Texas Futile Care Law Bush signed in its totality

HEALTH & SAFETY CODE

CHAPTER 166. ADVANCE DIRECTIVES

SUBCHAPTER A. GENERAL PROVISIONS


§ 166.001. SHORT TITLE. This chapter may be cited as
the Advance Directives Act.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.002. DEFINITIONS. In this chapter:
(1) "Advance directive" means:
(A) a directive, as that term is defined by
Section 166.031;
(B) an out-of-hospital DNR order, as that term is
defined by Section 166.081; or
(C) a medical power of attorney under Subchapter
D.
(2) "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).
(3) "Attending physician" means a physician selected
by or assigned to a patient who has primary responsibility for a
patient's treatment and care.
(4) "Competent" means possessing the ability, based on
reasonable medical judgment, to understand and appreciate the
nature and consequences of a treatment decision, including the
significant benefits and harms of and reasonable alternatives to a
proposed treatment decision.
(5) "Declarant" means a person who has executed or
issued a directive under this chapter.
(6) "Ethics or medical committee" means a committee
established under Sections 161.031-161.033.
(7) "Health care or treatment decision" means consent,
refusal to consent, or withdrawal of consent to health care,
treatment, service, or a procedure to maintain, diagnose, or treat
an individual's physical or mental condition, including such a
decision on behalf of a minor.
(8) "Incompetent" means lacking the ability, based on
reasonable medical judgment, to understand and appreciate the
nature and consequences of a treatment decision, including the
significant benefits and harms of and reasonable alternatives to a
proposed treatment decision.
(9) "Irreversible condition" means a condition,
injury, or illness:
(A) that may be treated but is never cured or
eliminated;
(B) that leaves a person unable to care for or
make decisions for the person's own self; and
(C) that, without life-sustaining treatment
provided in accordance with the prevailing standard of medical
care, is fatal.
(10) "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.
(11) "Medical power of attorney" means a document
delegating to an agent authority to make health care decisions
executed or issued under Subchapter D.
(12) "Physician" means:
(A) a physician licensed by the Texas State Board of Medical Examiners; or
(B) a properly credentialed physician who holds a commission in the uniformed services of the United States and who is serving on active duty in this state.
(13) "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. A patient
who has been admitted to a program under which the person receives
hospice services provided by a home and community support services
agency licensed under Chapter 142 is presumed to have a terminal
condition for purposes of this chapter.
(14) "Witness" means a person who may serve as a
witness under Section 166.003.
(15) "Cardiopulmonary resuscitation" means any
medical intervention used to restore circulatory or respiratory
function that has ceased.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999. Amended by Acts 2003, 78th Leg., ch. 1228, § 1, eff. June
20, 2003.


§ 166.003. WITNESSES. In any circumstance in which this
chapter requires the execution of an advance directive or the
issuance of a nonwritten advance directive to be witnessed:
(1) each witness must be a competent adult; and
(2) at least one of the witnesses must be a person who is not:
(A) a person designated by the declarant to make a treatment decision;
(B) a person related to the declarant by blood or marriage;
(C) a person entitled to any part of the
declarant's estate after the declarant's death under a will or
codicil executed by the declarant or by operation of law;
(D) the attending physician;
(E) an employee of the attending physician;
(F) an employee of a health care facility in
which the declarant is a patient if the employee is providing direct
patient care to the declarant or is an officer, director, partner,
or business office employee of the health care facility or of any
parent organization of the health care facility; or
(G) a person who, at the time the written advance directive is executed or, if the directive is a nonwritten
directive issued under this chapter, at the time the nonwritten
directive is issued, has a claim against any part of the declarant's
estate after the declarant's death.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.004. STATEMENT RELATING TO ADVANCE
DIRECTIVE. (a) In this section, "health care provider" means:
(1) a hospital;
(2) an institution licensed under Chapter 242,
including a skilled nursing facility;
(3) a home and community support services agency;
(4) a personal care facility; and
(5) a special care facility.
(b) A health care provider shall maintain written policies
regarding the implementation of advance directives. The policies
must include a clear and precise statement of any procedure the
health care provider is unwilling or unable to provide or withhold
in accordance with an advance directive.
(c) Except as provided by Subsection (g), the health care
provider shall provide written notice to an individual of the
written policies described by Subsection (b). The notice must be
provided at the earlier of:
(1) the time the individual is admitted to receive
services from the health care provider; or
(2) the time the health care provider begins providing care to the individual.
(d) If, at the time notice is to be provided under
Subsection (c), the individual is incompetent or otherwise
incapacitated and unable to receive the notice required by this
section, the provider shall provide the required written notice, in
the following order of preference, to:
(1) the individual's legal guardian;
(2) a person responsible for the health care decisions of the individual;
(3) the individual's spouse;
(4) the individual's adult child;
(5) the individual's parent; or
(6) the person admitting the individual.
(e) If Subsection (d) applies and except as provided by
Subsection (f), if a health care provider is unable, after diligent
search, to locate an individual listed by Subsection (d), the
health care provider is not required to provide the notice.
(f) If an individual who was incompetent or otherwise
incapacitated and unable to receive the notice required by this
section at the time notice was to be provided under Subsection (c)
later becomes able to receive the notice, the health care provider
shall provide the written notice at the time the individual becomes
able to receive the notice.
(g) This section does not apply to outpatient hospital
services, including emergency services.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.005. ENFORCEABILITY OF ADVANCE DIRECTIVES
EXECUTED IN ANOTHER JURISDICTION. An advance directive or similar
instrument validly executed in another state or jurisdiction shall
be given the same effect as an advance directive validly executed
under the law of this state. This section does not authorize the
administration, withholding, or withdrawal of health care
otherwise prohibited by the laws of this state.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.006. EFFECT OF ADVANCE DIRECTIVE ON INSURANCE
POLICY AND PREMIUMS. (a) The fact that a person has executed or
issued an advance directive does not:
(1) restrict, inhibit, or impair in any manner the
sale, procurement, or issuance of a life insurance policy to that
person; or
(2) modify the terms of an existing life insurance
policy.
(b) Notwithstanding the terms of any life insurance policy,
the fact that life-sustaining treatment is withheld or withdrawn
from an insured qualified patient under this chapter does not
legally impair or invalidate that person's life insurance policy
and may not be a factor for the purpose of determining, under the
life insurance policy, whether benefits are payable or the cause of
death.
(c) The fact that a person has executed or issued or failed
to execute or issue an advance directive may not be considered in
any way in establishing insurance premiums.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.007. EXECUTION OF ADVANCE DIRECTIVE MAY NOT BE
REQUIRED. A physician, health facility, health care provider,
insurer, or health care service plan may not require a person to
execute or issue an advance directive as a condition for obtaining
insurance for health care services or receiving health care
services.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.008. CONFLICT BETWEEN ADVANCE DIRECTIVES. To the
extent that a treatment decision or an advance directive validly
executed or issued under this chapter conflicts with another
treatment decision or an advance directive executed or issued under
this chapter, the treatment decision made or instrument executed
later in time controls.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.009. CERTAIN LIFE-SUSTAINING TREATMENT NOT
REQUIRED. This chapter may not be construed to require the
provision of life-sustaining treatment that cannot be provided to a
patient without denying the same treatment to another patient.

Added by Acts 1999, 76th Leg., ch. 450, § 1.02, eff. Sept. 1,
1999.


§ 166.010. APPLICABILITY OF FEDERAL LAW RELATING TO
CHILD ABUSE AND NEGLECT. This chapter is subject to applicable
federal law and regulations relating to child abuse and neglect to
the extent applicable to the state based on its receipt of federal
funds.

Added by Acts 2003, 78th Leg., ch. 1228, § 2, eff. June 20, 2003.
SUBCHAPTER B. DIRECTIVE TO PHYSICIANS



§ 166.031. DEFINITIONS. In this subchapter:
(1) "Directive" means an instruction made under
Section 166.032, 166.034, or 166.035 to administer, withhold, or
withdraw life-sustaining treatment in the event of a terminal or
irreversible condition.
(2) "Qualified patient" means a patient with a
terminal or irreversible condition that has been diagnosed and
certified in writing by the attending physician.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1991, 72nd Leg., ch. 14, § 208, eff. Sept. 1, 1991; Acts
1993, 73rd Leg., ch. 107, § 5.04, eff. Aug. 30, 1993. Renumbered
from § 672.002 and amended by Acts 1999, 76th Leg., ch. 450, §
1.03, eff. Sept. 1, 1999.


§ 166.032. WRITTEN DIRECTIVE BY COMPETENT ADULT; NOTICE
TO PHYSICIAN. (a) A competent adult may at any time execute a
written directive.
(b) The declarant must sign the directive in the presence of
two witnesses who qualify under Section 166.003, at least one of
whom must be a witness who qualifies under Section 166.003(2). The
witnesses must sign the directive.
(c) A declarant may include in a directive directions other
than those provided by Section 166.033 and may designate in a
directive a person to make a treatment decision for the declarant in
the event the declarant becomes incompetent or otherwise mentally
or physically incapable of communication.
(d) A declarant shall notify the attending physician of the
existence of a written directive. If the declarant is incompetent
or otherwise mentally or physically incapable of communication,
another person may notify the attending physician of the existence
of the written directive. The attending physician shall make the
directive a part of the declarant's medical record.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1991, 72nd Leg., ch. 14, § 209, eff. Sept. 1, 1991; Acts
1997, 75th Leg., ch. 291, § 1, eff. Jan. 1, 1998. Renumbered
from § 672.003 and amended by Acts 1999, 76th Leg., ch. 450, §
1.03, eff. Sept. 1, 1999.


§ 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.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1991, 72nd Leg., ch. 14, § 209, eff. Sept. 1, 1991; Acts
1997, 75th Leg., ch. 291, § 2, eff. Jan. 1, 1998. Renumbered
from § 672.004 and amended by Acts 1999, 76th Leg., ch. 450, §
1.03, eff. Sept. 1, 1999.


§ 166.034. ISSUANCE OF NONWRITTEN DIRECTIVE BY COMPETENT
ADULT QUALIFIED PATIENT. (a) A competent qualified patient who
is an adult may issue a directive by a nonwritten means of
communication.
(b) A declarant must issue the nonwritten directive in the
presence of the attending physician and two witnesses who qualify
under Section 166.003, at least one of whom must be a witness who
qualifies under Section 166.003(2).
(c) The physician shall make the fact of the existence of
the directive a part of the declarant's medical record, and the
names of the witnesses shall be entered in the medical record.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.005 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.035. EXECUTION OF DIRECTIVE ON BEHALF OF PATIENT
YOUNGER THAN 18 YEARS OF AGE. The following persons may execute a
directive on behalf of a qualified patient who is younger than 18
years of age:
(1) the patient's spouse, if the spouse is an adult;
(2) the patient's parents; or
(3) the patient's legal guardian.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.006 by Acts 1999, 76th Leg., ch. 450, §
1.03, eff. Sept. 1, 1999.


§ 166.036. NOTARIZED DOCUMENT NOT REQUIRED; REQUIREMENT
OF SPECIFIC FORM PROHIBITED. (a) A written directive executed
under Section 166.033 or 166.035 is effective without regard to
whether the document has been notarized.
(b) A physician, health care facility, or health care
professional may not require that:
(1) a directive be notarized; or
(2) a person use a form provided by the physician,
health care facility, or health care professional.

Added by Acts 1999, 76th Leg., ch. 450, § 1.03, eff. Sept. 1,
1999.


§ 166.037. PATIENT DESIRE SUPERSEDES DIRECTIVE. The
desire of a qualified patient, including a qualified patient
younger than 18 years of age, supersedes the effect of a directive.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.007 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.038. PROCEDURE WHEN DECLARANT IS INCOMPETENT OR
INCAPABLE OF COMMUNICATION. (a) This section applies when an
adult qualified patient has executed or issued a directive and is
incompetent or otherwise mentally or physically incapable of
communication.
(b) If the adult qualified patient has designated a person
to make a treatment decision as authorized by Section 166.032(c),
the attending physician and the designated person may make a
treatment decision in accordance with the declarant's directions.
(c) If the adult qualified patient has not designated a
person to make a treatment decision, the attending physician shall
comply with the directive unless the physician believes that the
directive does not reflect the patient's present desire.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from 672.008 and amended by Acts 1999, 76th Leg., ch.
450, § 1.03, eff. Sept. 1, 1999.


§ 166.039. PROCEDURE WHEN PERSON HAS NOT EXECUTED OR
ISSUED A DIRECTIVE AND IS INCOMPETENT OR INCAPABLE OF
COMMUNICATION. (a) If an adult qualified patient has not
executed or issued a directive and is incompetent or otherwise
mentally or physically incapable of communication, the attending
physician and the patient's legal guardian or an agent under a
medical power of attorney may make a treatment decision that may
include a decision to withhold or withdraw life-sustaining
treatment from the patient.
(b) If the patient does not have a legal guardian or an agent
under a medical power of attorney, the attending physician and one
person, if available, from one of the following categories, in the
following priority, may make a treatment decision that may include
a decision to withhold or withdraw life-sustaining treatment:
(1) the patient's spouse;
(2) the patient's reasonably available adult children;
(3) the patient's parents; or
(4) the patient's nearest living relative.
(c) A treatment decision made under Subsection (a) or (b)
must be based on knowledge of what the patient would desire, if
known.
(d) A treatment decision made under Subsection (b) must be
documented in the patient's medical record and signed by the
attending physician.
(e) If the patient does not have a legal guardian and a
person listed in Subsection (b) is not available, a treatment
decision made under Subsection (b) must be concurred in by another
physician who is not involved in the treatment of the patient or who
is a representative of an ethics or medical committee of the health
care facility in which the person is a patient.
(f) The fact that an adult qualified patient has not
executed or issued a directive does not create a presumption that
the patient does not want a treatment decision to be made to
withhold or withdraw life-sustaining treatment.
(g) A person listed in Subsection (b) who wishes to
challenge a treatment decision made under this section must apply
for temporary guardianship under Section 875, Texas Probate Code.
The court may waive applicable fees in that proceeding.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1997, 75th Leg., ch. 291, § 3, eff. Jan. 1, 1998.
Renumbered from § 672.009 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.040. PATIENT CERTIFICATION AND PREREQUISITES FOR
COMPLYING WITH DIRECTIVE. (a) An attending physician who has
been notified of the existence of a directive shall provide for the
declarant's certification as a qualified patient on diagnosis of a
terminal or irreversible condition.
(b) Before withholding or withdrawing life-sustaining
treatment from a qualified patient under this subchapter, the
attending physician must determine that the steps proposed to be
taken are in accord with this subchapter and the patient's existing
desires.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989. Amended
by Acts 1991, 72nd Leg., 1st C.S., ch. 14, § 6.01, eff. Nov. 12,
1991. Renumbered from § 672.010 and amended by Acts 1999, 76th
Leg., ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.041. DURATION OF DIRECTIVE. A directive is
effective until it is revoked as prescribed by Section 166.042.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.011 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.042. REVOCATION OF DIRECTIVE. (a) A declarant
may revoke a directive at any time without regard to the declarant's
mental state or competency. A directive may be revoked by:
(1) the declarant or someone in the declarant's
presence and at the declarant's direction canceling, defacing,
obliterating, burning, tearing, or otherwise destroying the
directive;
(2) the declarant signing and dating a written
revocation that expresses the declarant's intent to revoke the
directive; or
(3) the declarant orally stating the declarant's
intent to revoke the directive.
(b) A written revocation executed as prescribed by Subsection (a)(2) takes effect only when the declarant or a person
acting on behalf of the declarant notifies the attending physician
of its existence or mails the revocation to the attending
physician. The attending physician or the physician's designee
shall record in the patient's medical record the time and date when
the physician received notice of the written revocation and shall
enter the word "VOID" on each page of the copy of the directive in
the patient's medical record.
(c) An oral revocation issued as prescribed by Subsection
(a)(3) takes effect only when the declarant or a person acting on
behalf of the declarant notifies the attending physician of the
revocation. The attending physician or the physician's designee
shall record in the patient's medical record the time, date, and
place of the revocation, and, if different, the time, date, and
place that the physician received notice of the revocation. The
attending physician or the physician's designees shall also enter
the word "VOID" on each page of the copy of the directive in the
patient's medical record.
(d) Except as otherwise provided by this subchapter, a
person is not civilly or criminally liable for failure to act on a
revocation made under this section unless the person has actual
knowledge of the revocation.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.012 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.043. REEXECUTION OF DIRECTIVE. A declarant may at
any time reexecute a directive in accordance with the procedures
prescribed by Section 166.032, including reexecution after the
declarant is diagnosed as having a terminal or irreversible
condition.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.013 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.044. LIMITATION OF LIABILITY FOR WITHHOLDING OR
WITHDRAWING LIFE-SUSTAINING PROCEDURES. (a) A physician or
health care facility that causes life-sustaining treatment to be
withheld or withdrawn from a qualified patient in accordance with
this subchapter is not civilly liable for that action unless the
physician or health care facility fails to exercise reasonable care
when applying the patient's advance directive.
(b) A health professional, acting under the direction of a
physician, who participates in withholding or withdrawing
life-sustaining treatment from a qualified patient in accordance
with this subchapter is not civilly liable for that action unless
the health professional fails to exercise reasonable care when
applying the patient's advance directive.
(c) A physician, or a health professional acting under the
direction of a physician, who participates in withholding or
withdrawing life-sustaining treatment from a qualified patient in
accordance with this subchapter is not criminally liable or guilty
of unprofessional conduct as a result of that action unless the
physician or health professional fails to exercise reasonable care
when applying the patient's advance directive.
(d) The standard of care that a physician, health care
facility, or health care professional shall exercise under this
section is that degree of care that a physician, health care
facility, or health care professional, as applicable, of ordinary
prudence and skill would have exercised under the same or similar
circumstances in the same or a similar community.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.015 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.045. LIABILITY FOR FAILURE TO EFFECTUATE
DIRECTIVE. (a) A physician, health care facility, or health care
professional who has no knowledge of a directive is not civilly or
criminally liable for failing to act in accordance with the
directive.
(b) A physician, or a health professional acting under the
direction of a physician, is subject to review and disciplinary
action by the appropriate licensing board for failing to effectuate
a qualified patient's directive in violation of this subchapter or
other laws of this state. This subsection does not limit remedies
available under other laws of this state.
(c) If an attending physician refuses to comply with a
directive or treatment decision 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 outlined in Section 166.046.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.016 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.046. PROCEDURE IF NOT EFFECTUATING A DIRECTIVE OR
TREATMENT DECISION. (a) If an attending physician refuses to
honor a patient's advance directive or a health care or treatment
decision made by or on behalf of a patient, 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.
(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 Texas Health Care Information Council 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) The written explanation required by Subsection
(b)(2)(B) must be included in the patient's medical record.
(d) If the attending physician, the patient, or the person
responsible for the health care decisions of the individual does
not agree with the decision reached during the review process under
Subsection (b), the physician shall make a reasonable effort to
transfer the patient to a physician who is willing to comply with
the directive. If the patient is a patient in a health care
facility, the facility's personnel shall assist the physician in
arranging the patient's transfer to:
(1) another physician;
(2) an alternative care setting within that facility;
or
(3) another facility.
(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 review
process has affirmed is inappropriate treatment, the patient shall
be given available life-sustaining treatment pending transfer
under Subsection (d). The patient is responsible for any costs
incurred in transferring the patient to another facility. The
physician 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).
(e-1) If during a previous admission to a facility a
patient's attending physician and the review process under
Subsection (b) have determined that life-sustaining treatment is
inappropriate, and the patient is readmitted to the same facility
within six months from the date of the decision reached during the
review process conducted upon the previous admission, Subsections
(b) through (e) need not be followed if the patient's attending
physician and a consulting physician who is a member of the ethics
or medical committee of the facility document on the patient's
readmission that the patient's condition either has not improved or
has deteriorated since the review process was conducted.
(f) Life-sustaining treatment under this section may not be
entered in the patient's medical record as medically unnecessary
treatment until the time period provided under Subsection (e) has
expired.
(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.
(h) This section may not be construed to impose an
obligation on a facility or a home and community support services
agency licensed under Chapter 142 or similar organization that is
beyond the scope of the services or resources of the facility or
agency. This section does not apply to hospice services provided by
a home and community support services agency licensed under Chapter
142.

Added by Acts 1999, 76th Leg., ch. 450, § 1.03, eff. Sept. 1,
1999. Amended by Acts 2003, 78th Leg., ch. 1228, § 3, 4, eff.
June 20, 2003.


§ 166.047. HONORING DIRECTIVE DOES NOT CONSTITUTE
OFFENSE OF AIDING SUICIDE. A person does not commit an offense
under Section 22.08, Penal Code, by withholding or withdrawing
life-sustaining treatment from a qualified patient in accordance
with this subchapter.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.017 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.048. CRIMINAL PENALTY; PROSECUTION. (a) A
person commits an offense if the person intentionally conceals,
cancels, defaces, obliterates, or damages another person's
directive without that person's consent. An offense under this
subsection is a Class A misdemeanor.
(b) A person is subject to prosecution for criminal homicide
under Chapter 19, Penal Code, if the person, with the intent to
cause life-sustaining treatment to be withheld or withdrawn from
another person contrary to the other person's desires, falsifies or
forges a directive or intentionally conceals or withholds personal
knowledge of a revocation and thereby directly causes
life-sustaining treatment to be withheld or withdrawn from the
other person with the result that the other person's death is
hastened.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.018 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.049. PREGNANT PATIENTS. A person may not withdraw
or withhold life-sustaining treatment under this subchapter from a
pregnant patient.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.019 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.050. MERCY KILLING NOT CONDONED. This subchapter
does not condone, authorize, or approve mercy killing or permit an
affirmative or deliberate act or omission to end life except to
permit the natural process of dying as provided by this subchapter.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.020 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 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 a patient's advance directive or a treatment
decision to provide life-sustaining treatment, 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.

Acts 1989, 71st Leg., ch. 678, § 1, eff. Sept. 1, 1989.
Renumbered from § 672.021 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.03, eff. Sept. 1, 1999.


§ 166.052. STATEMENTS EXPLAINING PATIENT'S RIGHT TO
TRANSFER. (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)(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.
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 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.

*"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.

*"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.
(c) An attending physician or health care facility may, if
it chooses, include any additional information concerning the
physician's or facility's policy, perspective, experience, or
review procedure.

Added by Acts 2003, 78th Leg., ch. 1228, § 5, eff. June 20, 2003.


§ 166.053. REGISTRY TO ASSIST TRANSFERS. (a) The
Texas Health Care Information Council shall maintain a registry
listing the identity of and contact information for health care
providers and referral groups, situated inside and outside this
state, that have voluntarily notified the council they may consider
accepting or may assist in locating a provider willing to accept
transfer of a patient under Section 166.045 or 166.046.
(b) The listing of a provider or referral group in the
registry described in this section does not obligate the provider
or group to accept transfer of or provide services to any particular
patient.
(c) The Texas Health Care Information Council shall post the
current registry list on its website in a form appropriate for easy
comprehension by patients and persons responsible for the health
care decisions of patients and shall provide a clearly identifiable
link from its home page to the registry page. The list shall
separately indicate those providers and groups that have indicated
their interest in assisting the transfer of:
(1) those patients on whose behalf life-sustaining
treatment is being sought;
(2) those patients on whose behalf the withholding or
withdrawal of life-sustaining treatment is being sought; and
(3) patients described in both Subdivisions (1) and
(2).
(d) The registry list described in this section shall
include the following disclaimer:
"This registry lists providers and groups that have
indicated to the Texas Health Care Information Council their
interest in assisting the transfer of patients in the circumstances
described, and is provided for information purposes only. Neither
the Texas Health Care Information Council nor the State of Texas
endorses or assumes any responsibility for any representation,
claim, or act of the listed providers or groups."

Added by Acts 2003, 78th Leg., ch. 1228, § 5, eff. June 20, 2003.
SUBCHAPTER C. OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDERS



§ 166.081. DEFINITIONS. In this subchapter:
(1) Repealed by Acts 2003, 78th Leg., ch. 1228, § 8.
(2) "DNR identification device" means an
identification device specified by the board under Section 166.101
that is worn for the purpose of identifying a person who has
executed or issued an out-of-hospital DNR order or on whose behalf
an out-of-hospital DNR order has been executed or issued under this
subchapter.
(3) "Emergency medical services" has the meaning
assigned by Section 773.003.
(4) "Emergency medical services personnel" has the
meaning assigned by Section 773.003.
(5) "Health care professionals" means physicians,
physician assistants, nurses, and emergency medical services
personnel and, unless the context requires otherwise, includes
hospital emergency personnel.
(6) "Out-of-hospital DNR order":
(A) means a legally binding out-of-hospital
do-not-resuscitate order, in the form specified by the board under
Section 166.083, prepared and signed by the attending physician of
a person, that documents the instructions of a person or the
person's legally authorized representative and directs health care
professionals acting in an out-of-hospital setting not to initiate
or continue the following life-sustaining treatment:
(i) cardiopulmonary resuscitation;
(ii) advanced airway management;
(iii) artificial ventilation;
(iv) defibrillation;
(v) transcutaneous cardiac pacing; and
(vi) other life-sustaining treatment
specified by the board under Section 166.101(a); and
(B) does not include authorization to withhold medical interventions or therapies considered necessary to provide comfort care or to alleviate pain or to provide water or nutrition.
(7) "Out-of-hospital setting" means a location in
which health care professionals are called for assistance,
including long-term care facilities, in-patient hospice
facilities, private homes, hospital outpatient or emergency
departments, physician's offices, and vehicles during transport.
(8) "Proxy" means a person designated and authorized
by a directive executed or issued in accordance with Subchapter B to
make a treatment decision for another person in the event the other
person becomes incompetent or otherwise mentally or physically
incapable of communication.
(9) "Qualified relatives" means those persons
authorized to execute or issue an out-of-hospital DNR order on
behalf of a person who is incompetent or otherwise mentally or
physically incapable of communication under Section 166.088.
(10) "Statewide out-of-hospital DNR protocol" means a
set of statewide standardized procedures adopted by the board under
Section 166.101(a) for withholding cardiopulmonary resuscitation
and certain other life-sustaining treatment by health care
professionals acting in out-of-hospital settings.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.
Renumbered from § 674.001 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.04, eff. Sept. 1, 1999; Acts 2003, 78th Leg., ch.
1228, § 8, eff. June 20, 2003.


§ 166.082. OUT-OF-HOSPITAL DNR ORDER; DIRECTIVE TO
PHYSICIANS. (a) A competent person may at any time execute a
written out-of-hospital DNR order directing health care
professionals acting in an out-of-hospital setting to withhold
cardiopulmonary resuscitation and certain other life-sustaining
treatment designated by the board.
(b) The declarant must sign the out-of-hospital DNR order in
the presence of two witnesses who qualify under Section 166.003, at
least one of whom must be a witness who qualifies under Section
166.003(2). The witnesses must sign the order. The attending
physician of the declarant must sign the order and shall make the
fact of the existence of the order and the reasons for execution of
the order a part of the declarant's medical record.
(c) If the person is incompetent but previously executed or
issued a directive to physicians in accordance with Subchapter B,
the physician may rely on the directive as the person's
instructions to issue an out-of-hospital DNR order and shall place
a copy of the directive in the person's medical record. The
physician shall sign the order in lieu of the person signing under
Subsection (b).
(d) If the person is incompetent but previously executed or
issued a directive to physicians in accordance with Subchapter B
designating a proxy, the proxy may make any decisions required of
the designating person as to an out-of-hospital DNR order and shall
sign the order in lieu of the person signing under Subsection (b).
(e) If the person is now incompetent but previously executed
or issued a medical power of attorney designating an agent, the
agent may make any decisions required of the designating person as
to an out-of-hospital DNR order and shall sign the order in lieu of
the person signing under Subsection (b).
(f) The board, on the recommendation of the department,
shall by rule adopt procedures for the disposition and maintenance
of records of an original out-of-hospital DNR order and any copies
of the order.
(g) An out-of-hospital DNR order is effective on its
execution.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.
Renumbered from § 674.002 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.04, eff. Sept. 1, 1999.


§ 166.083. FORM OF OUT-OF-HOSPITAL DNR ORDER. (a) A
written out-of-hospital DNR order shall be in the standard form
specified by board rule as recommended by the department.
(b) The standard form of an out-of-hospital DNR order
specified by the board must, at a minimum, contain the following:
(1) a distinctive single-page format that readily
identifies the document as an out-of-hospital DNR order;
(2) a title that readily identifies the document as an
out-of-hospital DNR order;
(3) the printed or typed name of the person;
(4) a statement that the physician signing the
document is the attending physician of the person and that the
physician is directing health care professionals acting in
out-of-hospital settings, including a hospital emergency
department, not to initiate or continue certain life-sustaining
treatment on behalf of the person, and a listing of those procedures
not to be initiated or continued;
(5) a statement that the person understands that the
person may revoke the out-of-hospital DNR order at any time by
destroying the order and removing the DNR identification device, if
any, or by communicating to health care professionals at the scene
the person's desire to revoke the out-of-hospital DNR order;
(6) places for the printed names and signatures of the
witnesses and attending physician of the person and the medical
license number of the attending physician;
(7) a separate section for execution of the document
by the legal guardian of the person, the person's proxy, an agent of
the person having a medical power of attorney, or the attending
physician attesting to the issuance of an out-of-hospital DNR order
by nonwritten means of communication or acting in accordance with a
previously executed or previously issued directive to physicians
under Section 166.082(c) that includes the following:
(A) a statement that the legal guardian, the
proxy, the agent, the person by nonwritten means of communication,
or the physician directs that each listed life-sustaining treatment
should not be initiated or continued in behalf of the person; and
(B) places for the printed names and signatures of the witnesses and, as applicable, the legal guardian, proxy, agent, or physician;
(8) a separate section for execution of the document
by at least one qualified relative of the person when the person
does not have a legal guardian, proxy, or agent having a medical
power of attorney and is incompetent or otherwise mentally or
physically incapable of communication, including:
(A) a statement that the relative of the person is qualified to make a treatment decision to withhold
cardiopulmonary resuscitation and certain other designated
life-sustaining treatment under Section 166.088 and, based on the
known desires of the person or a determination of the best interest
of the person, directs that each listed life-sustaining treatment
should not be initiated or continued in behalf of the person; and
(B) places for the printed names and signatures of the witnesses and qualified relative of the person;
(9) a place for entry of the date of execution of the
document;
(10) a statement that the document is in effect on the date of its execution and remains in effect until the death of the
person or until the document is revoked;
(11) a statement that the document must accompany the
person during transport;
(12) a statement regarding the proper disposition of
the document or copies of the document, as the board determines
appropriate; and
(13) a statement at the bottom of the document, with
places for the signature of each person executing the document,
that the document has been properly completed.
(c) The board may, by rule and as recommended by the
department, modify the standard form of the out-of-hospital DNR
order described by Subsection (b) in order to accomplish the
purposes of this subchapter.
(d) A photocopy or other complete facsimile of the original
written out-of-hospital DNR order executed under this subchapter
may be used for any purpose for which the original written order may
be used under this subchapter.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.
Renumbered from § 674.003 and amended by Acts 1999, 76th Leg.,
ch. 450, § 1.04, eff. Sept. 1, 1999.


§ 166.084. ISSUANCE OF OUT-OF-HOSPITAL DNR ORDER BY
NONWRITTEN COMMUNICATION. (a) A competent person who is an adult
may issue an out-of-hospital DNR order by nonwritten communication.
(b) A declarant must issue the nonwritten out-of-hospital
DNR order in the presence of the attending physician and two
witnesses who qualify under Section 166.003,