Texas Hospitals and Physicians Oppose House Bill 995

Testimony of Texas Medical Association and Texas Hospital Association
House Bill 995 by Wray
House Judiciary and Civil Jurisprudence Committee
April 11, 2017 

The medical power of attorney form is a specific legal document prescribed in statute. Its purpose is to allow patients to designate a trusted agent who can make health care decisions in line with a patient’s choices and wishes regarding medical care if a patient is unable to make such decisions on his or her own. Only one person may hold the medical power of attorney for another individual at any given time.

House Bill 995 would significantly alter current statute by allowing:

  • ANY document to serve as a medical power of attorney, and 
  • Designation of multiple individuals to provide consent for medical care concurrently on behalf of another individual.

The Texas Hospital Association and Texas Medical Association oppose House Bill 995. 

HB 995 would unnecessarily complicate and cause confusion about important documents and processes that often are relied on during the most difficult times in a patient’s life. The consequence could be a substantial number of health care decisions left in limbo because a specific, final surrogate voice is lacking.

Our most significant concern is that HB 995 would make the medical power of attorney form permissive, by replacing “must” with “may” in the statute. The result will be that patients will be able to write anything, and physicians and health care providers will be left to interpret the validity without parameters or applicable standards.

We do agree with one provision of HB 995 that would expand the current marriage-related provisions of the medical power of attorney statute. Current law provides that a medical power of attorney for a spouse dissolves upon divorce unless the medical power of attorney form specifies otherwise. HB 995 replaces the narrower “divorce” provision to include cases where the marriage is “dissolved, annulled or declared void.” 

  • The primary purpose of a medical power of attorney is to clarify communications about medical decisionmaking for individuals who lose the ability to decide for themselves or express their own wishes. For these patients, medical decisions often must be made rapidly in very difficult circumstances and can be the subject of disagreements among family members or loved ones. Having a single medical power of attorney helps provide clarity and certainty in potentially fraught moments.
  • Assigning medical power of attorney to one individual tells physicians and care providers which specific individual has the right and responsibility to speak for the patient and express the patient’s wishes and choices as he or she would have done. When an individual does not wish to make this type of designation, a medical power of attorney document is neither helpful nor appropriate. 
  • Allowing the designation of multiple co-agents to make health care decisions would make challenging and complex situations even more difficult and confusing. HB 995 would allow any designated co-agent to act independently, and a third party, such as a physician or hospital, may rely on the decisions of any co-agent. It has been suggested that in the event of disagreement among co-agents, the physician or health care provider may refuse to accept the medical power of attorney with respect to that matter. However, that option fails to provide essential guidance and clarity for a physician when trying to make critical decisions, which may or may not include decisions related to the end of life. 
  • Individuals who want multiple decisionmakers involved in their health care or treatment decisions should decide who has ultimate decisionmaking authority if disagreements arise; documents should clearly reflect those choices. If the desire is for all medical decisions to be made through a consensus process, HB 995 fails to achieve that objective, as it allows each agent to make decisions independently. 
  • Physicians review the medical power of attorney to determine validity and legitimacy. Opening up the process to allow multiple forms of medical power of attorney potentially would delay essential medical treatment if physicians have to obtain legal review to sort through numerous documents to determine validity and on which one they should rely. 
  • The medical power of attorney and advance directives are instrumental in care decisions, end-of-life discussions, and the decisionmaking process outlined under Chapter 166 of the Health and Safety Code. Chapter 166 has been constructed very carefully and revised to balance the wide-ranging duties, interests, and obligations of various stakeholders such as patients, religious groups, family members, physicians, health care providers, and advocacy organizations. The proposed changes in HB 995 interact in multiple ways with other provisions within Chapter 166. 

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Last Updated On

April 11, 2017

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