By Naishtat                                           H.B. No. 1430
       74R5212 KLL-D
                                 A BILL TO BE ENTITLED
    1-1                                AN ACT
    1-2  relating to medical care decisions for persons with terminal
    1-3  conditions or for persons who lack capacity to make those
    1-4  decisions.
    1-5        BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
    1-6        SECTION 1.  Sections  672.002(5)-(9), Health and Safety Code,
    1-7  are amended to read as follows:
    1-8              (5)  "Directly involved in the financial affairs of the
    1-9  health facility" means serving as an officer, director, partner, or
   1-10  business office employee of the health facility or of any parent
   1-11  organization of the health facility.
   1-12              (6)  "Incompetent" means lacking the ability, based on
   1-13  reasonable medical judgment, to understand and appreciate the
   1-14  nature and consequences of a treatment decision, including the
   1-15  significant benefits and harms of and reasonable alternatives to a
   1-16  proposed treatment decision.
   1-17              (7) <(6)>  "Life-sustaining procedure" means a medical
   1-18  procedure or intervention that uses mechanical or other artificial
   1-19  means to sustain, restore, or supplant a vital function, and only
   1-20  artificially postpones the moment of death of a patient in a
   1-21  terminal condition whose death is imminent or will result within a
   1-22  relatively short time without the application of the procedure.
   1-23  The term does not include the administration of medication or the
   1-24  performance of a medical procedure considered to be necessary to
    2-1  provide comfort or care or to alleviate pain.
    2-2              (8) <(7)>  "Physician" means a physician licensed by
    2-3  the Texas State Board of Medical Examiners or a properly
    2-4  credentialed physician who holds a commission in the uniformed
    2-5  services of the United States and who is serving on active duty in
    2-6  this state.
    2-7              (9) <(8)>  "Qualified patient" means a patient with a
    2-8  terminal condition that has been diagnosed and certified in writing
    2-9  by the attending physician <and one other physician> who has <have>
   2-10  personally examined the patient.
   2-11              (10) <(9)>  "Terminal condition" means an incurable or
   2-12  irreversible condition caused by injury, disease, or illness that
   2-13  would produce death without the application of life-sustaining
   2-14  procedures, according to reasonable medical judgment, and in which
   2-15  the application of life-sustaining procedures serves only to
   2-16  postpone the moment of the patient's death.
   2-17        SECTION 2.  Section 672.004, Health and Safety Code, is
   2-18  amended to read as follows:
   2-19        Sec. 672.004.  Form of Written Directive.  A written
   2-20  directive may be in the following form:
   2-21                       "DIRECTIVE TO PHYSICIANS
   2-22        "Directive made this __________ day of __________ (month,
   2-23  year).
   2-24        "I __________, being of sound mind, wilfully and voluntarily
   2-25  make known my desire that my life shall not be artificially
   2-26  prolonged under the circumstances set forth in this directive.
   2-27        "1. If at any time I should have an incurable or irreversible
    3-1  condition caused by injury, disease, or illness certified to be a
    3-2  terminal condition by my attending physician <two physicians>, and
    3-3  if the application of life-sustaining procedures would serve only
    3-4  to artificially postpone the moment of my death, and if my
    3-5  attending physician determines that my death is imminent or will
    3-6  result within a relatively short time without the application of
    3-7  life-sustaining procedures, I direct that those procedures be
    3-8  withheld or withdrawn, and that I be permitted to die naturally.
    3-9        "2. In the absence of my ability to give directions regarding
   3-10  the use of those life-sustaining procedures, it is my intention
   3-11  that this directive be honored by my family and physicians as the
   3-12  final expression of my legal right to refuse medical or surgical
   3-13  treatment and accept the consequences from that refusal.
   3-14        "3. If I have been diagnosed as pregnant and that diagnosis
   3-15  is known to my physician, this directive has no effect during my
   3-16  pregnancy.
   3-17        "4. This directive is in effect until it is revoked.
   3-18        "5. I understand the full import of this directive and I am
   3-19  emotionally and mentally competent to make this directive.
   3-20        "6. I understand that I may revoke this directive at any
   3-21  time.
   3-22                                        "Signed _____________________
   3-23                                          (City, County, and State of
   3-24                                          Residence)
   3-25        I am not related to the declarant by blood or marriage.  I
   3-26  would not be entitled to any portion of the declarant's estate on
   3-27  the declarant's death.  I am not the attending physician of the
    4-1  declarant or an employee of the attending physician. I am not a
    4-2  patient in the health care facility in which the declarant is a
    4-3  patient.  I have no claim against any portion of the declarant's
    4-4  estate on the declarant's death. Furthermore, if I am an employee
    4-5  of a health facility in which the declarant is a patient, I am not
    4-6  involved in providing direct patient care to the declarant and am
    4-7  not directly involved in the financial affairs of the health
    4-8  facility.
    4-9                                        "Witness ____________________
   4-10                                        "Witness ___________________"
   4-11        SECTION 3.  Sections 672.009(b) and (c), Health and Safety
   4-12  Code, are amended to read as follows:
   4-13        (b)  If the patient does not have a legal guardian, the
   4-14  attending physician and at least two persons, if available, of the
   4-15  following categories, in the following priority, may make a
   4-16  treatment decision that may include a decision to withhold or
   4-17  withdraw life-sustaining procedures:
   4-18              (1)  the patient's spouse;
   4-19              (2)  an adult child of the patient who has the waiver
   4-20  and consent of all other qualified adult children of the patient to
   4-21  act as the sole decision maker;
   4-22              (3)  a majority of the patient's reasonably available
   4-23  adult children;
   4-24              (4) <(3)>  the patient's parents; or
   4-25              (5) <(4)>  the patient's nearest living relative or the
   4-26  individual clearly identified to act for the patient by the patient
   4-27  before the patient became comatose, incompetent, or otherwise
    5-1  mentally or physically incapable of communication.
    5-2        (c)  A treatment decision made under Subsection (a) or (b)
    5-3  must be based on knowledge of what the patient would desire, if
    5-4  known, or if not known, according to an assessment by the decision
    5-5  makers of the patient's best interests.
    5-6        SECTION 4.  Section 672.021, Health and Safety Code, is
    5-7  amended to read as follows:
    5-8        Sec. 672.021.  Legal Right or Responsibility not Affected.
    5-9  This chapter does not impair or supersede any legal right or
   5-10  responsibility a person may have under a constitution, other
   5-11  statute, rule, or court decision to effect the withholding or
   5-12  withdrawal of life-sustaining procedures <in a lawful manner>.
   5-13        SECTION 5.  Section 135.004(b), Civil Practice and Remedies
   5-14  Code, is amended to read as follows:
   5-15        (b)  A witness may not, at the time of execution, be:
   5-16              (1)  the agent;
   5-17              (2)  an employee of the principal's health or
   5-18  residential care provider if the employee:
   5-19                    (A)  is providing direct patient or resident care
   5-20  to the principal; or
   5-21                    (B)  is an officer, director, partner, or
   5-22  business office employee of the provider or of any parent
   5-23  organization of the provider <or the provider's employee>;
   5-24              (3)  the principal's spouse or heir;
   5-25              (4)  a person entitled to any part of the estate of the
   5-26  principal on the death of the principal under a will or deed in
   5-27  existence or by operation of law; or
    6-1              (5)  any other person who has any claim against the
    6-2  estate of the principal.
    6-3        SECTION 6.  The changes made by this Act to the suggested
    6-4  wording of a directive provided by Section 672.004, Health and
    6-5  Safety Code, do not affect the validity of a directive that uses
    6-6  the form provided by Section 672.004 before the effective date of
    6-7  this Act, regardless of the date on which the directive is
    6-8  executed.
    6-9        SECTION 7.  This Act takes effect September 1, 1995.
   6-10        SECTION 8.  The importance of this legislation and the
   6-11  crowded condition of the calendars in both houses create an
   6-12  emergency and an imperative public necessity that the
   6-13  constitutional rule requiring bills to be read on three several
   6-14  days in each house be suspended, and this rule is hereby suspended.