TEX. HEALTH & SAFETY CODE § 166.033
TITLE 2. HEALTH
SUBTITLE H.
PUBLIC HEALTH PROVISIONS
CHAPTER 166.
ADVANCE DIRECTIVES
SUBCHAPTER C. OUT-OF-HOSPITAL DO-NOT-RESUSCITATE ORDERS
Tex. Health & Safety Code § 166.082 (2000)
Chapter 166, Advance Directives
§ 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.
§ 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 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.
§ 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.