Advance Directive Act: Hitting the highlights
Advance Directive Act: Hitting the highlights
The following is a summary of the Texas Advance Directive Act that went into effect Sept. 1, 1999.
1. Three prior laws were combined and simplified into a single law.
2. The new advance directive is not exclusive for physician use. It is now titled, "Directive to Physicians and Family or Surrogate."
3. The new document is more user-friendly. It provides detailed instructions and definitions in the same document. Definitions in the document match those written into the law. The new document is designed to be less daunting to complete. It emphasizes the importance of communication between consumer and provider before talking about serious illnesses.
4. The new directive allows patients to request or reject treatment; the previous document was designed only to allow rejection of treatment.
5. Terminal and irreversible are defined separately. The word terminal is no longer associated with death being imminent or with treatment that postpones the moment of death. There is, however, a six-month time frame associated with the use of the word terminal. Terminal now takes into account incorporating life-sustaining treatments, whereas the previous definition was used in reference to the absence of life-sustaining treatment.
The word irreversible is broadly defined to account for a wide category of conditions — including persistent vegetative state, dementia, progressive organ failure, and advanced life support — and to increase the rights of patients to refuse life-sustaining treatment even if their conditions are not terminal.
6.The process of witnessing a document is much easier. Only one witness must meet the criteria, which are less stringent than in the past. Not only is the process easier for smaller facilities, it is less burdensome for chaplains, social workers, and nurses.
7. Only one physician needs to certify a patient’s condition as either terminal or irreversible. The physician no longer has to certify that death is imminent or will occur in a relatively short period of time.
8. The living will informs patients that treatment other than comfort care may be stopped unilaterally when death is imminent (defined in terms of hours or minutes), even if treatment is started.
9. The directive clarifies the decision to withdraw treatment. An out-of-hospital do-not-resuscitate order, for example, requires two physicians (one must not be involved in treat -ing the patient), or one physician and a physician representative from the ethics committee (for incompetent patients without designated surrogates).
10. The futility process outlined in the law requires certain notifications and includes a 10-day opportunity to transfer patients if the hospital ethics committee concurs with the treating physician that ongoing treatment is futile.
11. The out-of-hospital do-not-resuscitate statute no longer requires that a patient be terminal to have such an order.
12. The durable power of attorney for health care is now called the medical power of attorney.
13. Physicians or other health care providers who fail to honor an advance directive they know exists are subject to disciplinary review by their professional licensing body, unless they initiate the review process outlined in the law.
14. Ethics committees can act as surrogates of last resort for patients who are incompetent and do not have another surrogate. That includes circumstances involving end-of-life decisions and withdrawal-of-treatment decisions.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.