84R5812 SCL-D
 
  By: Naishtat H.B. No. 3183
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to an advance directive and do-not-resuscitate order of a
  pregnant patient.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 166.033, Health and Safety Code, is
  amended to read as follows:
         Sec. 166.033.  FORM OF WRITTEN DIRECTIVE. A written
  directive may be in the following form:
  DIRECTIVE TO PHYSICIANS AND FAMILY OR SURROGATES
         Instructions for completing this document:
         This is an important legal document known as an Advance
  Directive. It is designed to help you communicate your wishes about
  medical treatment at some time in the future when you are unable to
  make your wishes known because of illness or injury. These wishes
  are usually based on personal values. In particular, you may want
  to consider what burdens or hardships of treatment you would be
  willing to accept for a particular amount of benefit obtained if you
  were seriously ill.
         You are encouraged to discuss your values and wishes with
  your family or chosen spokesperson, as well as your physician. Your
  physician, other health care provider, or medical institution may
  provide you with various resources to assist you in completing your
  advance directive. Brief definitions are listed below and may aid
  you in your discussions and advance planning. Initial the
  treatment choices that best reflect your personal preferences.
  Provide a copy of your directive to your physician, usual hospital,
  and family or spokesperson. Consider a periodic review of this
  document. By periodic review, you can best assure that the
  directive reflects your preferences.
         In addition to this advance directive, Texas law provides for
  two other types of directives that can be important during a serious
  illness. These are the Medical Power of Attorney and the
  Out-of-Hospital Do-Not-Resuscitate Order. You may wish to discuss
  these with your physician, family, hospital representative, or
  other advisers. You may also wish to complete a directive related
  to the donation of organs and tissues.
  DIRECTIVE
         I, __________, recognize that the best health care is based
  upon a partnership of trust and communication with my physician. My
  physician and I will make health care decisions together as long as
  I am of sound mind and able to make my wishes known. If there comes
  a time that I am unable to make medical decisions about myself
  because of illness or injury, I direct that the following treatment
  preferences be honored:
         If, in the judgment of my physician, I am suffering with a
  terminal condition from which I am expected to die within six
  months, even with available life-sustaining treatment provided in
  accordance with prevailing standards of medical care:
 
__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
 
__________ I request that I be kept alive in this terminal condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
  If, in the judgment of my physician, I am suffering with an
  irreversible condition so that I cannot care for myself or make
  decisions for myself and am expected to die without life-sustaining
  treatment provided in accordance with prevailing standards of care:
 
__________ I request that all treatments other than those needed to keep me comfortable be discontinued or withheld and my physician allow me to die as gently as possible; OR
 
__________ I request that I be kept alive in this irreversible condition using available life-sustaining treatment. (THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.)
         Additional requests: (After discussion with your physician,
  you may wish to consider listing particular treatments in this
  space that you do or do not want in specific circumstances, such as
  artificial nutrition and fluids, intravenous antibiotics, etc. Be
  sure to state whether you do or do not want the particular
  treatment.)
 
________________________________________________________________
 
________________________________________________________________
 
________________________________________________________________
         After signing this directive, if my representative or I elect
  hospice care, I understand and agree that only those treatments
  needed to keep me comfortable would be provided and I would not be
  given available life-sustaining treatments.
         If I do not have a Medical Power of Attorney, and I am unable
  to make my wishes known, I designate the following person(s) to make
  treatment decisions with my physician compatible with my personal
  values:
 
1. __________
 
2. __________
         (If a Medical Power of Attorney has been executed, then an
  agent already has been named and you should not list additional
  names in this document.)
         If the above persons are not available, or if I have not
  designated a spokesperson, I understand that a spokesperson will be
  chosen for me following standards specified in the laws of Texas.
  If, in the judgment of my physician, my death is imminent within
  minutes to hours, even with the use of all available medical
  treatment provided within the prevailing standard of care, I
  acknowledge that all treatments may be withheld or removed except
  those needed to maintain my comfort. [I understand that under Texas
  law this directive has no effect if I have been diagnosed as
  pregnant.] This directive will remain in effect until I revoke it.
  No other person may do so.
         Signed__________ Date__________ City, County, State of
  Residence __________
         Two competent adult witnesses must sign below, acknowledging
  the signature of the declarant. The witness designated as Witness 1
  may not be a person designated to make a treatment decision for the
  patient and may not be related to the patient by blood or marriage.
  This witness may not be entitled to any part of the estate and may
  not have a claim against the estate of the patient. This witness
  may not be the attending physician or an employee of the attending
  physician. If this witness is an employee of a health care facility
  in which the patient is being cared for, this witness may not be
  involved in providing direct patient care to the patient. This
  witness may not be an officer, director, partner, or business
  office employee of a health care facility in which the patient is
  being cared for or of any parent organization of the health care
  facility.
         Witness 1 __________ Witness 2 __________
         Definitions:
         "Artificial nutrition and hydration" means the provision of
  nutrients or fluids by a tube inserted in a vein, under the skin in
  the subcutaneous tissues, or in the stomach (gastrointestinal
  tract).
         "Irreversible condition" means a condition, injury, or
  illness:
               (1)  that may be treated, but is never cured or
  eliminated;
               (2)  that leaves a person unable to care for or make
  decisions for the person's own self; and
               (3)  that, without life-sustaining treatment provided
  in accordance with the prevailing standard of medical care, is
  fatal.
         Explanation: Many serious illnesses such as cancer, failure
  of major organs (kidney, heart, liver, or lung), and serious brain
  disease such as Alzheimer's dementia may be considered irreversible
  early on. There is no cure, but the patient may be kept alive for
  prolonged periods of time if the patient receives life-sustaining
  treatments. Late in the course of the same illness, the disease may
  be considered terminal when, even with treatment, the patient is
  expected to die. You may wish to consider which burdens of
  treatment you would be willing to accept in an effort to achieve a
  particular outcome. This is a very personal decision that you may
  wish to discuss with your physician, family, or other important
  persons in your life.
         "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
  artificial hydration and nutrition. The term does not include the
  administration of pain management medication, the performance of a
  medical procedure necessary to provide comfort care, or any other
  medical care provided to alleviate a patient's pain.
         "Terminal condition" means an incurable condition caused by
  injury, disease, or illness that according to reasonable medical
  judgment will produce death within six months, even with available
  life-sustaining treatment provided in accordance with the
  prevailing standard of medical care.
         Explanation: Many serious illnesses may be considered
  irreversible early in the course of the illness, but they may not be
  considered terminal until the disease is fairly advanced. In
  thinking about terminal illness and its treatment, you again may
  wish to consider the relative benefits and burdens of treatment and
  discuss your wishes with your physician, family, or other important
  persons in your life.
         SECTION 2.  Sections 166.049 and 166.098, Health and Safety
  Code, are repealed.
         SECTION 3.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2015.