By Hirschi H.B. No. 1907
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the rights of citizens to be allowed to die by natural
1-3 means.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 672.001, Health and Safety Code, is
1-6 amended to read as follows:
1-7 Sec. 672.001. SHORT TITLE; PURPOSES. (a) This chapter may
1-8 be cited as the Texas Natural Death Act.
1-9 (b) This Act recognizes the right of individuals to make
1-10 decisions regarding their medical care, including the right to
1-11 request or refuse the application of life-sustaining procedures in
1-12 the event of a terminal condition, as defined in the Act.
1-13 SECTION 2. Section 672.002, Health and Safety Code, as
1-14 amended by S.B. 404, Acts of the 72nd Legislature, Regular Session,
1-15 1991, is amended by amending Subdivisions (6) and (9) and by adding
1-16 Subdivisions (10) and(11) to read as follows:
1-17 Sec. 672.002. Definitions. In this chapter:
1-18 (6) "Life-sustaining procedure" means a medical
1-19 procedure or intervention which <that> uses mechanical or other
1-20 artificial means to sustain, restore, or supplant a vital function,
1-21 and which, when applied to a qualified patient, would serve <and>
1-22 only to artificially postpone <postpones> the moment of death,
1-23 when, as noted in the qualified patient's medical records, in the
2-1 judgment of the attending physician, <of a patient in a terminal
2-2 condition whose> death is imminent whether or not such procedures
2-3 are utilized or will result within a relatively short time without
2-4 the application of the procedure. "Life-sustaining procedure"
2-5 shall <The term does> not include the administration of medication
2-6 or the performance of any <a> medical procedure deemed <considered
2-7 to be> necessary to provide comfort or care or <to> alleviate pain.
2-8 "Life-sustaining procedure" includes the administration of
2-9 nutrition and hydration to the patient by mechanical or artificial
2-10 means when, in the judgment of the attending physician, such
2-11 administration is for the purpose of sustaining, supplanting or
2-12 restoring a vital function.
2-13 (9) "Terminal condition" means an incurable or
2-14 irreversible condition caused by injury, disease, or illness that
2-15 <would produce death> without the application of life-sustaining
2-16 procedures, would, within <according to> reasonable medical
2-17 judgment, produce death, and in which the application of
2-18 life-sustaining procedures serves only to postpone the moment of
2-19 death of the patient <patient's death>. The term "terminal
2-20 condition" includes conditions referred to as a permanent
2-21 unconsciousness and persistent vegatative state.
2-22 (10) "Nutrition and hydration" is defined as the
2-23 artificial or mechanical means of supplying food and water through
2-24 a tub or intravenous line, including but not limited to nasogastric
2-25 tubes, gastrostomies, and intravenous infusions. Nutrition and
3-1 hydration by artificial or mechanical means does not include
3-2 assisted feeding such as spoon or bottle feeding.
3-3 (11) "Directly involved in the financial affairs of
3-4 the health facility" means serving as an officer, director,
3-5 partner, or business office employee of the health facility or of
3-6 any parent organization thereof.
3-7 SECTION 3. Section 672.003, Health and Safety Code, as
3-8 amended by S.B. 404, Acts of the 72nd Legislature, Regular Session,
3-9 1991, is amended by amending Subsections (a) and (c) and by adding
3-10 Subsection (f) to read as follows:
3-11 (a) Any <A> competent adult may at any time execute a
3-12 written directive for the withholding or withdrawal of
3-13 life-sustaining procedures in the event of a terminal condition.
3-14 (c) A witness shall <may> not be:
3-15 (1) related to the declarant by blood or marriage;
3-16 (2) entitled to any portion <part> of the declarant's
3-17 estate after the declarant's death under a will or codicil executed
3-18 by the declarant or by operation of law;
3-19 (3) the attending physician;
3-20 (4) an employee of the attending physician;
3-21 (5) an employee of a health care facility in which the
3-22 declarant is a patient if the employee is providing direct patient
3-23 care to the declarant or is directly involved in the financial
3-24 affairs of the facility;
3-25 (6) a patient in a health care facility in which the
4-1 declarant is a patient; or
4-2 (7) any <a> person who<, at the time the directive is
4-3 executed,> has a claim against any portion <part> of the
4-4 <declarant's> estate of <after> the declarant on his decease at the
4-5 time of the execution of the directive <declarant's death>.
4-6 (f) A directive made under this section, including the
4-7 signature of the declarant and the signatures of the witnesses,
4-8 need not be executed before a notary public in order to be legally
4-9 effective, although a directive executed before a notary public is
4-10 legally effective. However, a physician, health care facility,
4-11 health provider, or health care service plan may not require a
4-12 declarant to execute or reexecute a written directive to physicians
4-13 before a notary public before withholding or withdrawing
4-14 life-sustaining procedures from a qualified patient.
4-15 SECTION 4. Section 672.004, Health and Safety Code, as
4-16 amended by S.B. 404, Acts of the 72nd Legislature, Regular Session,
4-17 1991, is amended to read as follows:
4-18 Sec. 672.004. Form of Written Directive. A written
4-19 directive may be in the following form:
4-20 "DIRECTIVE TO PHYSICIANS
4-21 "Directive made this __________ day of __________, (month,
4-22 year).
4-23 "I __________, being of sound mind, wilfully and voluntarily
4-24 make known my desire that my life shall not be artificially
4-25 prolonged under the circumstances set forth in this directive and
5-1 do hereby declare: <.>
5-2 "1. If at any time I should have an incurable or irreversible
5-3 condition caused by injury, disease, or illness certified to be a
5-4 terminal condition by two physicians, and if the application of
5-5 life-sustaining procedures would serve only to artificially
5-6 postpone the moment of my death, and if my attending physician
5-7 determines that my death is imminent or will result within a
5-8 relatively short time without the application of life-sustaining
5-9 procedures, I direct that such <those> procedures be withheld or
5-10 withdrawn, and that I be permitted to die naturally.
5-11 "2. In the absence of my ability to give directions regarding
5-12 the use of those life-sustaining procedures, it is my intention
5-13 that this directive be honored by my family and physicians as the
5-14 final expression of my legal right to refuse medical or surgical
5-15 treatment and accept the consequences from that refusal.
5-16 "3. If I have been diagnosed as pregnant and that diagnosis
5-17 is known to my physician, this directive has no effect during my
5-18 pregnancy.
5-19 "4. Other directions:__________________________
5-20 _________________________.
5-21 "5. This directive is in effect until it is revoked.
5-22 "6 <5>. I understand the full import of this directive and I
5-23 am emotionally and mentally competent to make this directive.
5-24 "7 <6>. I understand that I may revoke this directive at any
5-25 time.
6-1 "Signed
6-2 _____________________
6-3 (City, County, and State of
6-4 Residence)
6-5 I am not related to the declarant by blood or marriage; nor <. I>
6-6 would I <not> be entitled to any portion of the declarant's estate
6-7 on his decease; nor <the declarant's death. I> am I <not> the
6-8 attending physician of the declarant or an employee of the
6-9 attending physician; nor am <.> I <am not> a patient in the health
6-10 care facility in which the declarant is a patient or any person who
6-11 has a <. I have no> claim against any portion of the <declarant's>
6-12 estate of <on> the declarant upon the declarant's death.
6-13 Furthermore, if I am an employee of a health facility in which the
6-14 declarant is a patient, I am not involved in providing direct
6-15 patient care to the declarant and am not directly involved in the
6-16 financial affairs of the health facility.
6-17 "Witness __________________
6-18 "Witness
6-19 ___________________"
6-20 SECTION 5. Section 672.005, Health and Safety Code, is
6-21 amended by adding Subsection (d) to read as follows:
6-22 (d) A nonwritten directive issued by a competent adult
6-23 qualified patient under this section may include such other
6-24 directions as those permitted by Section 672.003(d).
6-25 SECTION 6. Section 672.006, Health and Safety Code, is
7-1 amended to read as follows:
7-2 Sec. 672.006. Execution of Directive on Behalf of Patient
7-3 Younger Than 18 Years of Age. (a) The following persons may
7-4 execute a directive on behalf of a qualified patient who is younger
7-5 than 18 years of age:
7-6 (1) the patient's spouse, if the spouse is an adult;
7-7 (2) the patient's parents; or
7-8 (3) the patient's legal guardian.
7-9 (b) Directives under this section may be issued by either
7-10 written or nonwritten means. Written directives shall be executed
7-11 in substantially the same form as that set out in Section 672.004
7-12 and shall be witnessed by the persons who possess the same
7-13 qualifications as those set out in Section 672.003. Nonwritten
7-14 directives shall be issued in accordance with Section 672.005.
7-15 SECTION 7. Subsection (a), Section 672.008, Health and
7-16 Safety Code, is amended to read as follows:
7-17 (a) This section only applies when an adult qualified
7-18 patient has executed or issued a directive and is comatose,
7-19 incompetent, or otherwise mentally or physically incapable of
7-20 communication.
7-21 SECTION 8. Subsections (a) and (b), Section 672.009, Health
7-22 and Safety Code, are amended to read as follows:
7-23 (a) If an adult qualified patient has not executed or issued
7-24 a directive and is comatose, incompetent, or otherwise mentally or
7-25 physically incapable of communication, the attending physician and
8-1 the patient's legal guardian may make a treatment decision that may
8-2 include a decision to withhold or withdraw life-sustaining
8-3 procedures from the patient.
8-4 (b) If the patient does not have a legal guardian, the
8-5 attending physician and a person designated in writing by the
8-6 patient to make treatment decisions may make a treatment decision
8-7 that may include a decision to withhold or withdraw life-sustaining
8-8 procedures from the patient.
8-9 (c) <(b)> If the patient does not have a legal guardian and
8-10 has not designated another person to make treatment decisions, the
8-11 attending physician and at least two other persons, if available,
8-12 of the following categories, in the following priority, may make a
8-13 treatment decision that may include a decision to withhold or
8-14 withdraw life-sustaining procedures:
8-15 (1) the patient's spouse;
8-16 (2) a majority of the patient's reasonably available
8-17 adult children;
8-18 (3) the patient's parents; or
8-19 (4) the patient's nearest living relative.
8-20 SECTION 9. Section 672.010, Health and Safety Code, is
8-21 amended to read as follows:
8-22 Section 672.010. PATIENT CERTIFICATION AND PREREQUISITES FOR
8-23 COMPLYING WITH DIRECTIVE. (a) If a patient has been diagnosed as
8-24 having a terminal condition, as defined in this chapter, and the
8-25 <An> attending physician <who> has been notified of the existence
9-1 of a directive, the attending physician shall provide for the
9-2 patient's <declarant's> certification as a qualified patient <on
9-3 diagnosis of a terminal condition>.
9-4 (b) Before withholding or withdrawing life-sustaining
9-5 procedures from a qualified patient under this chapter, the
9-6 attending physician shall <must>:
9-7 (1) determine that the patient<'s> has a terminal
9-8 condition, as defined in this chapter < death is imminent
9-9 regardless of the application of life-sustaining procedures>;
9-10 (2) document <note> that determination in the
9-11 patient's medical record; and
9-12 (3) determine that the <steps> proposed <to be taken
9-13 are in> treatment decision is in accord with this chapter and the
9-14 patient's existing desires.
9-15 SECTION 10. Section 672.015, Health and Safety Code, is
9-16 amended by adding Subsection (d) to read as follows:
9-17 (d) A physician or a health professional acting under the
9-18 direction of a physician, health care facility, health care
9-19 professional, or health care service plan named as a defendant in
9-20 any civil action filed as a result of causing life-sustaining
9-21 procedures to be withheld or withdrawn from a qualified patient in
9-22 accordance with this chapter may recover any defense costs,
9-23 including court costs, attorney fees, and any damages incurred as a
9-24 result of the civil action, if the plaintiff's original suit is
9-25 determined to be frivolous or brought in bad faith.
10-1 SECTION 11. (a) This Act takes effect September 1, 1991.
10-2 (b) A written directive that uses the form provided by
10-3 Subsection (d), Section 3, Natural Death Act (Article 4590h,
10-4 Vernon's Texas Civil Statutes), as amended by Section 2, Chapter
10-5 674, Acts of the 71st Legislature, Regular Session, 1989, is not
10-6 impaired in its validity, regardless of the date on which the
10-7 directive is executed or the repeal of that subsection.
10-8 SECTION 12. The importance of this legislation and the
10-9 crowded condition of the calendars in both houses create an
10-10 emergency and an imperative public necessity that the
10-11 constitutional rule requiring bills to be read on three several
10-12 days in each house be suspended, and this rule is hereby suspended.