HB1161 - Relating to an advance directive and do-not-resuscitate order of a pregnant woman and information provided for an advance directive.

  89R4384 LRM-D     By: Hinojosa H.B. No. 1161       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.)           Pregnancy directive:           If I am pregnant, my decision concerning life-sustaining   treatment is modified as follows:   ________________________________________________________________   ________________________________________________________________   ________________________________________________________________   (THIS SECTION IS OPTIONAL, IS COMPLETED ONLY FOR A PERSON 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 PERSONS [ PATIENTS ]. A person of   child-bearing age that executes an advance directive may specify in   the advance directive the effect the person'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 if the person is of child-bearing   age, the person may specify in the form the effect the person's   pregnancy has on the out-of-hospital DNR order;                 (7)   places for the printed names and signatures of the [Text truncated for display. Full text available on Congress.gov.]