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A BILL TO BE ENTITLED
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AN ACT
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relating to a medical power of attorney. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 166.163 and 166.164, Health and Safety |
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Code, are amended to read as follows: |
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Sec. 166.163. FORM OF DISCLOSURE STATEMENT. The disclosure |
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statement must be in substantially the following form: |
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INFORMATION CONCERNING THE MEDICAL POWER OF ATTORNEY |
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THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS |
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DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS: |
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Except to the extent you state otherwise, this document gives |
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the person you name as your agent the authority to make any and all |
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health care decisions for you in accordance with your wishes, |
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including your religious and moral beliefs, when you are no longer |
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capable of making them yourself. Because "health care" means any |
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treatment, service, or procedure to maintain, diagnose, or treat |
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your physical or mental condition, your agent has the power to make |
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a broad range of health care decisions for you. Your agent may |
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consent, refuse to consent, or withdraw consent to medical |
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treatment and may make decisions about withdrawing or withholding |
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life-sustaining treatment. Your agent may not consent to voluntary |
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inpatient mental health services, convulsive treatment, |
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psychosurgery, or abortion. A physician must comply with your |
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agent's instructions or allow you to be transferred to another |
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physician. |
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Your agent's authority begins when your doctor certifies that |
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you lack the competence to make health care decisions. |
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Your agent is obligated to follow your instructions when |
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making decisions on your behalf. Unless you state otherwise, your |
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agent has the same authority to make decisions about your health |
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care as you would have had. |
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It is important that you discuss this document with your |
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physician or other health care provider before you sign it to make |
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sure that you understand the nature and range of decisions that may |
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be made on your behalf. If you do not have a physician, you should |
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talk with someone else who is knowledgeable about these issues and |
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can answer your questions. You do not need a lawyer's assistance to |
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complete this document, but if there is anything in this document |
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that you do not understand, you should ask a lawyer to explain it to |
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you. |
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The person you appoint as agent should be someone you know and |
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trust. The person must be 18 years of age or older or a person under |
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18 years of age who has had the disabilities of minority removed. |
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If you appoint your health or residential care provider (e.g., your |
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physician or an employee of a home health agency, hospital, nursing |
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home, or residential care home, other than a relative), that person |
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has to choose between acting as your agent or as your health or |
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residential care provider; the law does not permit a person to do |
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both at the same time. |
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You should inform the person you appoint that you want the |
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person to be your health care agent. You should discuss this |
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document with your agent and your physician and give each a signed |
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copy. You should indicate on the document itself the people and |
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institutions who have signed copies. Your agent is not liable for |
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health care decisions made in good faith on your behalf. |
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Even after you have signed this document, you have the right |
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to make health care decisions for yourself as long as you are able |
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to do so and treatment cannot be given to you or stopped over your |
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objection. You have the right to revoke the authority granted to |
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your agent by informing your agent or your health or residential |
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care provider orally or in writing or by your execution of a |
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subsequent medical power of attorney. Unless you state otherwise, |
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your appointment of a spouse dissolves on divorce. |
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This document may not be changed or modified. If you want to |
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make changes in the document, you must make an entirely new one. |
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You may wish to designate an alternate agent in the event that |
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your agent is unwilling, unable, or ineligible to act as your agent. |
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Any alternate agent you designate has the same authority to make |
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health care decisions for you. |
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THIS POWER OF ATTORNEY IS NOT VALID UNLESS: |
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(1) YOU SIGN IT AND HAVE YOUR SIGNATURE ACKNOWLEDGED |
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BEFORE A NOTARY PUBLIC; OR |
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(2) YOU SIGN IT [IS SIGNED] IN THE PRESENCE OF TWO |
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COMPETENT ADULT WITNESSES. |
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THE FOLLOWING PERSONS MAY NOT ACT AS ONE OF THE WITNESSES: |
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(1) the person you have designated as your agent; |
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(2) a person related to you by blood or marriage; |
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(3) a person entitled to any part of your estate after |
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your death under a will or codicil executed by you or by operation |
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of law; |
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(4) your attending physician; |
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(5) an employee of your attending physician; |
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(6) an employee of a health care facility in which you |
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are a patient if the employee is providing direct patient care to |
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you or is an officer, director, partner, or business office |
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employee of the health care facility or of any parent organization |
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of the health care facility; or |
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(7) a person who, at the time this power of attorney is |
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executed, has a claim against any part of your estate after your |
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death. |
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Sec. 166.164. FORM OF MEDICAL POWER OF ATTORNEY. The |
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medical power of attorney must be in substantially the following |
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form: |
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MEDICAL POWER OF ATTORNEY DESIGNATION OF HEALTH CARE AGENT. |
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I, __________ (insert your name) appoint: |
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Name:___________________________________________________________ |
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Address:________________________________________________________ |
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Phone___________________________________________________________ |
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as my agent to make any and all health care decisions for me, |
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except to the extent I state otherwise in this document. This |
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medical power of attorney takes effect if I become unable to make my |
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own health care decisions and this fact is certified in writing by |
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my physician. |
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LIMITATIONS ON THE DECISION-MAKING AUTHORITY OF MY AGENT ARE |
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AS FOLLOWS:_____________________________________________________ |
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_____________________________________________________ |
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DESIGNATION OF ALTERNATE AGENT. |
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(You are not required to designate an alternate agent but you |
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may do so. An alternate agent may make the same health care |
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decisions as the designated agent if the designated agent is unable |
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or unwilling to act as your agent. If the agent designated is your |
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spouse, the designation is automatically revoked by law if your |
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marriage is dissolved.) |
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If the person designated as my agent is unable or unwilling to |
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make health care decisions for me, I designate the following |
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persons to serve as my agent to make health care decisions for me as |
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authorized by this document, who serve in the following order: |
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A. First Alternate Agent |
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Name:_____________________________________________ |
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Address:__________________________________________ |
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Phone________________________________________ |
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B. Second Alternate Agent |
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Name:_____________________________________________ |
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Address:__________________________________________ |
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Phone________________________________________ |
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The original of this document is kept at: |
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__________________________________________________ |
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__________________________________________________ |
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__________________________________________________ |
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The following individuals or institutions have signed |
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copies: |
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Name:_____________________________________________ |
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Address:__________________________________________ |
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__________________________________________________ |
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Name:_____________________________________________ |
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Address:__________________________________________ |
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__________________________________________________ |
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DURATION. |
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I understand that this power of attorney exists indefinitely |
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from the date I execute this document unless I establish a shorter |
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time or revoke the power of attorney. If I am unable to make health |
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care decisions for myself when this power of attorney expires, the |
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authority I have granted my agent continues to exist until the time |
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I become able to make health care decisions for myself. |
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(IF APPLICABLE) This power of attorney ends on the following |
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date: __________ |
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PRIOR DESIGNATIONS REVOKED. |
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I revoke any prior medical power of attorney. |
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ACKNOWLEDGMENT OF DISCLOSURE STATEMENT. |
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I have been provided with a disclosure statement explaining |
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the effect of this document. I have read and understand that |
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information contained in the disclosure statement. |
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(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY. YOU MAY SIGN |
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IT AND HAVE YOUR SIGNATURE ACKNOWLEDGED BEFORE A NOTARY PUBLIC OR |
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YOU MAY SIGN IT IN THE PRESENCE OF TWO COMPETENT ADULT WITNESSES.) |
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SIGNATURE ACKNOWLEDGED BEFORE NOTARY |
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I sign my name to this medical power of attorney on __________ |
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day of __________ (month, year) at |
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_____________________________________________ |
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(City and State) |
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_____________________________________________ |
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(Signature) |
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_____________________________________________ |
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(Print Name) |
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State of Texas |
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County of ________ |
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This instrument was acknowledged before me on __________ (date) by |
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________________ (name of person acknowledging). |
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_____________________________ |
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NOTARY PUBLIC, State of Texas |
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Notary's printed name: |
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_____________________________ |
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My commission expires: |
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_____________________________ |
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OR |
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SIGNATURE IN PRESENCE OF TWO COMPETENT ADULT WITNESSES |
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I sign my name to this medical power of attorney on __________ |
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day of __________ (month, year) at |
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_____________________________________________ |
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(City and State) |
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_____________________________________________ |
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(Signature) |
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_____________________________________________ |
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(Print Name) |
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STATEMENT OF FIRST WITNESS. |
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I am not the person appointed as agent by this document. I am |
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not related to the principal by blood or marriage. I would not be |
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entitled to any portion of the principal's estate on the principal's |
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death. I am not the attending physician of the principal or an |
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employee of the attending physician. I have no claim against any |
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portion of the principal's estate on the principal's death. |
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Furthermore, if I am an employee of a health care facility in which |
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the principal is a patient, I am not involved in providing direct |
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patient care to the principal and am not an officer, director, |
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partner, or business office employee of the health care facility or |
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of any parent organization of the health care facility. |
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Signature:________________________________________________ |
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Print Name:___________________________________ Date:______ |
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Address:__________________________________________________ |
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SIGNATURE OF SECOND WITNESS. |
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Signature:________________________________________________ |
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Print Name:___________________________________ Date:______ |
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Address:__________________________________________________ |
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SECTION 2. Not later than October 1, 2013, the executive |
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commissioner of the Health and Human Services Commission shall |
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adopt the forms necessary to comply with the changes in law made by |
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this Act. |
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SECTION 3. The change in law made by this Act does not |
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affect the validity of a document executed under Section 166.164, |
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Health and Safety Code, before the effective date of this Act. A |
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document executed before the effective date of this Act is governed |
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by the law in effect on the date the document was executed, and that |
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law continues in effect for that purpose. |
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SECTION 4. (a) Except as provided by Subsection (b), this |
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Act takes effect January 1, 2014. |
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(b) Section 2 of this Act takes effect September 1, 2013. |