88R6321 AMF-D
 
  By: Hernandez H.B. No. 1746
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to prohibited nonconsensual medical procedures and
  treatment on certain minors with intersex traits.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 266, Family Code, is amended by
  designating Sections 266.001 through 266.013 as Subchapter A and
  adding a subchapter heading to read as follows:
  SUBCHAPTER A. GENERAL PROVISIONS; EDUCATIONAL SERVICES; MEDICAL
  CARE
         SECTION 2.  Chapter 266, Family Code, is amended by adding
  Subchapter B to read as follows:
  SUBCHAPTER B. MEDICAL PROCEDURES AND TREATMENTS RELATED TO
  INTERSEX TRAITS
         Sec. 266.051.  DEFINITIONS. In this subchapter:
               (1)  "Intersex trait" means an inborn chromosomal,
  gonadal, genital, or endocrine characteristic, or a combination of
  those characteristics, that is not suited to the typical definition
  of male or female or is atypical for the sex assigned to an
  individual.
               (2)  "Medical procedure or treatment related to an
  intersex trait" includes:
                     (A)  hormonal treatment to treat or modify an
  intersex trait; or
                     (B)  genital surgery, including:
                           (i)  clitorectomy, clitoroplasty, clitoral
  reduction, and clitoral recession, including corporal-sparing
  procedures;
                           (ii)  vaginoplasty, introitoplasty, vaginal
  exteriorization, and partial or total urogenital sinus
  mobilization;
                           (iii)  labiaplasty and labial reduction;
                           (iv)  hypospadias surgery, relocation of the
  urethral meatus, and chordee release;
                           (v)  phalloplasty; and
                           (vi)  gonadectomy, including of testes,
  ovaries, ovotestes, or streak gonads.
               (3)  "Medically necessary" means a medical procedure or
  treatment immediately necessary to treat an injury, illness,
  disease, or condition affecting a child's health that if delayed
  would adversely affect the child's physical health.
         Sec. 266.052.  REQUIREMENTS FOR CERTAIN MEDICAL PROCEDURES
  OR TREATMENTS. A physician may not perform a medical procedure or
  treatment related to an intersex trait on a foster child unless:
               (1)  the procedure or treatment is medically necessary
  and the child consents to the procedure or treatment; or
               (2)  for a procedure or treatment that is not medically
  necessary, the child consents to the procedure or treatment and a
  court authorizes the procedure or treatment as provided under this
  subchapter.
         Sec. 266.053.  INFORMED CONSENT. (a) Consent to a medical
  procedure or treatment related to an intersex trait is voluntary
  and informed only if:
               (1)  the physician provides to the child and the child's
  caregivers the information necessary for the child to provide
  voluntary and informed consent to the procedure or treatment,
  including:
                     (A)  the nature of the proposed procedure or
  treatment, including whether and the extent to which the procedure
  is irreversible;
                     (B)  the goals of the procedure or treatment,
  including whether the benefits of the proposed procedure or
  treatment are medical, psychological, or social, and the strength
  of the evidence supporting claims that the procedure provides each
  of those benefits;
                     (C)  the possible risks associated with the
  procedure or treatment, including, if applicable, risk from
  anesthesia, loss of reproductive capacity, and loss of sexual
  function or sensation; and
                     (D)  the alternatives to the proposed procedure or
  treatment, including delay of the procedure or treatment;
               (2)  on at least two separate occasions a mental health
  professional with previous experience treating individuals with
  intersex traits evaluates the child and the child's caregivers to
  ensure the child has capacity to understand the procedure or
  treatment and is providing voluntary and informed consent absent
  coercion from family members or medical staff; and
               (3)  the consent is in writing and includes the
  following statements:
                     (A)  "I (name of child) certify that I understand
  (reprint of Subdivisions (1)(A)-(D)) and consent to (description of
  medical procedure or treatment) to be performed or provided by
  (name of physician) on (date the medical procedure or treatment is
  scheduled to be performed or provided on the child).";
                     (B)  "I (name of physician performing the
  procedure or providing the treatment) certify that I have discussed
  with (name of child and names of child's caregivers) (reprint of
  Subdivisions (1)(A)-(D)) on (date the information was provided).";
  and
                     (C)  "I (name of mental health professional)
  certify that I have discussed with (name of child and names of
  child's caregivers) (reprint of Subdivisions (1)(A)-(D)) on (date
  the information was provided).  It is my professional opinion that
  (name of child) actively desires (name of procedure or treatment)
  and is capable of providing informed consent."
         (b)  The child's physician shall retain the original consent
  in the child's medical record and provide a copy of the consent to
  the child and the child's caregivers.
         Sec. 266.054.  COURT APPROVAL OF CERTAIN MEDICAL PROCEDURES
  OR TREATMENTS. (a) If the department determines a foster child
  should undergo a medical procedure or treatment related to an
  intersex trait that is not medically necessary or the child wants to
  undergo the procedure or treatment, the department or child may
  file a petition with the court having continuing jurisdiction over
  the child seeking court approval for the procedure or treatment.
         (b)  The court shall hold a hearing to determine whether the
  proposed medical procedure or treatment related to an intersex
  trait is in the child's best interest.
         (c)  The child must be represented by an attorney at the
  hearing. The attorney for the child must:
               (1)  possess adequate knowledge of intersex traits, the
  intersex population, and the range of medical procedures or
  treatments available to treat the child's intersex trait, including
  the option to delay any procedure or treatment;
               (2)  communicate with the child, to the extent possible
  given the child's age, regarding:
                     (A)  the nature of the proposed medical procedure
  or treatment;
                     (B)  whether and the extent to which the proposed
  medical procedure or treatment is irreversible; and
                     (C)  the projected outcome of, the possible risks
  associated with, and the alternatives, including delay, to the
  proposed medical procedure or treatment;
               (3)  interview the child, to the extent possible given
  the child's age, to determine the child's wishes regarding the
  pursuit or delay of any proposed medical procedure or treatment;
               (4)  assist the child, to the extent possible given the
  child's age, in assessing the child's desires related to the child's
  medical care and in communicating the child's desires to the court;
  and
               (5)  for a child younger than 12 years of age who has
  not been appointed a separate guardian ad litem, argue against a
  proposed medical procedure or treatment that is not medically
  necessary.
         (d)  If a guardian ad litem has been appointed for a child
  younger than 12 years of age, the guardian ad litem must argue
  against a proposed medical procedure or treatment that is not
  medically necessary at the hearing.
         (e)  Any party to the suit may submit to the court a report or
  introduce evidence from a qualified expert on:
               (1)  intersex traits and the intersex population in
  general;
               (2)  the child's specific intersex traits;
               (3)  the range of medical procedures and treatments
  available to treat the child's intersex traits, including delay;
               (4)  the specific medical procedure or treatment
  proposed for the child, including the risks and anticipated
  benefits associated with the procedure or treatment and the
  possibility that the child's ultimate gender identity may differ
  from the sex assigned;
               (5)  whether and the extent to which the medical
  procedure or treatment:
                     (A)  is irreversible; and
                     (B)  may safely be delayed until the child is of an
  age to participate in the decision-making process;
               (6)  the physician's duty to obtain informed consent
  from the child and whether the duty has been adequately discharged;
  and
               (7)  the public statements of intersex individuals or
  patient advocates regarding Subdivisions (1)-(6).
         (f)  Following the hearing, the court shall determine
  whether the proposed medical procedure or treatment related to an
  intersex trait is in the child's best interest and render an order
  with specific findings on:
               (1)  whether clear and convincing evidence establishes
  that the short-term or long-term physical benefits of the proposed
  medical procedure or treatment outweigh the short-term or long-term
  physical risks;
               (2)  whether clear and convincing evidence establishes
  that the short-term and long-term psychological benefits of the
  proposed medical procedure or treatment outweigh the short-term or
  long-term psychological risks;
               (3)  the extent to which the proposed medical procedure
  or treatment would limit the child's future options for:
                     (A)  fertility;
                     (B)  development or construction of
  female-typical characteristics;
                     (C)  development or construction of male-typical
  characteristics; and
                     (D)  preservation of body characteristics
  unaltered by decisions the child did not initiate; and
               (4)  whether clear and convincing evidence establishes
  that any limitation identified under Subdivision (3) is justified
  by an urgent need for the proposed medical procedure or treatment.
         (g)  If the requirements of Section 266.053 are satisfied,
  the court may consider the child's consent to the proposed medical
  procedure or treatment related to an intersex trait as clear and
  convincing evidence for purposes of the court's best-interest
  determination under Subsection (f).
         Sec. 266.055.  FOSTER CHILD'S CONSENT TO MEDICAL PROCEDURE
  OR TREATMENT. Notwithstanding Section 32.003 or 266.004 or other
  law, a foster child may consent to a medical procedure or treatment
  related to an intersex trait if the child provides voluntary and
  informed consent to the proposed medical procedure or treatment in
  accordance with Section 266.053.
         SECTION 3.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2023.