1-1 By: Rosson S.B. No. 1161
1-2 (In the Senate - Filed March 9, 1995; March 15, 1995, read
1-3 first time and referred to Committee on Health and Human Services;
1-4 April 20, 1995, reported favorably by the following vote: Yeas 8,
1-5 Nays 0; April 20, 1995, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to out-of-hospital do-not-resuscitate orders; providing
1-9 penalties.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Subtitle A, Title 8, Health and Safety Code, is
1-12 amended by adding Chapter 674 to read as follows:
1-13 Sec. 674.001. DEFINITIONS. In this chapter:
1-14 (1) "Attending physician" means the physician who has
1-15 primary responsibility for a person's treatment and care.
1-16 (2) "Board" means the Texas Board of Health.
1-17 (3) "Cardiopulmonary resuscitation" includes a
1-18 component of cardiopulmonary resuscitation.
1-19 (4) "Competent" means possessing the ability, based on
1-20 reasonable medical judgment, to understand and appreciate the
1-21 nature and consequences of a treatment decision, including the
1-22 significant benefits and harms of, and reasonable alternatives to,
1-23 a proposed treatment decision.
1-24 (5) "Declarant" means a person who has executed or
1-25 issued an out-of-hospital do-not-resuscitate order under this
1-26 chapter.
1-27 (6) "Department" means the Texas Department of Health.
1-28 (7) "DNR identification device" means an
1-29 identification device specified by the board under Section 674.023
1-30 that is worn for the purpose of identifying a person who has
1-31 executed or issued an out-of-hospital DNR order or on whose behalf
1-32 an out-of-hospital DNR order has been executed or issued under this
1-33 chapter.
1-34 (8) "Durable power of attorney for health care" means
1-35 a document delegating to an agent the authority to make health care
1-36 decisions for a person in accordance with Chapter 135, Civil
1-37 Practice and Remedies Code.
1-38 (9) "Emergency medical services" has the meaning
1-39 assigned by Section 773.003.
1-40 (10) "Emergency medical services personnel" has the
1-41 meaning assigned by Section 773.003.
1-42 (11) "Health care professionals" means physicians,
1-43 nurses, and emergency medical services personnel and, unless the
1-44 context requires otherwise, includes hospital emergency personnel.
1-45 (12) "Incompetent" means lacking the ability, based on
1-46 reasonable medical judgment, to understand and appreciate the
1-47 nature and consequences of a treatment decision, including the
1-48 significant benefits and harms of, and reasonable alternatives to,
1-49 a proposed treatment decision.
1-50 (13) "Life-sustaining procedure" means a medical
1-51 procedure, treatment, or intervention that uses mechanical or other
1-52 artificial means to sustain, restore, or supplant a spontaneous
1-53 vital function and, when applied to a person in a terminal
1-54 condition, serves only to prolong the process of dying. The term
1-55 does not include the administration of medication or the
1-56 performance of a medical procedure considered to be necessary to
1-57 provide comfort or care or to alleviate pain.
1-58 (14) "Out-of-hospital DNR order":
1-59 (A) means a legally binding out-of-hospital
1-60 do-not-resuscitate order, in the form specified by the board under
1-61 Section 674.003, prepared and signed by the attending physician of
1-62 a person who has been diagnosed as having a terminal condition,
1-63 that documents the instructions of a person or the person's legally
1-64 authorized representative and directs health care professionals
1-65 acting in an out-of-hospital setting not to initiate or continue
1-66 the following life-sustaining procedures:
1-67 (i) cardiopulmonary resuscitation;
1-68 (ii) endotracheal intubation or other
2-1 means of advanced airway management;
2-2 (iii) artificial ventilation;
2-3 (iv) defibrillation;
2-4 (v) transcutaneous cardiac pacing;
2-5 (vi) the administration of cardiac
2-6 resuscitation medications; and
2-7 (vii) other life-sustaining procedures
2-8 specified by the board under Section 674.023(a); and
2-9 (B) does not include authorization to withhold
2-10 medical interventions or therapies considered necessary to provide
2-11 comfort or care or to alleviate pain.
2-12 (15) "Out-of-hospital setting" means any setting
2-13 outside of a licensed acute care hospital in which health care
2-14 professionals are called for assistance, including long-term care
2-15 facilities, in-patient hospice facilities, private homes, and
2-16 vehicles during transport.
2-17 (16) "Physician" means a physician licensed by the
2-18 Texas State Board of Medical Examiners or a properly credentialed
2-19 physician who holds a commission in the uniformed services of the
2-20 United States and who is serving on active duty in this state.
2-21 (17) "Proxy" means a person designated and authorized
2-22 by a directive executed or issued in accordance with Chapter 672 to
2-23 make a treatment decision for another person in the event the other
2-24 person becomes comatose, incompetent, or otherwise mentally or
2-25 physically incapable of communication.
2-26 (18) "Qualified relatives" means those persons
2-27 authorized to execute or issue an out-of-hospital DNR order on
2-28 behalf of a person who is comatose, incompetent, or otherwise
2-29 mentally or physically incapable of communication under Section
2-30 674.008.
2-31 (19) "Statewide out-of-hospital DNR protocol" means a
2-32 set of statewide standardized procedures adopted by the board under
2-33 Section 674.023 for withholding cardiopulmonary resuscitation and
2-34 certain other life-sustaining procedures by health care
2-35 professionals acting in out-of-hospital settings.
2-36 (20) "Terminal condition" means an incurable or
2-37 irreversible condition caused by injury, disease, or illness that
2-38 would produce death without the application of life-sustaining
2-39 procedures, according to reasonable medical judgment, and in which
2-40 the application of life-sustaining procedures serves only to
2-41 postpone the moment of the person's death.
2-42 Sec. 674.002. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE TO
2-43 PHYSICIANS. (a) A competent person who has been diagnosed by a
2-44 physician as having a terminal condition may at any time execute a
2-45 written out-of-hospital DNR order directing health care
2-46 professionals acting in an out-of-hospital setting to withhold
2-47 cardiopulmonary resuscitation and certain other life-sustaining
2-48 procedures designated by the board.
2-49 (b) The declarant must sign the out-of-hospital DNR order in
2-50 the presence of two witnesses, and those witnesses must sign the
2-51 order. The attending physician of the declarant must sign the
2-52 order and shall make the fact of the existence of the order and the
2-53 reasons for execution of the order a part of the declarant's
2-54 medical record.
2-55 (c) A witness must have the same qualifications as those
2-56 provided by Section 672.003(c).
2-57 (d) If the person is incompetent but previously executed or
2-58 issued a directive to physicians in accordance with Chapter 672,
2-59 the physician may rely on the directive as the person's
2-60 instructions to issue an out-of-hospital DNR order and shall place
2-61 a copy of the directive in the person's medical record. The
2-62 physician shall sign the order in lieu of the person signing under
2-63 Subsection (b).
2-64 (e) If the person is incompetent but previously executed or
2-65 issued a directive to physicians in accordance with Chapter 672
2-66 designating a proxy, the proxy may make any decisions required of
2-67 the designating person as to an out-of-hospital DNR order and shall
2-68 sign the order in lieu of the person signing under Subsection (b).
2-69 (f) If the person is now incompetent but previously executed
2-70 or issued a durable power of attorney for health care in accordance
3-1 with Chapter 135, Civil Practice and Remedies Code, designating an
3-2 agent, the agent may make any decisions required of the designating
3-3 person as to an out-of-hospital DNR order and shall sign the order
3-4 in lieu of the person signing under Subsection (b).
3-5 (g) The board, on the recommendation of the department,
3-6 shall by rule adopt procedures for the disposition and maintenance
3-7 of records of an original out-of-hospital DNR order and any copies
3-8 of the order.
3-9 (h) An out-of-hospital DNR order is effective on its
3-10 execution.
3-11 Sec. 674.003. FORM OF OUT-OF-HOSPITAL DNR ORDER. (a) A
3-12 written out-of-hospital DNR order shall be in the standard form
3-13 specified by board rule as recommended by the department.
3-14 (b) The standard form of an out-of-hospital DNR order
3-15 specified by the board must, at a minimum, contain the following:
3-16 (1) a distinctive single-page format that readily
3-17 identifies the document as an out-of-hospital DNR order;
3-18 (2) a title that readily identifies the document as an
3-19 out-of-hospital DNR order;
3-20 (3) the printed or typed name of the person;
3-21 (4) a statement that the physician signing the
3-22 document is the attending physician of the person, that the
3-23 physician has diagnosed the person as having a terminal condition,
3-24 and that the physician is directing health care professionals
3-25 acting in out-of-hospital settings not to initiate or continue
3-26 certain life-sustaining procedures on behalf of the person, and a
3-27 listing of those procedures not to be initiated or continued;
3-28 (5) a statement that the person understands that the
3-29 person may revoke the out-of-hospital DNR order at any time by
3-30 destroying the order and removing the DNR identification device, if
3-31 any, or by communicating to health care professionals at the scene
3-32 the person's desire to revoke the out-of-hospital DNR order;
3-33 (6) places for the printed names and signatures of the
3-34 witnesses and attending physician of the person and the medical
3-35 license number of the attending physician;
3-36 (7) a separate section for execution of the document
3-37 by the legal guardian of the person, the person's proxy, an agent
3-38 of the person having a durable power of attorney for health care,
3-39 or the attending physician attesting to the issuance of an
3-40 out-of-hospital DNR order by nonwritten means of communication or
3-41 acting in accordance with a previously executed or previously
3-42 issued directive to physicians under Section 674.002(d) that
3-43 includes the following:
3-44 (A) a statement that the legal guardian, the
3-45 proxy, the agent, the person by nonwritten means of communication,
3-46 or the physician directs that the listed life-sustaining procedures
3-47 should not be initiated or continued in behalf of the person; and
3-48 (B) places for the printed names and signatures
3-49 of the witnesses and, as applicable, the legal guardian, proxy,
3-50 agent, or physician;
3-51 (8) a separate section for execution of the document
3-52 by at least two qualified relatives of the person when the person
3-53 does not have a legal guardian, proxy, or agent having a durable
3-54 power of attorney for health care and is comatose, incompetent, or
3-55 otherwise mentally or physically incapable of communication,
3-56 including:
3-57 (A) a statement that the relatives of the person
3-58 are qualified to make a treatment decision to withhold
3-59 cardiopulmonary resuscitation and certain other designated
3-60 life-sustaining procedures under Section 674.008 and, based on the
3-61 known desires of the person or a determination of the best interest
3-62 of the person, direct that the listed life-sustaining procedures
3-63 should not be initiated or continued in behalf of the person; and
3-64 (B) places for the printed names and signatures
3-65 of the witnesses and qualified relatives of the person;
3-66 (9) a place for entry of the date of execution of the
3-67 document;
3-68 (10) a statement that the document is in effect on the
3-69 date of its execution and remains in effect until the death of the
3-70 person or until the document is revoked;
4-1 (11) a statement that the document must accompany the
4-2 person during transport;
4-3 (12) a statement regarding the proper disposition of
4-4 the document or copies of the document, as the board determines
4-5 appropriate; and
4-6 (13) a statement at the bottom of the document, with
4-7 places for the signature of each person executing the document,
4-8 that the document has been properly completed.
4-9 (c) The board may, by rule and as recommended by the
4-10 department, modify the standard form of the out-of-hospital DNR
4-11 order described by Subsection (b) in order to accomplish the
4-12 purposes of this chapter.
4-13 Sec. 674.004. ISSUANCE OF OUT-OF-HOSPITAL DNR ORDER BY
4-14 NONWRITTEN COMMUNICATION. (a) A competent person who is an adult
4-15 may issue an out-of-hospital DNR order by nonwritten communication.
4-16 (b) A declarant must issue the nonwritten out-of-hospital
4-17 DNR order in the presence of the attending physician and two
4-18 witnesses. The witnesses must possess the same qualifications as
4-19 those provided by Section 672.003(c).
4-20 (c) The attending physician and witnesses shall sign the
4-21 out-of-hospital DNR order in that place of the document provided by
4-22 Section 674.003(b)(7) and the attending physician shall sign the
4-23 document in the place required by Section 674.003(b)(13). The
4-24 physician shall make the fact of the existence of the
4-25 out-of-hospital DNR order a part of the declarant's medical record
4-26 and the witnesses shall sign that entry in the medical record.
4-27 (d) An out-of-hospital DNR order issued in the manner
4-28 provided by this section is valid and shall be honored by
4-29 responding health care professionals as if executed in the manner
4-30 provided by Section 674.002.
4-31 Sec. 674.005. EXECUTION OF OUT-OF-HOSPITAL DNR ORDER ON
4-32 BEHALF OF A MINOR. The following persons may execute an
4-33 out-of-hospital DNR order on behalf of a minor:
4-34 (1) the minor's parents;
4-35 (2) the minor's legal guardian; or
4-36 (3) the minor's managing conservator.
4-37 Sec. 674.006. DESIRE OF PERSON SUPERSEDES OUT-OF-HOSPITAL
4-38 DNR ORDER. The desire of a competent person, including a competent
4-39 minor, supersedes the effect of an out-of-hospital DNR order
4-40 executed or issued by or on behalf of the person when the desire is
4-41 communicated to responding health care professionals as provided by
4-42 this chapter.
4-43 Sec. 674.007. PROCEDURE WHEN DECLARANT IS INCOMPETENT OR
4-44 INCAPABLE OF COMMUNICATION. (a) This section applies when a
4-45 person 18 years of age or older has executed or issued an
4-46 out-of-hospital DNR order and subsequently becomes comatose,
4-47 incompetent, or otherwise mentally or physically incapable of
4-48 communication.
4-49 (b) If the adult person has designated a person to make a
4-50 treatment decision as authorized by Section 672.003(d), the
4-51 attending physician and the designated person shall comply with the
4-52 out-of-hospital DNR order.
4-53 (c) If the adult person has not designated a person to make
4-54 a treatment decision as authorized by Section 672.003(d), the
4-55 attending physician shall comply with the out-of-hospital DNR order
4-56 unless the physician believes that the order does not reflect the
4-57 person's present desire.
4-58 Sec. 674.008. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR
4-59 ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR INCAPABLE OF
4-60 COMMUNICATION. (a) If an adult person has not executed or issued
4-61 an out-of-hospital DNR order and is comatose, incompetent, or
4-62 otherwise mentally or physically incapable of communication, the
4-63 attending physician and the person's legal guardian, proxy, or
4-64 agent having a durable power of attorney for health care may
4-65 execute an out-of-hospital DNR order on behalf of the person.
4-66 (b) If the person does not have a legal guardian, proxy, or
4-67 agent, the attending physician and at least two qualified relatives
4-68 may execute an out-of-hospital DNR order in the same manner as a
4-69 treatment decision made under Section 672.009(b).
4-70 (c) A decision to execute an out-of-hospital DNR order made
5-1 under Subsection (a) or (b) must be based on knowledge of what the
5-2 person would desire, if known.
5-3 (d) An out-of-hospital DNR order executed under Subsection
5-4 (b) must be made in the presence of at least two witnesses who
5-5 possess the same qualifications that are required by Section
5-6 672.003(c).
5-7 (e) The fact that an adult person has not executed or issued
5-8 an out-of-hospital DNR order does not create a presumption that the
5-9 person does not want a treatment decision made to withhold
5-10 cardiopulmonary resuscitation and certain other designated
5-11 life-sustaining procedures designated by the board.
5-12 Sec. 674.009. COMPLIANCE WITH OUT-OF-HOSPITAL DNR ORDER.
5-13 (a) When responding to a call for assistance, health care
5-14 professionals shall honor an out-of-hospital DNR order in
5-15 accordance with the statewide out-of-hospital DNR protocol and,
5-16 where applicable, locally adopted out-of-hospital DNR protocols not
5-17 in conflict with the statewide protocol if:
5-18 (1) the responding health care professionals discover
5-19 an executed or issued out-of-hospital DNR order form on their
5-20 arrival at the scene; and
5-21 (2) the responding health care professionals comply
5-22 with this section.
5-23 (b) If the person is wearing a DNR identification device,
5-24 the responding health care professionals must comply with Section
5-25 674.010.
5-26 (c) The responding health care professionals must establish
5-27 the identity of the person as the person who executed or issued the
5-28 out-of-hospital DNR order or for whom the out-of-hospital DNR order
5-29 was executed or issued.
5-30 (d) The responding health care professionals must determine
5-31 that the out-of-hospital DNR order form appears to be valid in that
5-32 it includes:
5-33 (1) written responses in the places designated on the
5-34 form for the names, signatures, and other information required of
5-35 persons executing or issuing, or witnessing the execution or
5-36 issuance of, the order;
5-37 (2) a date in the place designated on the form for the
5-38 date the order was executed or issued; and
5-39 (3) the signature of the declarant or persons
5-40 executing or issuing the order and the attending physician in the
5-41 appropriate places designated on the form for indicating that the
5-42 order form has been properly completed.
5-43 (e) If the conditions prescribed by Subsections (a) through
5-44 (d) are not determined to apply by the responding health care
5-45 professionals at the scene, the out-of-hospital DNR order may not
5-46 be honored and life-sustaining procedures otherwise required by law
5-47 or local emergency medical services protocols shall be initiated or
5-48 continued. Health care professionals acting in out-of-hospital
5-49 settings are not required to accept or interpret an out-of-hospital
5-50 DNR order that does not meet the requirements of this chapter.
5-51 (f) The out-of-hospital DNR order form, when available, must
5-52 accompany the person during transport.
5-53 (g) A record shall be made and maintained of the
5-54 circumstances of each emergency medical services response in which
5-55 an out-of-hospital DNR order or DNR identification device is
5-56 encountered, in accordance with the statewide out-of-hospital DNR
5-57 protocol and any applicable local out-of-hospital DNR protocol not
5-58 in conflict with the statewide protocol.
5-59 (h) An out-of-hospital DNR order executed or issued and
5-60 documented or evidenced in the manner prescribed by this chapter is
5-61 valid and shall be honored by responding health care professionals
5-62 unless the person or persons found at the scene:
5-63 (1) identify themselves as the declarant or as the
5-64 attending physician, legal guardian, qualified relative, or agent
5-65 of the person having a durable power of attorney for health care
5-66 who executed or issued the out-of-hospital DNR order on behalf of
5-67 the person; and
5-68 (2) request that cardiopulmonary resuscitation or
5-69 certain other life-sustaining procedures designated by the board be
5-70 initiated or continued.
6-1 (i) If the policies of a health care facility preclude
6-2 compliance with the out-of-hospital DNR order of a person or an
6-3 out-of-hospital DNR order issued by an attending physician on
6-4 behalf of a person who is admitted to or a resident of the
6-5 facility, or if the facility is unwilling to accept DNR
6-6 identification devices as evidence of the existence of an
6-7 out-of-hospital DNR order, that facility shall take all reasonable
6-8 steps to notify the person or, if the person is incompetent, the
6-9 person's guardian or the person or persons having authority to make
6-10 health care treatment decisions on behalf of the person, of the
6-11 facility's policy and shall take all reasonable steps to effect the
6-12 transfer of the person to the person's home or to a facility where
6-13 the provisions of this chapter can be carried out.
6-14 Sec. 674.010. DNR IDENTIFICATION DEVICE. (a) A person who
6-15 has a valid out-of-hospital DNR order under this chapter may wear a
6-16 DNR identification device around the neck or on the wrist as
6-17 prescribed by board rule adopted under Section 674.023.
6-18 (b) The presence of a DNR identification device on the body
6-19 of a person is conclusive evidence that the person has executed or
6-20 issued a valid out-of-hospital DNR order or has a valid
6-21 out-of-hospital DNR order executed or issued on the person's
6-22 behalf. Responding health care professionals shall honor the DNR
6-23 identification device as if a valid out-of-hospital DNR order form
6-24 executed or issued by the person were found in the possession of
6-25 the person.
6-26 Sec. 674.011. Duration of Out-of-Hospital DNR Order. An
6-27 out-of-hospital DNR order is effective until it is revoked as
6-28 prescribed by Section 674.012.
6-29 Sec. 674.012. Revocation of Out-of-Hospital DNR Order.
6-30 (a) A declarant may revoke an out-of-hospital DNR order at any
6-31 time without regard to the declarant's mental state or competency.
6-32 An order may be revoked by:
6-33 (1) the declarant or someone in the declarant's
6-34 presence and at the declarant's direction destroying the order form
6-35 and removing the DNR identification device, if any;
6-36 (2) a person who identifies himself or herself as the
6-37 legal guardian, as a qualified relative, or as the agent of the
6-38 declarant having a durable power of attorney for health care who
6-39 executed the out-of-hospital DNR order or another person in the
6-40 person's presence and at the person's direction destroying the
6-41 order form and removing the DNR identification device, if any;
6-42 (3) the declarant communicating the declarant's intent
6-43 to revoke the order; or
6-44 (4) a person who identifies himself or herself as the
6-45 legal guardian, a qualified relative, or the agent of the declarant
6-46 having a durable power of attorney for health care who executed the
6-47 out-of-hospital DNR order orally stating the person's intent to
6-48 revoke the order.
6-49 (b) An oral revocation under Subsection (a)(3) or (a)(4)
6-50 takes effect only when the declarant or a person who identifies
6-51 himself or herself as the legal guardian, a qualified relative, or
6-52 the agent of the declarant having a durable power of attorney for
6-53 health care who executed the out-of-hospital DNR order communicates
6-54 the intent to revoke the order to the responding health care
6-55 professionals or the attending physician at the scene. The
6-56 responding health care professionals shall record the time, date,
6-57 and place of the revocation in accordance with the statewide
6-58 out-of-hospital DNR protocol and rules adopted by the board and any
6-59 applicable local out-of-hospital DNR protocol. The attending
6-60 physician or the physician's designee shall record in the person's
6-61 medical record the time, date, and place of the revocation and, if
6-62 different, the time, date, and place that the physician received
6-63 notice of the revocation. The attending physician or the
6-64 physician's designee shall also enter the word "VOID" on each page
6-65 of the copy of the order in the person's medical record.
6-66 (c) Except as otherwise provided by this chapter, a person
6-67 is not civilly or criminally liable for failure to act on a
6-68 revocation made under this section unless the person has actual
6-69 knowledge of the revocation.
6-70 Sec. 674.013. Reexecution of Out-of-Hospital DNR Order. A
7-1 declarant may at any time reexecute or reissue an out-of-hospital
7-2 DNR order in accordance with the procedures prescribed by Section
7-3 674.002, including reexecution or reissuance after the declarant is
7-4 diagnosed as having a terminal condition.
7-5 Sec. 674.014. CONFLICT WITH NATURAL DEATH ACT OR DURABLE
7-6 POWER OF ATTORNEY FOR HEALTH CARE. To the extent that an
7-7 out-of-hospital DNR order conflicts with a directive or treatment
7-8 decision executed or issued under Chapter 672 or a durable power of
7-9 attorney for health care executed or issued in accordance with
7-10 Chapter 135, Civil Practice and Remedies Code, the instrument
7-11 executed later in time controls.
7-12 Sec. 674.015. Effect of Out-of-Hospital DNR Order on
7-13 Insurance Policy and Premiums. (a) The fact that a person has
7-14 executed or issued an out-of-hospital DNR order under this chapter
7-15 does not:
7-16 (1) restrict, inhibit, or impair in any manner the
7-17 sale, procurement, or issuance of a life insurance policy to that
7-18 person; or
7-19 (2) modify the terms of an existing life insurance
7-20 policy.
7-21 (b) Notwithstanding the terms of any life insurance policy,
7-22 the fact that cardiopulmonary resuscitation or certain other
7-23 life-sustaining procedures designated by the board are withheld
7-24 from an insured person under this chapter does not legally impair
7-25 or invalidate that person's life insurance policy and may not be a
7-26 factor for the purpose of determining the payability of benefits or
7-27 the cause of death under the life insurance policy.
7-28 (c) A physician, health facility, health care provider,
7-29 insurer, or health care service plan may not require a person to
7-30 execute or issue an out-of-hospital DNR order as a condition for
7-31 obtaining insurance for health care services or receiving health
7-32 care services.
7-33 (d) The fact that a person has executed or issued or failed
7-34 to execute or issue an out-of-hospital DNR order under this chapter
7-35 may not be considered in any way in establishing insurance
7-36 premiums.
7-37 Sec. 674.016. Limitation on Liability for Withholding
7-38 Cardiopulmonary Resuscitation and Certain other Life-Sustaining
7-39 Procedures. (a) A health care professional or health care
7-40 facility or entity that in good faith causes cardiopulmonary
7-41 resuscitation or certain other life-sustaining procedures
7-42 designated by the board to be withheld from a person in accordance
7-43 with this chapter is not civilly liable for that action.
7-44 (b) A health care professional or health care facility or
7-45 entity that in good faith participates in withholding
7-46 cardiopulmonary resuscitation or certain other life-sustaining
7-47 procedures designated by the board from a person in accordance with
7-48 this chapter is not civilly liable for that action.
7-49 (c) A health care professional or health care facility or
7-50 entity that in good faith participates in withholding
7-51 cardiopulmonary resuscitation or certain other life-sustaining
7-52 procedures designated by the board from a person in accordance with
7-53 this chapter is not criminally liable or guilty of unprofessional
7-54 conduct as a result of that action.
7-55 (d) A health care professional or health care facility or
7-56 entity that in good faith causes or participates in withholding
7-57 cardiopulmonary resuscitation or certain other life-sustaining
7-58 procedures designated by the board from a person in accordance with
7-59 this chapter and rules adopted under this chapter is not in
7-60 violation of any other licensing or regulatory laws or rules of
7-61 this state and is not subject to any disciplinary action or
7-62 sanction by any licensing or regulatory agency of this state as a
7-63 result of that action.
7-64 Sec. 674.017. Limitation on Liability for Failure to
7-65 Effectuate Out-of-hospital DNR order. (a) A health care
7-66 professional or health care facility or entity that has no actual
7-67 knowledge of an out-of-hospital DNR order is not civilly or
7-68 criminally liable for failing to act in accordance with the order.
7-69 (b) A health care professional or health care facility or
7-70 entity is not civilly or criminally liable for failing to
8-1 effectuate an out-of-hospital DNR order.
8-2 (c) If an attending physician refuses to execute or comply
8-3 with an out-of-hospital DNR order, the physician shall inform the
8-4 person, the legal guardian or qualified relatives of the person, or
8-5 the agent of the person having a durable power of attorney for
8-6 health care and, if the person or another authorized to act on
8-7 behalf of the person so directs, shall make a reasonable effort to
8-8 transfer the person to another physician who is willing to execute
8-9 or comply with an out-of-hospital DNR order.
8-10 Sec. 674.018. Honoring Out-of-hospital DNR Order Does Not
8-11 Constitute Offense of Aiding Suicide. A person does not commit an
8-12 offense under Section 22.08, Penal Code, by withholding
8-13 cardiopulmonary resuscitation or certain other life-sustaining
8-14 procedures designated by the board from a person in accordance with
8-15 this chapter.
8-16 Sec. 674.019. Criminal Penalty; Prosecution. (a) A person
8-17 commits an offense if the person intentionally conceals, cancels,
8-18 defaces, obliterates, or damages another person's out-of-hospital
8-19 DNR order or DNR identification device without that person's
8-20 consent or the consent of the person or persons authorized to
8-21 execute or issue an out-of-hospital DNR order on behalf of the
8-22 person under this chapter. An offense under this subsection is a
8-23 Class A misdemeanor.
8-24 (b) A person is subject to prosecution for criminal homicide
8-25 under Chapter 19, Penal Code, if the person, with the intent to
8-26 cause cardiopulmonary resuscitation or certain other
8-27 life-sustaining procedures designated by the board to be withheld
8-28 from another person contrary to the other person's desires,
8-29 falsifies or forges an out-of-hospital DNR order or intentionally
8-30 conceals or withholds personal knowledge of a revocation and
8-31 thereby directly causes cardiopulmonary resuscitation and certain
8-32 other life-sustaining procedures designated by the board to be
8-33 withheld from the other person with the result that the other
8-34 person's death is hastened.
8-35 Sec. 674.020. PREGNANT PERSONS. A person may not withhold
8-36 cardiopulmonary resuscitation or certain other life-sustaining
8-37 procedures designated by the board under this chapter from a person
8-38 known by the responding health care professionals to be pregnant.
8-39 Sec. 674.021. Mercy Killing Not Condoned. This chapter does
8-40 not condone, authorize, or approve mercy killing or permit an
8-41 affirmative or deliberate act or omission to end life except to
8-42 permit the natural process of dying as provided by this chapter.
8-43 Sec. 674.022. LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
8-44 This chapter does not impair or supersede any legal right or
8-45 responsibility a person may have under a constitution, other
8-46 statute, regulation, or court decision to effect the withholding of
8-47 cardiopulmonary resuscitation or certain other life-sustaining
8-48 procedures designated by the board.
8-49 Sec. 674.023. DUTIES OF DEPARTMENT AND BOARD. (a) The
8-50 board shall, on the recommendation of the department, adopt all
8-51 reasonable and necessary rules to carry out the purposes of this
8-52 chapter, including rules:
8-53 (1) adopting a statewide out-of-hospital DNR order
8-54 protocol that sets out standard procedures for the withholding of
8-55 cardiopulmonary resuscitation and certain other life-sustaining
8-56 procedures by health care professionals acting in out-of-hospital
8-57 settings;
8-58 (2) designating life-sustaining procedures that may be
8-59 included in an out-of-hospital DNR order, including all procedures
8-60 listed in Section 674.001(14)(A)(i) through (vi); and
8-61 (3) governing recordkeeping in circumstances in which
8-62 an out-of-hospital DNR order or DNR identification device is
8-63 encountered by responding health care professionals.
8-64 (b) The rules adopted by the board under Subsection (a) are
8-65 not effective until approved by the Texas State Board of Medical
8-66 Examiners.
8-67 (c) Local emergency medical services authorities may adopt
8-68 local out-of-hospital DNR order protocols if the local protocols do
8-69 not conflict with the statewide out-of-hospital DNR order protocol
8-70 adopted by the board.
9-1 (d) The board by rule shall specify a distinctive standard
9-2 design for a necklace and a bracelet DNR identification device that
9-3 signifies, when worn by a person, that the possessor has executed
9-4 or issued a valid out-of-hospital DNR order under this chapter or
9-5 is a person for whom a valid out-of-hospital DNR order has been
9-6 executed or issued.
9-7 (e) The department shall report to the board from time to
9-8 time regarding issues identified in emergency medical services
9-9 responses in which an out-of-hospital DNR order or DNR
9-10 identification device is encountered. The report may contain
9-11 recommendations to the board for necessary modifications to the
9-12 form of the standard out-of-hospital DNR order or the designated
9-13 life-sustaining procedures listed in the standard out-of-hospital
9-14 DNR order, the statewide out-of-hospital DNR order protocol, or the
9-15 DNR identification devices.
9-16 Sec. 674.024. Recognition of Out-of-Hospital DNR Order
9-17 Executed or Issued in Other State. An out-of-hospital DNR order
9-18 executed, issued, or authorized in another state or a territory or
9-19 possession of the United States in compliance with the law of that
9-20 jurisdiction is effective for purposes of this chapter.
9-21 SECTION 2. This Act takes effect January 1, 1996.
9-22 SECTION 3. The importance of this legislation and the
9-23 crowded condition of the calendars in both houses create an
9-24 emergency and an imperative public necessity that the
9-25 constitutional rule requiring bills to be read on three several
9-26 days in each house be suspended, and this rule is hereby suspended.
9-27 * * * * *