HB 1161

relating to an advance directive and do-not-resuscitate order of a
pregnant woman and information provided for an advance directive.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Section 166.033, Health and Safety Code, is
Sec. 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
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
three [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, and the Health Care
Facility 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.
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 or treatment 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.)
If I am pregnant, my decision concerning life-sustaining
treatment is modified as follows:
________________________________________________________________
________________________________________________________________
________________________________________________________________
(THIS SECTION IS OPTIONAL, IS COMPLETED ONLY FOR A PERSON OF
CHILD-BEARING AGE, AND DOES NOT AFFECT THE VALIDITY OF THIS FORM IF
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
artificially administered nutrition and hydration, intravenous
antibiotics, etc.  Be sure to state whether you do or do not want the
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
health care or treatment decisions with my physician compatible
(If a Medical Power of Attorney has been executed, then an
agent already has been named and you should not list additional
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.
Signed__________ Date__________ City, County, State of
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 health care or 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
Witness 1 __________ Witness 2 __________
"Artificially administered 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
"Irreversible condition" means a condition, injury, or
(1)  that may be treated, but is never cured or
(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
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
"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
artificially administered nutrition and hydration.  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
"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
SECTION 2.  Section 166.049, Health and Safety Code, is
Sec. 166.049.  PREGNANT PERSONS [PATIENTS].  A person of
child-bearing age that executes an advance directive may specify in
the advance directive the effect the person's pregnancy has on the
advance directive [A person may  not withdraw or withhold
life-sustaining treatment under this subchapter from a pregnant
SECTION 3.  Section 166.083(b), Health and Safety Code, is
(b)  The standard form of an out-of-hospital DNR order
specified by department rule must, at a minimum, contain the
(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
(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)  a statement that if the person is of child-bearing
age, the person may specify in the form the effect the person's
pregnancy has on the out-of-hospital DNR order;
(7)  places for the printed names and signatures of the
witnesses or the notary public's acknowledgment and for the printed
name and signature of the attending physician of the person and the
medical license number of the attending physician;
(8) [(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
(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,
(9) [(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;
(10) [(9)]  a place for entry of the date of execution
(11) [(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;
(12) [(11)]  a statement that the document must
accompany the person during transport;
(13) [(12)]  a statement regarding the proper
disposition of the document or copies of the document, as the
executive commissioner determines appropriate; and
(14) [(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.
SECTION 4.  Section 166.084(c), Health and Safety Code, is
(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)(8) [166.083(b)(7)] and the attending physician
shall sign the document in the place required by Section
166.083(b)(14) [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
SECTION 5.  Section 166.098, Health and Safety Code, is
Sec. 166.098.  PREGNANT PERSONS.  A person of child-bearing
age may specify in an out-of-hospital DNR order executed by the
person the effect the person's pregnancy has on the order [A person
may not withhold cardiopulmonary resuscitation or certain other
life-sustaining treatment designated by department rule under this
subchapter from a person known by the responding health care
SECTION 6.  This Act takes effect September 1, 2025.