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, at least one of whom 
must be a witness who qualifies under Section 166.003(2).
	(c)  The attending physician and witnesses shall sign the 
out-of-hospital DNR order in the place of the document provided by 
Section 166.083(b)(7) and the attending physician shall sign the 
document in the place required by Section 166.083(b)(13).  The 
physician shall make the fact of the existence of the 
out-of-hospital DNR order a part of the declarant's medical record 
and the names of the witnesses shall be entered in the medical 
record.
	(d)  An out-of-hospital DNR order issued in the manner 
provided by this section is valid and shall be honored by responding 
health care professionals as if executed in the manner provided by 
Section 166.082.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.004 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.085.  EXECUTION OF OUT-OF-HOSPITAL DNR ORDER ON 
BEHALF OR A MINOR.  (a)  The following persons may execute an 
out-of-hospital DNR order on behalf of a minor:
		(1)  the minor's parents;                                                     
		(2)  the minor's legal guardian;  or                                          
		(3)  the minor's managing conservator.                                        
	(b)  A person listed under Subsection (a) may not execute an 
out-of-hospital DNR order unless the minor has been diagnosed by a 
physician as suffering from a terminal or irreversible condition.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.005 by Acts 1999, 76th Leg., ch. 450, § 
1.04, eff. Sept. 1, 1999.  Amended by Acts 2003, 78th Leg., ch. 
1228, § 6, eff. June 20, 2003.


	§ 166.086.  DESIRE OF PERSON SUPERSEDES OUT-OF-HOSPITAL 
DNR ORDER.  The desire of a competent person, including a competent 
minor, supersedes the effect of an out-of-hospital DNR order 
executed or issued by or on behalf of the person when the desire is 
communicated to responding health care professionals as provided by 
this subchapter.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.006 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.087.  PROCEDURE WHEN DECLARANT IS INCOMPETENT OR 
INCAPABLE OF COMMUNICATION.  (a)  This section applies when a 
person 18 years of age or older has executed or issued an 
out-of-hospital DNR order and subsequently becomes incompetent or 
otherwise mentally or physically incapable of communication.
	(b)  If the adult person has designated a person to make a 
treatment decision as authorized by Section 166.032(c), the 
attending physician and the designated person shall comply with the 
out-of-hospital DNR order.
	(c)  If the adult person has not designated a person to make a 
treatment decision as authorized by Section 166.032(c), the 
attending physician shall comply with the out-of-hospital DNR order 
unless the physician believes that the order does not reflect the 
person's present desire.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.007 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.088.  PROCEDURE WHEN PERSON HAS NOT EXECUTED OR 
ISSUED OUT-OF-HOSPITAL DNR ORDER AND IS INCOMPETENT OR INCAPABLE OF 
COMMUNICATION.  (a)  If an adult person has not executed or issued 
an out-of-hospital DNR order and is incompetent or otherwise 
mentally or physically incapable of communication, the attending 
physician and the person's legal guardian, proxy, or agent having a 
medical power of attorney may execute an out-of-hospital DNR order 
on behalf of the person.
	(b)  If the person does not have a legal guardian, proxy, or 
agent under a medical power of attorney, the attending physician 
and at least one qualified relative from a category listed by 
Section 166.039(b), subject to the priority established under that 
subsection, may execute an out-of-hospital DNR order in the same 
manner as a treatment decision made under Section 166.039(b).
	(c)  A decision to execute an out-of-hospital DNR order made 
under Subsection (a) or (b) must be based on knowledge of what the 
person would desire, if known.
	(d)  An out-of-hospital DNR order executed under Subsection 
(b) must be made in the presence of at least two witnesses who 
qualify under Section 166.003, at least one of whom must be a 
witness who qualifies under Section 166.003(2).
	(e)  The fact that an adult person has not executed or issued 
an out-of-hospital DNR order does not create a presumption that the 
person does not want a treatment decision made to withhold 
cardiopulmonary resuscitation and certain other designated 
life-sustaining treatment designated by the board.
	(f)  If there is not a qualified relative available to act 
for the person under Subsection (b), an out-of-hospital DNR order 
must be concurred in by another physician who is not involved in the 
treatment of the patient or who is a representative of the ethics or 
medical committee of the health care facility in which the person is 
a patient.
	(g)  A person listed in Section 166.039(b) who wishes to 
challenge a 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.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.008 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.089.  COMPLIANCE WITH OUT-OF-HOSPITAL DNR ORDER.  
(a)  When responding to a call for assistance, health care 
professionals shall honor an out-of-hospital DNR order in 
accordance with the statewide out-of-hospital DNR protocol and, 
where applicable, locally adopted out-of-hospital DNR protocols 
not in conflict with the statewide protocol if:
		(1)  the responding health care professionals discover 
an executed or issued out-of-hospital DNR order form on their 
arrival at the scene;  and
		(2)  the responding health care professionals comply 
with this section.     
	(b)  If the person is wearing a DNR identification device, 
the responding health care professionals must comply with Section 
166.090.
	(c)  The responding health care professionals must establish 
the identity of the person as the person who executed or issued the 
out-of-hospital DNR order or for whom the out-of-hospital DNR order 
was executed or issued.
	(d)  The responding health care professionals must determine 
that the out-of-hospital DNR order form appears to be valid in that 
it includes:
		(1)  written responses in the places designated on the 
form for the names, signatures, and other information required of 
persons executing or issuing, or witnessing the execution or 
issuance of, the order;
		(2)  a date in the place designated on the form for the 
date the order was executed or issued;  and
		(3)  the signature of the declarant or persons 
executing or issuing the order and the attending physician in the 
appropriate places designated on the form for indicating that the 
order form has been properly completed.
	(e)  If the conditions prescribed by Subsections (a) through 
(d) are not determined to apply by the responding health care 
professionals at the scene, the out-of-hospital DNR order may not 
be honored and life-sustaining procedures otherwise required by law 
or local emergency medical services protocols shall be initiated or 
continued.  Health care professionals acting in out-of-hospital 
settings are not required to accept or interpret an out-of-hospital 
DNR order that does not meet the requirements of this subchapter.
	(f)  The out-of-hospital DNR order form or a copy of the 
form, when available, must accompany the person during transport.
	(g)  A record shall be made and maintained of the 
circumstances of each emergency medical services response in which 
an out-of-hospital DNR order or DNR identification device is 
encountered, in accordance with the statewide out-of-hospital DNR 
protocol and any applicable local out-of-hospital DNR protocol not 
in conflict with the statewide protocol.
	(h)  An out-of-hospital DNR order executed or issued and 
documented or evidenced in the manner prescribed by this subchapter 
is valid and shall be honored by responding health care 
professionals unless the person or persons found at the scene:
		(1)  identify themselves as the declarant or as the 
attending physician, legal guardian, qualified relative, or agent 
of the person having a medical power of attorney who executed or 
issued the out-of-hospital DNR order on behalf of the person;  and
		(2)  request that cardiopulmonary resuscitation or 
certain other life-sustaining treatment designated by the board be 
initiated or continued.
	(i)  If the policies of a health care facility preclude 
compliance with the out-of-hospital DNR order of a person or an 
out-of-hospital DNR order issued by an attending physician on 
behalf of a person who is admitted to or a resident of the facility, 
or if the facility is unwilling to accept DNR identification 
devices as evidence of the existence of an out-of-hospital DNR 
order, that facility shall take all reasonable steps to notify the 
person or, if the person is incompetent, the person's guardian or 
the person or persons having authority to make health care 
treatment decisions on behalf of the person, of the facility's 
policy and shall take all reasonable steps to effect the transfer of 
the person to the person's home or to a facility where the 
provisions of this subchapter can be carried out.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.009 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.090.  DNR IDENTIFICATION DEVICE.  (a)  A person who 
has a valid out-of-hospital DNR order under this subchapter may 
wear a DNR identification device around the neck or on the wrist as 
prescribed by board rule adopted under Section 166.101.
	(b)  The presence of a DNR identification device on the body 
of a person is conclusive evidence that the person has executed or 
issued a valid out-of-hospital DNR order or has a valid 
out-of-hospital DNR order executed or issued on the person's 
behalf.  Responding health care professionals shall honor the DNR 
identification device as if a valid out-of-hospital DNR order form 
executed or issued by the person were found in the possession of the 
person.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.010 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.091.  DURATION OF OUT-OF-HOSPITAL DNR ORDER.  An 
out-of-hospital DNR order is effective until it is revoked as 
prescribed by Section 166.092.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.011 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.092.  REVOCATION OF OUT-OF-HOSPITAL DNR ORDER.  
(a)  A declarant may revoke an out-of-hospital DNR order at any 
time without regard to the declarant's mental state or competency.  
An order may be revoked by:
		(1)  the declarant or someone in the declarant's 
presence and at the declarant's direction destroying the order form 
and removing the DNR identification device, if any;
		(2)  a person who identifies himself or herself as the 
legal guardian, as a qualified relative, or as the agent of the 
declarant having a medical power of attorney who executed the 
out-of-hospital DNR order or another person in the person's 
presence and at the person's direction destroying the order form 
and removing the DNR identification device, if any;
		(3)  the declarant communicating the declarant's intent 
to revoke the order;  or
		(4)  a person who identifies himself or herself as the 
legal guardian, a qualified relative, or the agent of the declarant 
having a medical power of attorney who executed the out-of-hospital 
DNR order orally stating the person's intent to revoke the order.
	(b)  An oral revocation under Subsection (a)(3) or (a)(4) 
takes effect only when the declarant or a person who identifies 
himself or herself as the legal guardian, a qualified relative, or 
the agent of the declarant having a medical power of attorney who 
executed the out-of-hospital DNR order communicates the intent to 
revoke the order to the responding health care professionals or the 
attending physician at the scene.  The responding health care 
professionals shall record the time, date, and place of the 
revocation in accordance with the statewide out-of-hospital DNR 
protocol and rules adopted by the board and any applicable local 
out-of-hospital DNR protocol.  The attending physician or the 
physician's designee shall record in the person'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 designee 
shall also enter the word "VOID" on each page of the copy of the 
order in the person's medical record.
	(c)  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.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16 1995.  
Renumbered from § 674.012 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.093.  REEXECUTION OF OUT-OF-HOSPITAL DNR ORDER.  A 
declarant may at any time reexecute or reissue an out-of-hospital 
DNR order in accordance with the procedures prescribed by Section 
166.082, including reexecution or reissuance after the declarant is 
diagnosed as having a terminal or irreversible condition.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.013 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.094.  LIMITATION ON LIABILITY FOR WITHHOLDING 
CARDIOPULMONARY RESUSCITATION AND CERTAIN OTHER LIFE-SUSTAINING 
PROCEDURES.  (a)  A health care professional or health care 
facility or entity that in good faith causes cardiopulmonary 
resuscitation or certain other life-sustaining treatment 
designated by the board to be withheld from a person in accordance 
with this subchapter is not civilly liable for that action.
	(b)  A health care professional or health care facility or 
entity that in good faith participates in withholding 
cardiopulmonary resuscitation or certain other life-sustaining 
treatment designated by the board from a person in accordance with 
this subchapter is not civilly liable for that action.
	(c)  A health care professional or health care facility or 
entity that in good faith participates in withholding 
cardiopulmonary resuscitation or certain other life-sustaining 
treatment designated by the board from a person in accordance with 
this subchapter is not criminally liable or guilty of 
unprofessional conduct as a result of that action.
	(d)  A health care professional or health care facility or 
entity that in good faith causes or participates in withholding 
cardiopulmonary resuscitation or certain other life-sustaining 
treatment designated by the board from a person in accordance with 
this subchapter and rules adopted under this subchapter is not in 
violation of any other licensing or regulatory laws or rules of this 
state and is not subject to any disciplinary action or sanction by 
any licensing or regulatory agency of this state as a result of that 
action.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.016 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.095.  LIMITATION ON LIABILITY FOR FAILURE TO 
EFFECTUATE OUT-OF-HOSPITAL DNR ORDER.  (a)  A health care 
professional or health care facility or entity that has no actual 
knowledge of an out-of-hospital DNR order is not civilly or 
criminally liable for failing to act in accordance with the order.
	(b)  A health care professional or health care facility or 
entity is subject to review and disciplinary action by the 
appropriate licensing board for failing to effectuate an 
out-of-hospital DNR order.  This subsection does not limit remedies 
available under other laws of this state.
	(c)  If an attending physician refuses to execute or comply 
with an out-of-hospital DNR order, the physician shall inform the 
person, the legal guardian or qualified relatives of the person, or 
the agent of the person having a medical power of attorney and, if 
the person or another authorized to act on behalf of the person so 
directs, shall make a reasonable effort to transfer the person to 
another physician who is willing to execute or comply with an 
out-of-hospital DNR order.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.017 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.096.  HONORING OUT-OF-HOSPITAL DNR ORDER DOES NOT 
CONSTITUTE OFFENSE OF AIDING SUICIDE.  A person does not commit an 
offense under Section 22.08, Penal Code, by withholding 
cardiopulmonary resuscitation or certain other life-sustaining 
treatment designated by the board from a person in accordance with 
this subchapter.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.018 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.097.  CRIMINAL PENALTY;  PROSECUTION.  (a)  A 
person commits an offense if the person intentionally conceals, 
cancels, defaces, obliterates, or damages another person's 
out-of-hospital DNR order or DNR identification device without that 
person's consent or the consent of the person or persons authorized 
to execute or issue an out-of-hospital DNR order on behalf of the 
person under this subchapter. 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 cardiopulmonary resuscitation or certain other 
life-sustaining treatment designated by the board to be withheld 
from another person contrary to the other person's desires, 
falsifies or forges an out-of-hospital DNR order or intentionally 
conceals or withholds personal knowledge of a revocation and 
thereby directly causes cardiopulmonary resuscitation and certain 
other life-sustaining treatment designated by the board to be 
withheld from the other person with the result that the other 
person's death is hastened.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.019 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.098.  PREGNANT PERSONS.  A person may not withhold 
cardiopulmonary resuscitation or certain other life-sustaining 
treatment designated by the board under this subchapter from a 
person known by the responding health care professionals to be 
pregnant.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.020 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.099.  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.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.021 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.100.  LEGAL RIGHT OR RESPONSIBILITY NOT AFFECTED.  
This subchapter does not impair or supersede any legal right or 
responsibility a person may have under a constitution, other 
statute, regulation, or court decision to effect the withholding of 
cardiopulmonary resuscitation or certain other life-sustaining 
treatment designated by the board.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.022 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.101.  DUTIES OF DEPARTMENT AND BOARD.  (a)  The 
board shall, on the recommendation of the department, adopt all 
reasonable and necessary rules to carry out the purposes of this 
subchapter, including rules:
		(1)  adopting a statewide out-of-hospital DNR order 
protocol that sets out standard procedures for the withholding of 
cardiopulmonary resuscitation and certain other life-sustaining 
treatment by health care professionals acting in out-of-hospital 
settings;
		(2)  designating life-sustaining treatment that may be 
included in an out-of-hospital DNR order, including all procedures 
listed in Sections 166.081(6)(A)(i) through (v);  and
		(3)  governing recordkeeping in circumstances in which 
an out-of-hospital DNR order or DNR identification device is 
encountered by responding health care professionals.
	(b)  The rules adopted by the board under Subsection (a) are 
not effective until approved by the Texas State Board of Medical 
Examiners.
	(c)  Local emergency medical services authorities may adopt 
local out-of-hospital DNR order protocols if the local protocols do 
not conflict with the statewide out-of-hospital DNR order protocol 
adopted by the board.
	(d)  The board by rule shall specify a distinctive standard 
design for a necklace and a bracelet DNR identification device that 
signifies, when worn by a person, that the possessor has executed or 
issued a valid out-of-hospital DNR order under this subchapter or 
is a person for whom a valid out-of-hospital DNR order has been 
executed or issued.
	(e)  The department shall report to the board from time to 
time regarding issues identified in emergency medical services 
responses in which an out-of-hospital DNR order or DNR 
identification device is encountered.  The report may contain 
recommendations to the board for necessary modifications to the 
form of the standard out-of-hospital DNR order or the designated 
life-sustaining procedures listed in the standard out-of-hospital 
DNR order, the statewide out-of-hospital DNR order protocol, or the 
DNR identification devices.

Added by Acts 1995, 74th Leg., ch. 965, § 10, eff. June 16, 1995.  
Renumbered from § 674.023 and amended by Acts 1999, 76th Leg., 
ch. 450, § 1.04, eff. Sept. 1, 1999.


	§ 166.102.  PHYSICIAN'S DNR ORDER MAY BE HONORED BY 
HEALTH CARE PERSONNEL OTHER THAN EMERGENCY MEDICAL SERVICES 
PERSONNEL.  (a)  Except as provided by Subsection (b), a licensed 
nurse or person providing health care services in an 
out-of-hospital setting may honor a physician's do-not-resuscitate 
order.
	(b)  When responding to a call for assistance, emergency 
medical services personnel shall honor only a properly executed or 
issued out-of-hospital DNR order or prescribed DNR identification 
device in accordance with this subchapter.

Added by Acts 2003, 78th Leg., ch. 1228, § 7, eff. June 20, 2003.          

SUBCHAPTER D. MEDICAL POWER OF ATTORNEY


	§ 166.151.  DEFINITIONS.  In this subchapter:                               
		(1)  "Adult" means a person 18 years of age or older or 
a person under 18 years of age who has had the disabilities of 
minority removed.
		(2)  "Agent" means an adult to whom authority to make 
health care decisions is delegated under a medical power of 
attorney.
		(3)  "Health care provider" means an individual or 
facility licensed, certified, or otherwise authorized to 
administer health care, for profit or otherwise, in the ordinary 
course of business or professional practice and includes a 
physician.
		(4)  "Principal" means an adult who has executed a 
medical power of attorney.
		(5)  "Residential care provider" means an individual or 
facility licensed, certified, or otherwise authorized to operate, 
for profit or otherwise, a residential care home.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.001 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.152.  SCOPE AND DURATION OF AUTHORITY.  
(a)  Subject to this subchapter or any express limitation on the 
authority of the agent contained in the medical power of attorney, 
the agent may make any health care decision on the principal's 
behalf that the principal could make if the principal were 
competent.
	(b)  An agent may exercise authority only if the principal's 
attending physician certifies in writing and files the 
certification in the principal's medical record that, based on the 
attending physician's reasonable medical judgment, the principal 
is incompetent.
	(c)  Notwithstanding any other provisions of this 
subchapter, treatment may not be given to or withheld from the 
principal if the principal objects regardless of whether, at the 
time of the objection:
		(1)  a medical power of attorney is in effect;  or                            
		(2)  the principal is competent.                                              
	(d)  The principal's attending physician shall make 
reasonable efforts to inform the principal of any proposed 
treatment or of any proposal to withdraw or withhold treatment 
before implementing an agent's advance directive.
	(e)  After consultation with the attending physician and 
other health care providers, the agent shall make a health care 
decision:
		(1)  according to the agent's knowledge of the 
principal's wishes, including the principal's religious and moral 
beliefs;  or
		(2)  if the agent does not know the principal's wishes, 
according to the agent's assessment of the principal's best 
interests.
	(f)  Notwithstanding any other provision of this subchapter, 
an agent may not consent to:
		(1)  voluntary inpatient mental health services;                              
		(2)  convulsive treatment;                                                    
		(3)  psychosurgery;                                                           
		(4)  abortion;  or                                                            
		(5)  neglect of the principal through the omission of 
care primarily intended to provide for the comfort of the 
principal.
	(g)  The power of attorney is effective indefinitely on 
execution as provided by this subchapter and delivery of the 
document to the agent, unless it is revoked as provided by this 
subchapter or the principal becomes competent. If the medical power 
of attorney includes an expiration date and on that date the 
principal is incompetent, the power of attorney continues to be 
effective until the principal becomes competent unless it is 
revoked as provided by this subchapter.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.002 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.153.  PERSONS WHO MAY NOT EXERCISE AUTHORITY OF 
AGENT.  A person may not exercise the authority of an agent while 
the person serves as:
		(1)  the principal's health care provider;                                    
		(2)  an employee of the principal's health care 
provider unless the person is a relative of the principal;
		(3)  the principal's residential care provider;  or                           
		(4)  an employee of the principal's residential care 
provider unless the person is a relative of the principal.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.003 
by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 1, 1999.


	§ 166.154.  EXECUTION AND WITNESSES.  (a)  The medical 
power of attorney must be signed by the principal 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 document.
	(b)  If the principal is physically unable to sign, another 
person may sign the medical power of attorney with the principal's 
name in the principal's presence and at the principal's express 
direction.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.004 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.155.  REVOCATION.  (a)  A medical power of attorney 
is revoked by:  
		(1)  oral or written notification at any time by the 
principal to the agent or a licensed or certified health or 
residential care provider or by any other act evidencing a specific 
intent to revoke the power, without regard to whether the principal 
is competent or the principal's mental state;
		(2)  execution by the principal of a subsequent medical 
power of attorney;  or
		(3)  the divorce of the principal and spouse, if the 
spouse is the principal's agent, unless the medical power of 
attorney provides otherwise.
	(b)  A principal's licensed or certified health or 
residential care provider who is informed of or provided with a 
revocation of a medical power of attorney shall immediately record 
the revocation in the principal's medical record and give notice of 
the revocation to the agent and any known health and residential 
care providers currently responsible for the principal's care.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.005 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.156.  APPOINTMENT OF GUARDIAN.  (a)  On motion 
filed in connection with a petition for appointment of a guardian 
or, if a guardian has been appointed, on petition of the guardian, a 
probate court shall determine whether to suspend or revoke the 
authority of the agent.
	(b)  The court shall consider the preferences of the 
principal as expressed in the medical power of attorney.
	(c)  During the pendency of the court's determination under 
Subsection (a), the guardian has the sole authority to make any 
health care decisions unless the court orders otherwise.  If a 
guardian has not been appointed, the agent has the authority to make 
any health care decisions unless the court orders otherwise.
	(d)  A person, including any attending physician or health or 
residential care provider, who does not have actual knowledge of 
the appointment of a guardian or an order of the court granting 
authority to someone other than the agent to make health care 
decisions is not subject to criminal or civil liability and has not 
engaged in unprofessional conduct for implementing an agent's 
health care decision.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.006 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.157.  DISCLOSURE OF MEDICAL INFORMATION.  Subject 
to any limitations in the medical power of attorney, an agent may, 
for the purpose of making a health care decision:
		(1)  request, review, and receive any information, oral 
or written, regarding the principal's physical or mental health, 
including medical and hospital records;
		(2)  execute a release or other document required to 
obtain the information;  and
		(3)  consent to the disclosure of the information.                            

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.007 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.158.  DUTY OF HEALTH OR RESIDENTIAL CARE PROVIDER.  
(a)  A principal's health or residential care provider and an 
employee of the provider who knows of the existence of the 
principal's medical power of attorney shall follow a directive of 
the principal's agent to the extent it is consistent with the 
desires of the principal, this subchapter, and the medical power of 
attorney.
	(b)  The attending physician does not have a duty to verify 
that the agent's directive is consistent with the principal's 
wishes or religious or moral beliefs.
	(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 established 
under Sections 166.045 and 166.046 apply if the agent's directive 
concerns providing, withholding, or withdrawing life-sustaining 
treatment.
	(d)  This subchapter may not be construed to require a health 
or residential care provider who is not a physician to act in a 
manner contrary to a physician's order.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.008 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.159.  DISCRIMINATION RELATING TO EXECUTION OF 
MEDICAL POWER OF ATTORNEY.  A health or residential care provider, 
health care service plan, insurer issuing disability insurance, 
self-insured employee benefit plan, or nonprofit hospital service 
plan may not:
		(1)  charge a person a different rate solely because 
the person has executed a medical power of attorney;
		(2)  require a person to execute a medical power of 
attorney before:        
			(A)  admitting the person to a hospital, nursing 
home, or residential care home;
			(B)  insuring the person;  or                                                
			(C)  allowing the person to receive health or 
residential care;  or        
		(3)  refuse health or residential care to a person 
solely because the person has executed a medical power of attorney.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.009 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.160.  LIMITATION ON LIABILITY.  (a)  An agent is 
not subject to criminal or civil liability for a health care 
decision if the decision is made in good faith under the terms of 
the medical power of attorney and the provisions of this 
subchapter.
	(b)  An attending physician, health or residential care 
provider, or a person acting as an agent for or under the 
physician's or provider's control is not subject to criminal or 
civil liability and has not engaged in unprofessional conduct for 
an act or omission if the act or omission:
		(1)  is done in good faith under the terms of the 
medical power of attorney, the directives of the agent, and the 
provisions of this subchapter;  and
		(2)  does not constitute a failure to exercise 
reasonable care in the provision of health care services.
	(c)  The standard of care that the attending physician, 
health or residential care provider, or person acting as an agent 
for or under the physician's or provider's control shall exercise 
under Subsection (b) is that degree of care that an attending 
physician, health or residential care provider, or person acting as 
an agent for or under the physician's or provider's control, as 
applicable, of ordinary prudence and skill would have exercised 
under the same or similar circumstances in the same or similar 
community.
	(d)  An attending physician, health or residential care 
provider, or person acting as an agent for or under the physician's 
or provider's control has not engaged in unprofessional conduct 
for:
		(1)  failure to act as required by the directive of an 
agent or a medical power of attorney if the physician, provider, or 
person was not provided with a copy of the medical power of attorney 
or had no knowledge of a directive;  or
		(2)  acting as required by an agent's directive if the 
medical power of attorney has expired or been revoked but the 
physician, provider, or person does not have knowledge of the 
expiration or revocation.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.010 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.161.  LIABILITY FOR HEALTH CARE COSTS.  Liability 
for the cost of health care provided as a result of the agent's 
decision is the same as if the health care were provided as a result 
of the principal's decision.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.011 
by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 1, 1999.


	§ 166.162.  DISCLOSURE STATEMENT.  A medical power of 
attorney is not effective unless the principal, before executing 
the medical power of attorney, signs a statement that the principal 
has received a disclosure statement and has read and understood its 
contents.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.014 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.163.  FORM OF DISCLOSURE STATEMENT.  The disclosure 
statement must be in substantially the following form:

INFORMATION CONCERNING THE MEDICAL POWER OF ATTORNEY
	THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS 
DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS:
	Except to the extent you state otherwise, this document gives 
the person you name as your agent the authority to make any and all 
health care decisions for you in accordance with your wishes, 
including your religious and moral beliefs, when you are no longer 
capable of making them yourself.  Because "health care" means any 
treatment, service, or procedure to maintain, diagnose, or treat 
your physical or mental condition, your agent has the power to make 
a broad range of health care decisions for you.  Your agent may 
consent, refuse to consent, or withdraw consent to medical 
treatment and may make decisions about withdrawing or withholding 
life-sustaining treatment.  Your agent may not consent to voluntary 
inpatient mental health services, convulsive treatment, 
psychosurgery, or abortion.  A physician must comply with your 
agent's instructions or allow you to be transferred to another 
physician.
	Your agent's authority begins when your doctor certifies that 
you lack the competence to make health care decisions.
	Your agent is obligated to follow your instructions when 
making decisions on your behalf.  Unless you state otherwise, your 
agent has the same authority to make decisions about your health 
care as you would have had.
	It is important that you discuss this document with your 
physician or other health care provider before you sign it to make 
sure that you understand the nature and range of decisions that may 
be made on your behalf.  If you do not have a physician, you should 
talk with someone else who is knowledgeable about these issues and 
can answer your questions.  You do not need a lawyer's assistance to 
complete this document, but if there is anything in this document 
that you do not understand, you should ask a lawyer to explain it to 
you.
	The person you appoint as agent should be someone you know and 
trust.  The person must be 18 years of age or older or a person under 
18 years of age who has had the disabilities of minority removed.  
If you appoint your health or residential care provider (e.g., your 
physician or an employee of a home health agency, hospital, nursing 
home, or residential care home, other than a relative), that person 
has to choose between acting as your agent or as your health or 
residential care provider;  the law does not permit a person to do 
both at the same time.
	You should inform the person you appoint that you want the 
person to be your health care agent.  You should discuss this 
document with your agent and your physician and give each a signed 
copy.  You should indicate on the document itself the people and 
institutions who have signed copies.  Your agent is not liable for 
health care decisions made in good faith on your behalf.
	Even after you have signed this document, you have the right 
to make health care decisions for yourself as long as you are able 
to do so and treatment cannot be given to you or stopped over your 
objection.  You have the right to revoke the authority granted to 
your agent by informing your agent or your health or residential 
care provider orally or in writing or by your execution of a 
subsequent medical power of attorney. Unless you state otherwise, 
your appointment of a spouse dissolves on divorce.
	This document may not be changed or modified.  If you want to 
make changes in the document, you must make an entirely new one.
	You may wish to designate an alternate agent in the event that 
your agent is unwilling, unable, or ineligible to act as your agent.  
Any alternate agent you designate has the same authority to make 
health care decisions for you.
	THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS SIGNED IN THE 
PRESENCE OF TWO COMPETENT ADULT WITNESSES. THE FOLLOWING PERSONS 
MAY NOT ACT AS ONE OF THE WITNESSES:
		(1)  the person you have designated as your agent;                            
		(2)  a person related to you by blood or marriage;                            
		(3)  a person entitled to any part of your estate after 
your death under a will or codicil executed by you or by operation 
of law;
		(4)  your attending physician;                                                
		(5)  an employee of your attending physician;                                 
		(6)  an employee of a health care facility in which you 
are a patient if the employee is providing direct patient care to 
you 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
		(7)  a person who, at the time this power of attorney is 
executed, has a claim against any part of your estate after your 
death.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.015 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.164.  FORM OF MEDICAL POWER OF ATTORNEY.  The 
medical power of attorney must be in substantially the following 
form:

MEDICAL POWER OF ATTORNEY DESIGNATION OF HEALTH CARE AGENT.

I,__________(insert your name) appoint:                                       

Name:___________________________________________________________              

Address:________________________________________________________              

Phone___________________________________________________________              
	as my agent to make any and all health care decisions for me, 
except to the extent I state otherwise in this document.  This 
medical power of attorney takes effect if I become unable to make my 
own health care decisions and this fact is certified in writing by 
my physician.
	LIMITATIONS ON THE DECISION-MAKING AUTHORITY OF MY AGENT ARE 
AS FOLLOWS:_____________________________________________________
	     _____________________________________________________                     
	DESIGNATION OF ALTERNATE AGENT.                                                
	(You are not required to designate an alternate agent but you 
may do so.  An alternate agent may make the same health care 
decisions as the designated agent if the designated agent is unable 
or unwilling to act as your agent.  If the agent designated is your 
spouse, the designation is automatically revoked by law if your 
marriage is dissolved.)
	If the person designated as my agent is unable or unwilling to 
make health care decisions for me, I designate the following 
persons to serve as my agent to make health care decisions for me as 
authorized by this document, who serve in the following order:
	A.  First Alternate Agent                                                      


		Name:_____________________________________________                          
		Address:__________________________________________                            
			Phone________________________________________                                
	B.  Second Alternate Agent                                                     


		Name:_____________________________________________                          
		Address:__________________________________________                            
			Phone________________________________________                                


		The original of this document is kept at:                                   
		__________________________________________________                            
		__________________________________________________                            
		__________________________________________________                            


	The following individuals or institutions have signed 
copies:              


		Name:_____________________________________________                          
		Address:__________________________________________                            
		__________________________________________________                            


		Name:_____________________________________________                          
		Address:__________________________________________                            
		__________________________________________________                            
	DURATION.                                                                      
	I understand that this power of attorney exists indefinitely 
from the date I execute this document unless I establish a shorter 
time or revoke the power of attorney.  If I am unable to make health 
care decisions for myself when this power of attorney expires, the 
authority I have granted my agent continues to exist until the time 
I become able to make health care decisions for myself.
	(IF APPLICABLE)  This power of attorney ends on the following 
date: __________
	PRIOR DESIGNATIONS REVOKED.                                                    
	I revoke any prior medical power of attorney.                                  
	ACKNOWLEDGMENT OF DISCLOSURE STATEMENT.                                        
	I have been provided with a disclosure statement explaining 
the effect of this document.  I have read and understand that 
information contained in the disclosure statement.
	(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY.)                               
	I sign my name to this medical power of attorney on __________ 
day of __________ (month, year) at


_____________________________________________

(City and State)


_____________________________________________

(Signature)


_____________________________________________

(Print Name)
	STATEMENT OF FIRST WITNESS.                                                    
	I am not the person appointed as agent by this document. I am 
not related to the principal by blood or marriage.  I would not be 
entitled to any portion of the principal's estate on the principal's 
death.  I am not the attending physician of the principal or an 
employee of the attending physician.  I have no claim against any 
portion of the principal's estate on the principal's death.  
Furthermore, if I am an employee of a health care facility in which 
the principal is a patient, I am not involved in providing direct 
patient care to the principal and am not an officer, director, 
partner, or business office employee of the health care facility or 
of any parent organization of the health care facility.

	Signature:________________________________________________                   
	Print Name:___________________________________ Date:______                     
	Address:__________________________________________________                     
	SIGNATURE OF SECOND WITNESS.                                                   

	Signature:________________________________________________                   
	Print Name:___________________________________ Date:______                     
	Address:__________________________________________________                     

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.016 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 166.165.  CIVIL ACTION.  (a)  A person who is a near 
relative of the principal or a responsible adult who is directly 
interested in the principal, including a guardian, social worker, 
physician, or clergyman, may bring an action in district court to 
request that the medical power of attorney be revoked because the 
principal, at the time the medical power of attorney was signed:
		(1)  was not competent;  or                                                   
		(2)  was under duress, fraud, or undue influence.                             
	(b)  The action may be brought in the county of the 
principal's residence or the residence of the person bringing the 
action.
	(c)  During the pendency of the action, the authority of the 
agent to make health care decisions continues in effect unless the 
district court orders otherwise.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.017 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.


	§ 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 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.

Added by Acts 1991, 72nd Leg., ch. 16, § 3.02(a), eff. Aug. 26, 
1991.  Renumbered from Civil Practice & Remedies Code § 135.018 
and amended by Acts 1999, 76th Leg., ch. 450, § 1.05, eff. Sept. 
1, 1999.