bill lets pregnancy stop voiding advance directives

The text as introduced · 2,373 words

89R4384 LRM-D

By: Eckhardt, et al.
S.B. No. 360

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

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 PERSONS. A person of child-bearing

age may specify in an out-of-hospital DNR order executed by the

person the effect the person'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, 2025.