Revised (referral change)
REPORT OF COUNCIL ON HEALTH SERVICE ORGANIZATIONS
CHSO Report 2-A-06
Subject: Advance Directives
Presented by: Dennis Pacl, MD, Chair
Referred to: Reference Committee on Science and Education
The Texas Advance Directives Coalition is an informal stakeholders group that works to develop consensus legislation on advance directives issues in Texas. The coalition is comprised of diverse groups with extremely diverse opinions. Membership is open, but it is preferred that members represent an organized group. Current members include hospitals, National and Texas Right-to-Life groups, nursing homes, THA, TMA, TNA, AARP, and disability rights advocates. Often attending as resource or as observers are the Department of Assistance and Disability Services and Texas Department of State Health Services staff and representatives from the Governor's, Lt. Governor's and various legislator's offices. The group does not reach consensus on all issues, but works to draft a specific legislative proposal for all issues that can be agreed upon. The member organizations have historically supported the coalition's consensus bill, but there is nothing to prevent any of those organizations from advocating for other measures.
For the upcoming legislative session, the coalition's primary purpose is to make legislative recommendations on issues raised about the ten-day notice provision in Sec. 166.046, and the language proposed last session as an amendment to CSSB 1188. Issues that already have been suggested for discussion include the following:
- Requiring hospitals to release a copy of the medical record to the patient, family, or surrogate decision-maker immediately when the decision is made to terminate care (to aid in trying to secure a transfer).
- Hospital should give the family information about efforts hospital employees have made to secure a transfer.
- A method to make it clear to patients, families, and surrogates that they MAY have an attorney at meetings with the hospital ethics committee.
- Three specific fixes to the statutory language about appeals. The three remedies are outlined in a concurring opinion of the court in the Nikolouzos case.
- Some provision on how physicians and hospitals can work with decision-makers who refuse to meet with physicians or the ethics team to discuss treatment decisions.
- Formalizing the existence and composition of the Advance Directives Coalition.
- Implementing Physician Order for Life Sustaining Treatment, in addition to or as substitute for out-of-hospital Do Not Resuscitate form.
- Replace "DNR" with "Allow Natural Death."
- Revise existing power of attorney forms to clarify HIPAA privacy issues.
- Clarification on what should happen when the patient fires the attending physician(s) that request the ethics consult.
- Doing something to implement "5 Wishes."
Recommendation : That the Texas Medical Association continue to work with the Texas Advanced Directives Coalition to develop consensus on Texas advanced directives law for physicians.
TMA House of Delegates: TexMed 2006
Last Updated On
June 24, 2010
Originally Published On
March 23, 2010