84R11643 AJZ-F
	By: Hancock	S.B. No. 1163

	A BILL TO BE ENTITLED
	AN ACT
	relating to advance directives and health care and treatment
	decisions.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Section 166.002, Health and Safety Code, is
	amended by adding Subdivision (16) to read as follows:
	(16)  "Reasonable medical judgment" means a medical
	judgment that would be made by a reasonably prudent physician,
	knowledgeable about the case and the treatment possibilities with
	respect to the medical conditions involved.
	SECTION 2.  Sections 166.045(c) and (d), Health and Safety
	Code, are amended to read as follows:
	(c)  If an attending physician refuses to comply with a
	directive or treatment decision for a reason permitted by Section
	166.046(a-1) and not prohibited by Section 166.0455 and does not
	wish to follow the procedure established under Section 166.046,
	life-sustaining treatment shall be provided to the patient, but
	only until a reasonable opportunity has been afforded for the
	transfer of the patient to another physician or health care
	facility willing to comply with the directive or treatment
	decision.
	(d)  A physician, health professional acting under the
	direction of a physician, or health care facility is not civilly or
	criminally liable or subject to review or disciplinary action by
	the person's appropriate licensing board if the person has complied
	with the procedures and limitations outlined in Sections 166.0455
	and [Section] 166.046.
	SECTION 3.  Subchapter B, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.0455 to read as follows:
	Sec. 166.0455.  LIMITATION ON REFUSAL TO EFFECTUATE CERTAIN
	ADVANCE DIRECTIVES OR TREATMENT DECISIONS. A physician or other
	health care professional, a health care facility, or an ethics or
	medical committee shall not override or refuse to honor and comply
	with a patient's advance directive or a health care or treatment
	decision made by or on behalf of a patient that directs the
	provision of life-sustaining treatment and shall not consider
	life-sustaining treatment to be inappropriate treatment under
	Section 166.046 based on:
	(1)  the lesser value the physician or professional,
	facility, or committee places on sustaining the life of an elderly,
	disabled, or terminally ill patient compared to the value of
	sustaining the life of a patient who is younger, not disabled, or
	not terminally ill; or
	(2)  a disagreement between the physician or
	professional, facility, or committee and the patient, or the person
	authorized to make a treatment decision for the patient under
	Section 166.039, over the greater weight the patient or person
	places on sustaining the patient's life than the risk of
	disability.
	SECTION 4.  Section 166.046, Health and Safety Code, is
	amended by amending Subsections (a) and (g) and adding Subsections
	(a-1) and (c-1) to read as follows:
	(a)  If an attending physician refuses to honor or comply
	with a patient's advance directive or a health care or treatment
	decision made by or on behalf of a patient for a reason permitted by
	Subsection (a-1) and not prohibited by Section 166.0455, the
	physician's refusal shall be reviewed by an ethics or medical
	committee. The attending physician may not be a member of that
	committee. The patient shall be given life-sustaining treatment
	during the review. A person may not coerce or attempt to coerce a
	physician not to comply with a patient's advance directive or a
	health care or treatment decision made by or on behalf of a patient
	by threatening or implementing adverse employment decisions or
	professional discipline.
	(a-1)  The ethics or medical committee reviewing the
	physician's refusal under Subsection (a) shall not consider
	life-sustaining treatment inappropriate unless, based on
	reasonable medical judgment, the life-sustaining treatment
	requested by or on behalf of the patient is:
	(1)  futile because the treatment is physiologically
	ineffective in achieving the specific intended benefit to the
	patient as intended by or on behalf of the patient; or
	(2)  medically inappropriate because providing the
	treatment to the patient would clearly create a substantially
	greater risk of causing or hastening the death of the patient than
	would withholding or withdrawing the treatment.
	(c-1)  The ethics or medical committee shall not approve
	withdrawing or withholding life-sustaining treatment if the ethics
	or medical committee determines during the review described by
	Subsection (a) that the physician refused to honor a patient's
	advance directive or a health care or treatment decision made by or
	on behalf of the patient for a reason prohibited by Section
	166.0455.
	(g)  At the request of the patient or the person responsible
	for the health care decisions of the patient, the appropriate
	[district or county] court shall extend the time period provided
	under Subsection (e) [only] if the court finds, by a preponderance
	of the evidence, that there is a reasonable expectation that a
	physician or health care facility that will honor the patient's
	directive will be found if the time extension is granted.
	SECTION 5.  Subchapter B, Chapter 166, Health and Safety
	Code, is amended by adding Section 166.0465 to read as follows:
	Sec. 166.0465.  COURT PROCEEDINGS; APPEAL; FILING FEE AND
	COURT COSTS. (a) A patient, the person responsible for the
	patient's health care decisions, or the person who has made the
	decision regarding the advance directive or treatment decision may
	file a motion for injunctive relief in any county court at law,
	court having probate jurisdiction, or district court, including a
	family district court, based on:
	(1)  a request for extension of time to effect a patient
	transfer for relief under Section 166.046(g); or
	(2)  an allegation that a physician or other health
	care professional, health care facility, or ethics or medical
	committee is violating or threatening to violate this chapter.
	(b)  The person filing a motion under Subsection (a) shall
	immediately serve a copy of the motion on the defendant.
	(c)  The court shall promptly set a time for a hearing on a
	motion filed under Subsection (a) and shall keep a record of all
	testimony and other oral proceedings in the action. The court shall
	rule on the motion and issue written findings of fact and
	conclusions of law not later than the fifth business day after the
	date the motion is filed with the court.
	(d)  The time for the hearing and the date by which the court
	must rule on the motion under Subsection (c) may be extended, for
	good cause shown, by the court.
	(e)  Any party may appeal the decision of the court under
	Subsection (c) to the court of appeals having jurisdiction over
	civil matters in the county in which the motion was filed by filing
	a notice of appeal with the clerk of the court that ruled on the
	motion not later than the first business day after the date the
	decision of the court was issued.
	(f)  On receipt of a notice of appeal under Subsection (e),
	the clerk of the court that ruled on the motion shall deliver a copy
	of the notice of appeal and record on appeal to the clerk of the
	court of appeals. On receipt of the notice and record, the clerk of
	the court of appeals shall place the appeal on the docket of the
	court, and the court of appeals shall promptly issue an expedited
	briefing schedule and set a time for a hearing.
	(g)  The court of appeals shall rule on an appeal under
	Subsection (f) not later than the fifth business day after the date
	the notice of appeal is filed with the court that ruled on the
	motion.
	(h)  The times for the filing of briefs, the hearing, and the
	date by which the court of appeals must rule on the appeal under
	Subsection (g) may be extended, for good cause shown, by the court
	of appeals.
	(i)  Any party may file a petition for review of the decision
	of the court of appeals under Subsection (g) with the clerk of the
	supreme court not later than the third business day after the date
	the decision of the court of appeals was issued. Other parties may
	file responses not later than the third business day after the date
	the petition for review was filed. The supreme court shall grant,
	deny, refuse, or dismiss the petition, without regard to whether a
	reply to any response has been filed, not later than the third
	business day after the date the response was due. If the supreme
	court grants the petition for review, the court shall exercise the
	court's sound discretion in determining how expeditiously to hear
	and decide the case.
	(j)  If a motion is filed under Subsection (a) and the
	dispute concerns whether life-sustaining treatment should be
	provided to the patient, life-sustaining treatment must be provided
	through midnight of the day by which a notice of appeal must be
	filed unless the court directs that the life-sustaining treatment
	be provided for a longer period. If a notice of appeal under
	Subsection (e) is filed, life-sustaining treatment must be provided
	through midnight of the day by which a petition for review to the
	supreme court must be filed, unless the court of appeals directs
	that the life-sustaining treatment be provided for a longer period.
	If a petition for review to the supreme court is filed under
	Subsection (i), life-sustaining treatment must be provided through
	midnight of the day on which the supreme court denies, refuses, or
	dismisses the petition or issues a ruling on the merits, unless the
	supreme court directs that the life-sustaining treatment be
	provided for a longer period.
	(k)  A filing fee or court cost may not be assessed for any
	proceeding in a trial or appellate court under this section.
	SECTION 6.  Section 166.051, Health and Safety Code, is
	amended to read as follows:
	Sec. 166.051.  LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.
	This subchapter does not impair or supersede any legal right or
	responsibility a person may have to effect the withholding or
	withdrawal of life-sustaining treatment in a lawful manner,
	provided that if an attending physician or health care facility is
	unwilling to honor and comply with a patient's advance directive or
	a treatment decision to provide life-sustaining treatment for a
	reason permitted by Section 166.046(a-1) and not prohibited by
	Section 166.0455, life-sustaining treatment is required to be
	provided the patient, but only until a reasonable opportunity has
	been afforded for transfer of the patient to another physician or
	health care facility willing to comply with the advance directive
	or treatment decision.
	SECTION 7.  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 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 Life-Sustaining Treatment That You
	Wish To Continue
	You have been given this information because you have
	requested life-sustaining treatment,* which the attending
	physician believes is not 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 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.
	A physician or other health care professional, a health care
	facility, or an ethics or medical committee may not deny a patient
	life-sustaining treatment based on:
	1.  the lesser value the physician or professional,
	facility, or committee places on sustaining the life of an elderly,
	disabled, or terminally ill patient compared to the value of
	sustaining the life of a patient who is younger, not disabled, or
	not terminally ill; or
	2.  a disagreement between the physician or professional,
	facility, or committee and the patient, or the person authorized to
	make a treatment decision for the patient under Section 166.039,
	over the greater weight the patient or person places on sustaining
	the patient's life than the risk of disability.
	Life-sustaining treatment may be denied if the treatment is:
	1.  futile because the treatment is physiologically
	ineffective in achieving the specific intended benefit to the
	patient as intended by or on behalf of the patient; or
	2.  medically inappropriate because providing the treatment
	to the patient would clearly create a substantially greater risk of
	causing or hastening the death of the patient than would
	withholding or withdrawing it.
	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 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 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 Texas Health Care Information
	Council. You may wish to contact providers 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 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 ruled otherwise [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 a physician or health care facility
	willing to provide life-sustaining treatment will be found if the
	extension is granted.
	7.  The law gives you the right to seek a court order to
	require a physician or other health care professional, health care
	facility, or ethics or medical committee to comply with your rights
	under the Texas Advance Directives Act if the physician or
	professional, facility, or committee is violating or threatening to
	violate a provision of that Act. You may wish to talk to legal
	counsel for further information about your right to seek a court
	order.
	*"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 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* and the attending physician 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 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 Texas Health Care Information
	Council. You may wish to contact providers or referral groups on
	the list or others of your choice to get help in arranging a
	transfer.
	3.  The law gives you a right to seek a court order to require
	a physician or other health care professional, health care
	facility, or ethics or medical committee to comply with your rights
	under the Texas Advance Directives Act if the physician, facility,
	or committee is violating or threatening to violate a provision of
	that Act. You may wish to talk to legal counsel for further
	information about your right to seek a court order.
	*"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 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.
	SECTION 8.  Section 166.158(c), Health and Safety Code, is
	amended to read as follows:
	(c)  A principal's health or residential care provider who
	finds it impossible to follow a directive by the agent because of a
	conflict with this subchapter or the medical power of attorney
	shall inform the agent as soon as is reasonably possible. The agent
	may select another attending physician. The procedures and
	limitations established under Sections 166.045, 166.0455, and
	166.046 apply if the agent's directive concerns providing,
	withholding, or withdrawing life-sustaining treatment.
	SECTION 9.  Section 166.166, Health and Safety Code, is
	amended to read as follows:
	Sec. 166.166.  OTHER RIGHTS OR RESPONSIBILITIES NOT
	AFFECTED. This subchapter does not limit or impair any legal right
	or responsibility that any person, including a physician or health
	or residential care provider, may have to make or implement health
	care decisions on behalf of a person, provided that if an attending
	physician or health care facility is unwilling to honor and comply
	with a patient's advance directive or a treatment decision to
	provide life-sustaining treatment for a reason permitted by Section
	166.046(a-1) and not prohibited by Section 166.0455,
	life-sustaining treatment is required to be provided the patient,
	but only until a reasonable opportunity has been afforded for
	transfer of the patient to another physician or health care
	facility willing to comply with the advance directive or treatment
	decision.
	SECTION 10.  Not later than December 1, 2015, the Supreme
	Court of Texas shall issue the rules and prescribe the forms
	necessary for the process established by Section 166.0465, Health
	and Safety Code, as added by this Act. The rules shall prescribe
	the method of service of the application under Section 166.0465,
	Health and Safety Code, and may require filing and service of
	notices, petitions, and briefs electronically to the extent the
	Supreme Court of Texas considers appropriate.
	SECTION 11.  The changes in law made by this Act apply only
	to a health care or treatment decision made on or after the
	effective date of this Act.
	SECTION 12.  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.