Health and Safety Code
CHAPTER 672. NATURAL DEATH ACT
Sec. 672.001. Short Title.
This chapter may be cited as the Natural Death Act.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.002. Definitions.
In this chapter:
(1) "Attending physician" means the physician who has
primary responsibility for a patient's treatment and care.
(2) "Competent" means possessing the ability, based on
reasonable medical judgment, to understand and appreciate the
nature and consequences of a treatment decision, including the
significant benefits and harms of and reasonable alternatives
to a proposed treatment decision.
(3) "Declarant" means a person who has executed or issued a
directive under this chapter.
(4) "Directive" means an instruction made under Section
672.003, 672.005, or 672.006 to withhold or withdraw
life-sustaining procedures in the event of a terminal
condition.
(5) "Incompetent" means lacking the ability, based on
reasonable medical judgment, to understand and appreciate the
nature and consequences of a treatment decision, including the
significant benefits and harms of and reasonable alternatives
to a proposed treatment decision.
(6) "Life-sustaining procedure" means a medical procedure or
intervention that uses mechanical or other artificial means to
sustain, restore, or supplant a vital function, and only
artificially postpones the moment of death of a patient in a
terminal condition whose death is imminent or will result
within a relatively short time without the application of the
procedure. The term does not include the administration of
medication or the performance of a medical procedure considered
to be necessary to provide comfort or care or to alleviate
pain.
(7) "Physician" means a physician licensed by the Texas
State Board of Medical Examiners or a properly credentialed
physician who holds a commission in the uniformed services of
the United States and who is serving on active duty in this
state.
(8) "Qualified patient" means a patient with a terminal
condition that has been diagnosed and certified in writing by
the attending physician and one other physician who have
personally examined the patient.
(9) "Terminal condition" means an incurable or irreversible
condition caused by injury, disease, or illness that would
produce death without the application of life-sustaining
procedures, according to reasonable medical judgment, and in
which the application of life-sustaining procedures serves only
to postpone the moment of the patient's death.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 208, eff. Sept. 1,
1991.
Amended by Acts 1993, 73rd Leg., ch. 107, Sec. 5.04, eff. Aug.
30, 1993.
Sec. 672.003. Written Directive by Competent Adult; Notice to Physician.
(a) A competent adult may at any time execute a written
directive.
(b) The declarant must sign the directive in the presence of
two witnesses, and those witnesses must sign the directive.
(c) A witness may not be:
(1) a person designated by the declarant to make a treatment
decision;
(2) a person related to the declarant by blood or marriage;
(3) a person entitled to any part of the declarant's estate
after the declarant's death under a will or codicil executed by
the declarant or by operation of law;
(4) the attending physician;
(5) an employee of the attending physician;
(6) an employee of a health care facility in which the
declarant is a patient if the employee is providing direct
patient care to the declarant or is an officer, director,
partner, or business office employee of the health care
facility or of any parent organization of the health care
facility; or
(7) a person who, at the time the written directive is
executed or if the directive is a nonwritten directive issued
under Section 672.005, at the time the nonwritten directive is
issued, has a claim against any part of the declarant's estate
after the declarant's death.
(d) A declarant may include in a directive directions other
than those provided by Section 672.004 and may designate in a
directive a person to make a treatment decision for the declarant
in the event the declarant becomes comatose, incompetent, or
otherwise mentally or physically incapable of communication.
(e) A declarant shall notify the attending physician of the
existence of a written directive. If the declarant is comatose,
incompetent, or otherwise mentally or physically incapable of
communication, another person may notify the attending physician
of the existence of the written directive. The attending
physician shall make the directive a part of the declarant's
medical record.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 209, eff. Sept. 1,
1991.
Amended by Acts 1997, 75th Leg., ch. 291, Sec. 1, eff. Jan. 1,
1998.
Sec. 672.004. Form of Written Directive.
A written directive may be in the following form:
"DIRECTIVE TO PHYSICIANS
"Directive made this __________ day of __________ (month, year).
"I __________, being of sound mind, wilfully and voluntarily make
known my desire that my life shall not be artificially prolonged
under the circumstances set forth in this directive.
"1. If at any time I should have an incurable or irreversible
condition caused by injury, disease, or illness certified to be a
terminal condition by two physicians, and if the application of
life-sustaining procedures would serve only to artificially
postpone the moment of my death, and if my attending physician
determines that my death is imminent or will result within a
relatively short time without the application of life-sustaining
procedures, I direct that those procedures be withheld or
withdrawn, and that I be permitted to die naturally.
"2. In the absence of my ability to give directions regarding
the use of those life-sustaining procedures, it is my intention
that this directive be honored by my family and physicians as the
final expression of my legal right to refuse medical or surgical
treatment and accept the consequences from that refusal.
"3. If I have been diagnosed as pregnant and that diagnosis is
known to my physician, this directive has no effect during my
pregnancy.
"4. This directive is in effect until it is revoked.
"5. I understand the full import of this directive and I am
emotionally and mentally competent to make this directive.
"6. I understand that I may revoke this directive at any time.
"Signed ___
(City, County, and State of Residence)
I am not a person designated by the declarant to make a
treatment decision. I am not related to the declarant by blood
or marriage. I would not be entitled to any portion of the
declarant's estate on the declarant's death. I am not the
attending physician of the declarant or an employee of the
attending physician. I have no claim against any portion of the
declarant's estate on the declarant's death. Furthermore, if I
am an employee of a health care facility in which the declarant
is a patient, I am not involved in providing direct patient care
to the declarant and am not an officer, director, partner, or
business office employee of the health care facility or of any
parent organization of the health care facility.
"Witness ___
"Witness ___"
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., ch. 14, Sec. 209, eff. Sept. 1,
1991.
Amended by Acts 1997, 75th Leg., ch. 291, Sec. 2, eff. Jan. 1,
1998.
Sec. 672.005. Issuance of Nonwritten Directive by Competent Adult Qualified
Patient.
(a) A competent qualified patient who is an adult may issue a
directive by a nonwritten means of communication.
(b) A declarant must issue the nonwritten directive in the
presence of the attending physician and two witnesses. The
witnesses must possess the same qualifications as are required by
Section 672.003(c).
(c) The physician shall make the fact of the existence of the
directive a part of the declarant's medical record and the
witnesses shall sign the entry in the medical record.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.006. Execution of Directive on Behalf of Patient Younger Than 18
Years of Age.
The following persons may execute a directive on behalf of a
qualified patient who is younger than 18 years of age:
(1) the patient's spouse, if the spouse is an adult;
(2) the patient's parents; or
(3) the patient's legal guardian.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.007. Patient Desire Supersedes Directive.
The desire of a competent qualified patient, including a
competent qualified patient younger than 18 years of age,
supersedes the effect of a directive.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.008. Procedure When Declarant is Incompetent or Incapable of
Communication.
(a) This section applies when an adult qualified patient has
executed or issued a directive and is comatose, incompetent, or
otherwise mentally or physically incapable of communication.
(b) If the adult qualified patient has designated a person to
make a treatment decision as authorized by Section 672.003(d),
the attending physician and the designated person may make a
treatment decision to withhold or withdraw life-sustaining
procedures from the patient.
(c) If the adult qualified patient has not designated a person
to make a treatment decision, the attending physician shall
comply with the directive unless the physician believes that the
directive does not reflect the patient's present desire.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.009. Procedure When Person Has not Executed or Issued a Directive
and is Incompetent or Incapable of Communication.
(a) If an adult qualified patient has not executed or issued a
directive and is comatose, incompetent, or otherwise mentally or
physically incapable of communication, the attending physician
and the patient's legal guardian may make a treatment decision
that may include a decision to withhold or withdraw
life-sustaining procedures from the patient.
(b) If the patient does not have a legal guardian, the
attending physician and at least two persons, if available, of
the following categories, in the following priority, may make a
treatment decision that may include a decision to withhold or
withdraw life-sustaining procedures:
(1) the patient's spouse;
(2) a majority of the patient's reasonably available adult
children;
(3) the patient's parents; or
(4) the patient's nearest living relative.
(c) A treatment decision made under Subsection (a) or (b) must
be based on knowledge of what the patient would desire, if known.
(d) A treatment decision made under Subsection (b) must be
documented in the patient's medical record and signed by the
attending physician.
(e) If the patient does not have a legal guardian and a person
listed in Subsection (b) is not available, a treatment decision
made under Subsection (b) must be witnessed by another physician
who is not involved in the treatment of the patient.
(f) The fact that an adult qualified patient has not executed
or issued a directive does not create a presumption that the
patient does not want a treatment decision to be made to withhold
or withdraw life-sustaining procedures.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1997, 75th Leg., ch. 291, Sec. 3, eff. Jan. 1,
1998.
Sec. 672.010. Patient Certification and Prerequisites for Complying With
Directive.
(a) An attending physician who has been notified of the
existence of a directive shall provide for the declarant's
certification as a qualified patient on diagnosis of a terminal
condition.
(b) Before withholding or withdrawing life-sustaining
procedures from a qualified patient under this chapter, the
attending physician must:
(1) determine that the patient's death is imminent or will
result within a relatively short time without application of
those procedures;
(2) note that determination in the patient's medical record;
and
(3) determine that the steps proposed to be taken are in
accord with this chapter and the patient's existing desires.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Amended by Acts 1991, 72nd Leg., 1st C.S., ch. 14, Sec. 6.01,
eff. Nov. 12, 1991.
Sec. 672.011. Duration of Directive.
A directive is effective until it is revoked as prescribed by
Section 672.012.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.012. Revocation of Directive.
(a) A declarant may revoke a directive at any time without
regard to the declarant's mental state or competency. A
directive may be revoked by:
(1) the declarant or someone in the declarant's presence and
at the declarant's direction canceling, defacing, obliterating,
burning, tearing, or otherwise destroying the directive;
(2) the declarant signing and dating a written revocation
that expresses the declarant's intent to revoke the directive;
or
(3) the declarant orally stating the declarant's intent to
revoke the directive.
(b) A written revocation executed as prescribed by Subsection
(a)(2) takes effect only when the declarant or a person acting on
behalf of the declarant notifies the attending physician of its
existence or mails the revocation to the attending physician.
The attending physician or the physician's designee shall record
in the patient's medical record the time and date when the
physician received notice of the written revocation and shall
enter the word "VOID" on each page of the copy of the directive
in the patient's medical record.
(c) An oral revocation issued as prescribed by Subsection
(a)(3) takes effect only when the declarant or a person acting on
behalf of the declarant notifies the attending physician of the
revocation. The attending physician or the physician's designee
shall record in the patient'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 designees shall also enter
the word "VOID" on each page of the copy of the directive in the
patient's medical record.
(d) Except as otherwise provided by this chapter, 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.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.013. Reexecution of Directive.
A declarant may at any time reexecute a directive in accordance
with the procedures prescribed by Section 672.003, including
reexecution after the declarant is diagnosed as having a terminal
condition.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.014. Effect of Directive on Insurance Policy and Premiums.
(a) The fact that a person has executed or issued a directive
under this chapter does not:
(1) restrict, inhibit, or impair in any manner the sale,
procurement, or issuance of a life insurance policy to that
person; or
(2) modify the terms of an existing life insurance policy.
(b) Notwithstanding the terms of any life insurance policy, the
fact that life-sustaining procedures are withheld or withdrawn
from an insured qualified patient under this chapter does not
legally impair or invalidate that person's life insurance policy.
(c) A physician, health facility, health provider, insurer, or
health care service plan may not require a person to execute or
issue a directive as a condition for obtaining insurance for
health care services or receiving health care services.
(d) The fact that a person has executed or issued or failed to
execute or issue a directive under this chapter may not be
considered in any way in establishing insurance premiums.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.015. Limitation of Liability for Withholding or Withdrawing
Life-Sustaining Procedures.
(a) A physician or health facility that causes life-sustaining
procedures to be withheld or withdrawn from a qualified patient
in accordance with this chapter is not civilly liable for that
action unless negligent.
(b) A health professional, acting under the direction of a
physician, who participates in withholding or withdrawing
life-sustaining procedures from a qualified patient in accordance
with this chapter is not civilly liable for that action unless
negligent.
(c) A physician, or a health professional acting under the
direction of a physician, who participates in withholding or
withdrawing life-sustaining procedures from a qualified patient
in accordance with this chapter is not criminally liable or
guilty of unprofessional conduct as a result of that action
unless negligent.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.016. Limitation of Liability for Failure to Effectuate Directive.
(a) A physician, health care facility, or health care
professional who has no knowledge of a directive is not civilly
or criminally liable for failing to act in accordance with the
directive.
(b) A physician, or a health professional acting under the
direction of a physician, is not civilly or criminally liable for
failing to effectuate a qualified patient's directive.
(c) If an attending physician refuses to comply with a
directive or treatment decision, the physician shall make a
reasonable effort to transfer the patient to another physician.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.017. Honoring Directive Does not Constitute Offense of Aiding
Suicide.
A person does not commit an offense under Section 22.08, Penal
Code, by withholding or withdrawing life-sustaining procedures
from a qualified patient in accordance with this chapter.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.018. Criminal Penalty; Prosecution.
(a) A person commits an offense if the person intentionally
conceals, cancels, defaces, obliterates, or damages another
person's directive without that person's consent. An offense
under this subsection is a Class A misdemeanor.
(b) A person is subject to prosecution for criminal homicide
under Chapter 19, Penal Code, if the person, with the intent to
cause life-sustaining procedures to be withheld or withdrawn from
another person contrary to the other person's desires, falsifies
or forges a directive or intentionally conceals or withholds
personal knowledge of a revocation and thereby directly causes
life-sustaining procedures to be withheld or withdrawn from the
other person with the result that the other person's death is
hastened.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.019. Pregnant Patients.
A person may not withdraw or withhold life-sustaining
procedures under this chapter from a pregnant patient.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.020. Mercy Killing not Condoned.
This chapter does not condone, authorize, or approve mercy
killing or permit an affirmative or deliberate act or omission to
end life except to permit the natural process of dying as
provided by this chapter.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989.
Sec. 672.021. Legal Right or Responsibility not Affected.
This chapter does not impair or supersede any legal right or
responsibility a person may have to effect the withholding or
withdrawal of life-sustaining procedures in a lawful manner.
Acts 1989, 71st Leg., ch. 678, Sec. 1, eff. Sept. 1, 1989