of-hospital DNR order
  executed by the woman the effect the woman's pregnancy has on the
  order [A person may not withhold cardiopulmonary resuscitation or
  certain other life-sustaining treatment designated by department
  rule under this subchapter from a person known by the responding
  health care professionals to be pregnant].
         SECTION 6.  This Act takes effect September 1, 2019.
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