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SECTION 5. Section
166.046(e), Health and Safety Code, is amended to read as follows:
No
equivalent provision.
(e) If the patient or the
person responsible for the health care decisions of the patient is
requesting life-sustaining treatment that the attending physician has
decided and the ethics or medical committee [review process]
has affirmed is medically inappropriate treatment, the patient shall
be given available life-sustaining treatment pending transfer under
Subsection (d). This subsection does not authorize withholding or
withdrawing pain management medication, medical procedures necessary to
provide comfort, or any other health care provided to alleviate a patient's
pain. The patient is responsible for any costs incurred in
transferring the patient to another facility. The attending
physician, any other physician responsible for the care of the patient,
and the health care facility are not obligated to provide life-sustaining
treatment after the 10th day after the written decision required under
Subsection (b) is provided to the patient or the person responsible for the
health care decisions of the patient unless ordered to do so under Subsection
(g), except that artificially administered nutrition and hydration must
be provided unless, based on reasonable medical judgment, providing
artificially administered nutrition and hydration would:
(1) hasten the patient's
death;
(2) seriously exacerbate other major medical
problems not outweighed by the benefit of the provision of the treatment;
(3) result in substantial
irremediable physical pain, suffering, or
discomfort not outweighed by the benefit of the provision of the
treatment;
(4) be medically
ineffective; or
(5) be contrary to the
patient's clearly stated desire not
to receive artificially administered nutrition or hydration.
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SECTION 5. Sections
166.046(b) and (e), Health and Safety Code, as amended by S.B. 219, Acts of
the 84th Legislature, Regular Session, 2015, are amended to read as
follows:
(b) The patient or the
person responsible for the health care decisions of the individual who has
made the decision regarding the directive or treatment decision:
(1) may be given a written
description of the ethics or medical committee review process and any other
policies and procedures related to this section adopted by the health care
facility;
(2) shall be informed of the
committee review process not less than 48 hours before the meeting called
to discuss the patient's directive, unless the time period is waived by
mutual agreement;
(3) at the time of being so
informed, shall be provided:
(A) a copy of the
appropriate statement set forth in Section 166.052; and
(B) a copy of the registry
list of health care providers and referral groups that have volunteered
their readiness to consider accepting transfer or to assist in locating a
provider willing to accept transfer that is posted on the website
maintained by the department under Section 166.053; and
(4) is entitled to:
(A) attend the meeting; [and]
(B) receive a written
explanation of the decision reached during the review process;
(C) receive a copy of the
portion of the patient's medical record related to the treatment received
by the patient in the facility for the lesser of:
(i) the period of the
patient's current admission to the facility; or
(ii) the preceding 30
calendar days; and
(D) receive a copy of all
of the patient's reasonably available diagnostic results and reports
related to the medical record provided under Paragraph (C).
(e) If the patient or the
person responsible for the health care decisions of the patient is
requesting life-sustaining treatment that the attending physician has
decided and the ethics or medical committee [review process]
has affirmed is medically inappropriate treatment, the patient shall
be given available life-sustaining treatment pending transfer under
Subsection (d). This subsection does not authorize withholding or
withdrawing pain management medication, medical procedures necessary to
provide comfort, or any other health care provided to alleviate a patient's
pain. The patient is responsible for any costs incurred in
transferring the patient to another facility. The attending physician,
any other physician responsible for the care of the patient, and the
health care facility are not obligated to provide life-sustaining treatment
after the 10th day after both
the written decision and the patient's
medical record required under Subsection (b) are [is]
provided to the patient or the person responsible for the health care
decisions of the patient unless ordered to do so under Subsection (g),
except that artificially administered nutrition and hydration must be
provided unless, based on reasonable medical judgment, providing
artificially administered nutrition and hydration would:
(1) hasten the patient's
death;
(2) be medically contraindicated such that the
provision of the treatment seriously exacerbates life-threatening
medical problems not outweighed by the benefit of the provision of the
treatment;
(3) result in substantial
irremediable physical pain not outweighed by the benefit of the provision
of the treatment;
(4) be medically
ineffective in prolonging life; or
(5) be contrary to the
patient's or surrogate's clearly documented desire not to receive
artificially administered nutrition or hydration.
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SECTION 6. Sections
166.052(a) and (b), Health and Safety Code, are amended to read as follows:
(a) In cases in which the
attending physician refuses to honor an advance directive or health care
or treatment decision requesting the provision of life-sustaining
treatment, the statement required by Section 166.046(b)(3)(A) [166.046(b)(2)(A)]
shall be in substantially the following form:
When There Is A Disagreement
About Medical Treatment: The Physician Recommends Against Certain
Life-Sustaining Treatment That You Wish To Continue
You have been given this
information because you have requested life-sustaining treatment[,]*
for yourself as the patient or on behalf of the patient, as applicable,
which the attending physician believes is not medically
appropriate. This information is being provided to help you understand
state law, your rights, and the resources available to you in such
circumstances. It outlines the process for resolving disagreements about
treatment among patients, families, and physicians. It is based upon
Section 166.046 of the Texas Advance Directives Act, codified in Chapter
166, [of the] Texas Health and Safety Code.
When an attending physician
refuses to comply with an advance directive or other request for
life-sustaining treatment because of the physician's judgment that the
treatment would be medically inappropriate, the case will be
reviewed by an ethics or medical committee. Life-sustaining treatment will
be provided through the review.
You will receive notification
of this review at least 48 hours before a meeting of the committee related
to your case. You are entitled to attend the meeting. With your
agreement, the meeting may be held sooner than 48 hours, if possible.
You are entitled to receive a
written explanation of the decision reached during the review process.
If after this review process
both the attending physician and the ethics or medical committee conclude
that life-sustaining treatment is medically inappropriate and yet
you continue to request such treatment, then the following procedure will
occur:
1. The physician, with the
help of the health care facility, will assist you in trying to find a
physician and facility willing to provide the requested treatment.
2. You are being given a
list of health care providers, licensed physicians, health care
facilities, and referral groups that have volunteered their readiness
to consider accepting transfer, or to assist in locating a provider willing
to accept transfer, maintained by the Department of State [Texas]
Health Services [Care Information Council]. You may wish to
contact providers, facilities, or referral groups on the list or
others of your choice to get help in arranging a transfer.
3. The patient will continue
to be given life-sustaining treatment and treatment to enhance pain
management and reduce suffering, including artificially administered
nutrition and hydration unless, based on reasonable medical judgment,
providing artificially administered nutrition and hydration would hasten
the patient's death, seriously exacerbate
other major medical problems, result in substantial irremediable
physical pain, suffering, or discomfort
not outweighed by the benefit of the treatment, be medically ineffective,
or be contrary to the patient's clearly stated
desires, until the patient [he or she] can be transferred
to a willing provider for up to 10 days from the time you were given the
committee's written decision that life-sustaining treatment is not
appropriate.
4. If a transfer can be
arranged, the patient will be responsible for the costs of the transfer.
5. If a provider cannot be
found willing to give the requested treatment within 10 days,
life-sustaining treatment may be withdrawn unless a court of law has
granted an extension.
6. You may ask the
appropriate district or county court to extend the 10-day period if the
court finds that there is a reasonable expectation that you may find
a physician or health care facility willing to provide life-sustaining
treatment [will be found] if the extension is granted.
*"Life-sustaining
treatment" means treatment that, based on reasonable medical judgment,
sustains the life of a patient and without which the patient will die. The
term includes both life-sustaining medications and artificial life support,
such as mechanical breathing machines, kidney dialysis treatment, and artificially
administered [artificial] nutrition and hydration. The term
does not include the administration of pain management medication or the
performance of a medical procedure considered to be necessary to provide
comfort care, or any other medical care provided to alleviate a patient's
pain.
(b) In cases in which the
attending physician refuses to comply with an advance directive or
treatment decision requesting the withholding or withdrawal of
life-sustaining treatment, the statement required by Section
166.046(b)(3)(A) shall be in substantially the following form:
When There Is A Disagreement
About Medical Treatment: The Physician Recommends Life-Sustaining
Treatment That You Wish To Stop
You have been given this
information because you have requested the withdrawal or withholding of
life-sustaining treatment* for yourself as the patient or on behalf of
the patient, as applicable, and the attending physician disagrees
with and refuses to comply with that request. The information is being
provided to help you understand state law, your rights, and the resources available
to you in such circumstances. It outlines the process for resolving
disagreements about treatment among patients, families, and physicians. It
is based upon Section 166.046 of the Texas Advance Directives Act, codified
in Chapter 166, [of the] Texas Health and Safety Code.
When an attending physician
refuses to comply with an advance directive or other request for withdrawal
or withholding of life-sustaining treatment for any reason, the case will
be reviewed by an ethics or medical committee. Life-sustaining treatment
will be provided through the review.
You will receive notification
of this review at least 48 hours before a meeting of the committee related
to your case. You are entitled to attend the meeting. With your
agreement, the meeting may be held sooner than 48 hours, if possible.
You are entitled to receive a
written explanation of the decision reached during the review process.
If you or the attending
physician do not agree with the decision reached during the review process,
and the attending physician still refuses to comply with your request to
withhold or withdraw life-sustaining treatment, then the following
procedure will occur:
1. The physician, with the
help of the health care facility, will assist you in trying to find a physician
and facility willing to withdraw or withhold the life-sustaining treatment.
2. You are being given a
list of health care providers, licensed physicians, health care
facilities, and referral groups that have volunteered their readiness
to consider accepting transfer, or to assist in locating a provider willing
to accept transfer, maintained by the Department of State [Texas]
Health Services [Care Information Council]. You may wish to
contact providers, facilities, or referral groups on the list or others
of your choice to get help in arranging a transfer.
*"Life-sustaining
treatment" means treatment that, based on reasonable medical judgment,
sustains the life of a patient and without which the patient will die. The
term includes both life-sustaining medications and artificial life support,
such as mechanical breathing machines, kidney dialysis treatment, and artificially
administered [artificial] nutrition and hydration. The term
does not include the administration of pain management medication or the
performance of a medical procedure considered to be necessary to provide
comfort care, or any other medical care provided to alleviate a patient's
pain.
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SECTION 6. Sections
166.052(a) and (b), Health and Safety Code, as amended by S.B. 219, Acts of
the 84th Legislature, Regular Session, 2015, are amended to read as
follows:
(a) In cases in which the
attending physician refuses to honor an advance directive or health care
or treatment decision requesting the provision of life-sustaining
treatment, the statement required by Section 166.046(b)(3)(A) shall be in
substantially the following form:
When There Is A Disagreement
About Medical Treatment: The Physician Recommends Against Certain
Life-Sustaining Treatment That You Wish To Continue
You have been given this
information because you have requested life-sustaining treatment[,]*
for yourself as the patient or on behalf of the patient, as applicable,
which the attending physician believes is not medically
appropriate. This information is being provided to help you understand
state law, your rights, and the resources available to you in such
circumstances. It outlines the process for resolving disagreements about
treatment among patients, families, and physicians. It is based upon
Section 166.046 of the Texas Advance Directives Act, codified in Chapter
166, [of the] Texas Health and Safety Code.
When an attending physician
refuses to comply with an advance directive or other request for
life-sustaining treatment because of the physician's judgment that the
treatment would be medically inappropriate, the case will be
reviewed by an ethics or medical committee. Life-sustaining treatment will
be provided through the review.
You will receive notification
of this review at least 48 hours before a meeting of the committee related
to your case. You are entitled to attend the meeting. With your
agreement, the meeting may be held sooner than 48 hours, if possible.
You are entitled to receive a
written explanation of the decision reached during the review process.
If after this review process
both the attending physician and the ethics or medical committee conclude
that life-sustaining treatment is medically inappropriate and yet
you continue to request such treatment, then the following procedure will
occur:
1. The physician, with the
help of the health care facility, will assist you in trying to find a
physician and facility willing to provide the requested treatment.
2. You are being given a
list of health care providers, licensed physicians, health care facilities,
and referral groups that have volunteered their readiness to consider
accepting transfer, or to assist in locating a provider willing to accept
transfer, maintained by the Department of State Health Services. You may
wish to contact providers, facilities, or referral groups on the
list or others of your choice to get help in arranging a transfer.
3. The patient will continue
to be given life-sustaining treatment until the patient [he or
she] can be transferred to a willing provider for up to 10 days from
the time you were given both
the committee's written decision that life-sustaining treatment is not
appropriate and the patient's medical
record. The patient will
continue to be given after the 10-day period treatment to enhance
pain management and reduce suffering, including artificially administered
nutrition and hydration, unless, based on reasonable medical judgment,
providing artificially administered nutrition and hydration would hasten
the patient's death, be medically
contraindicated such that the provision of the treatment seriously
exacerbates life-threatening medical problems not outweighed by the benefit
of the provision of the treatment, result in substantial
irremediable physical pain not outweighed by the benefit of the provision
of the treatment, be medically ineffective in
prolonging life, or be contrary to the patient's or surrogate's
clearly documented desires.
4. If a transfer can be
arranged, the patient will be responsible for the costs of the transfer.
5. If a provider cannot be
found willing to give the requested treatment within 10 days,
life-sustaining treatment may be withdrawn unless a court of law has
granted an extension.
6. You may ask the
appropriate district or county court to extend the 10-day period if the
court finds that there is a reasonable expectation that you may find
a physician or health care facility willing to provide life-sustaining
treatment [will be found] if the extension is granted. Patient medical records will be provided to the
patient or surrogate in accordance with Section 241.154, Texas Health and
Safety Code.
*"Life-sustaining
treatment" means treatment that, based on reasonable medical judgment,
sustains the life of a patient and without which the patient will die. The
term includes both life-sustaining medications and artificial life support,
such as mechanical breathing machines, kidney dialysis treatment, and artificially
administered [artificial] nutrition and hydration. The term
does not include the administration of pain management medication or the
performance of a medical procedure considered to be necessary to provide
comfort care, or any other medical care provided to alleviate a patient's
pain.
(b) In cases in which the
attending physician refuses to comply with an advance directive or
treatment decision requesting the withholding or withdrawal of
life-sustaining treatment, the statement required by Section
166.046(b)(3)(A) shall be in substantially the following form:
When There Is A Disagreement
About Medical Treatment: The Physician Recommends Life-Sustaining
Treatment That You Wish To Stop
You have been given this
information because you have requested the withdrawal or withholding of
life-sustaining treatment* for yourself as the patient or on behalf of
the patient, as applicable, and the attending physician disagrees
with and refuses to comply with that request. The information is being
provided to help you understand state law, your rights, and the resources
available to you in such circumstances. It outlines the process for
resolving disagreements about treatment among patients, families, and
physicians. It is based upon Section 166.046 of the Texas Advance
Directives Act, codified in Chapter 166, [of the] Texas
Health and Safety Code.
When an attending physician
refuses to comply with an advance directive or other request for withdrawal
or withholding of life-sustaining treatment for any reason, the case will
be reviewed by an ethics or medical committee. Life-sustaining treatment
will be provided through the review.
You will receive notification
of this review at least 48 hours before a meeting of the committee related
to your case. You are entitled to attend the meeting. With your
agreement, the meeting may be held sooner than 48 hours, if possible.
You are entitled to receive a
written explanation of the decision reached during the review process.
If you or the attending
physician do not agree with the decision reached during the review process,
and the attending physician still refuses to comply with your request to withhold
or withdraw life-sustaining treatment, then the following procedure will
occur:
1. The physician, with the
help of the health care facility, will assist you in trying to find a
physician and facility willing to withdraw or withhold the life-sustaining
treatment.
2. You are being given a
list of health care providers, licensed physicians, health care
facilities, and referral groups that have volunteered their readiness
to consider accepting transfer, or to assist in locating a provider willing
to accept transfer, maintained by the Department of State Health Services.
You may wish to contact providers, facilities, or referral groups on
the list or others of your choice to get help in arranging a transfer.
*"Life-sustaining
treatment" means treatment that, based on reasonable medical judgment,
sustains the life of a patient and without which the patient will die. The
term includes both life-sustaining medications and artificial life support,
such as mechanical breathing machines, kidney dialysis treatment, and artificially
administered [artificial] nutrition and hydration. The term
does not include the administration of pain management medication or the
performance of a medical procedure considered to be necessary to provide
comfort care, or any other medical care provided to alleviate a patient's
pain.
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