Health and Safety Code
CHAPTER 674. OUT-OF-HOSPITAL DO-NOT-RESUSCITATE
Sec. 674.001. Definitions.
In this chapter:
(1) "Attending physician" means the physician who has
primary responsibility for a person's treatment and care.
(2) "Board" means the Texas Board of Health.
(3) "Cardiopulmonary resuscitation" includes a component of
cardiopulmonary resuscitation.
(4) "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.
(5) "Declarant" means a person who has executed or issued an
out-of-hospital do-not-resuscitate order under this chapter.
(6) "Department" means the Texas Department of Health.
(7) "DNR identification device" means an identification
device specified by the board under Section 674.023 that is
worn for the purpose of identifying a person who has executed
or issued an out-of-hospital DNR order or on whose behalf an
out-of-hospital DNR order has been executed or issued under
this chapter.
(8) "Durable power of attorney for health care" means a
document delegating to an agent the authority to make health
care decisions for a person in accordance with Chapter 135,
Civil Practice and Remedies Code.
(9) "Emergency medical services" has the meaning assigned by
Section 773.003.
(10) "Emergency medical services personnel" has the meaning
assigned by Section 773.003.
(11) "Health care professionals" means physicians, nurses,
and emergency medical services personnel and, unless the
context requires otherwise, includes hospital emergency
personnel.
(12) "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.
(13) "Life-sustaining procedure" means a medical procedure,
treatment, or intervention that uses mechanical or other
artificial means to sustain, restore, or supplant a spontaneous
vital function and, when applied to a person in a terminal
condition, serves only to prolong the process of dying. 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 or the
provision of water or nutrition.
(14) "Out-of-hospital DNR order":
(A) means a legally binding out-of-hospital
do-not-resuscitate order, in the form specified by the board
under Section 674.003, prepared and signed by the attending
physician of a person who has been diagnosed as having a
terminal condition, that documents the instructions of a
person or the person's legally authorized representative and
directs health care professionals acting in an
out-of-hospital setting not to initiate or continue the
following life-sustaining procedures:
(i) cardiopulmonary resuscitation;
(ii) endotracheal intubation or other means
of advanced airway management;
(iii) artificial ventilation;
(iv) defibrillation;
(v) transcutaneous cardiac pacing;
(vi) the administration of cardiac
resuscitation medications; and
(vii) other life-sustaining procedures
specified by the board under Section 674.023(a); and
(B) does not include authorization to withhold medical
interventions or therapies considered necessary to provide
comfort or care or to alleviate pain or to provide water or
nutrition.
(15) "Out-of-hospital setting" means any setting outside of
a licensed acute care hospital in which health care
professionals are called for assistance, including long-term
care facilities, in-patient hospice facilities, private homes,
and vehicles during transport.
(16) "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.
(17) "Proxy" means a person designated and authorized by a
directive executed or issued in accordance with Chapter 672 to
make a treatment decision for another person in the event the
other person becomes comatose, incompetent, or otherwise
mentally or physically incapable of communication.
(18) "Qualified relatives" means those persons authorized to
execute or issue an out-of-hospital DNR order on behalf of a
person who is comatose, incompetent, or otherwise mentally or
physically incapable of communication under Section 674.008.
(19) "Statewide out-of-hospital DNR protocol" means a set of
statewide standardized procedures adopted by the board under
Section 674.023 for withholding cardiopulmonary resuscitation
and certain other life-sustaining procedures by health care
professionals acting in out-of-hospital settings.
(20) "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 person's death.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.002. Out-Of-Hospital DNR Order; Directive to Physicians.
(a) A competent person who has been diagnosed by a physician as
having a terminal condition may at any time execute a written
out-of-hospital DNR order directing health care professionals
acting in an out-of-hospital setting to withhold cardiopulmonary
resuscitation and certain other life-sustaining procedures
designated by the board.
(b) The declarant must sign the out-of-hospital DNR order in
the presence of two witnesses, and those witnesses must sign the
order. The attending physician of the declarant must sign the
order and shall make the fact of the existence of the order and
the reasons for execution of the order a part of the declarant's
medical record.
(c) A witness must have the same qualifications as those
provided by Section 672.003(c).
(d) If the person is incompetent but previously executed or
issued a directive to physicians in accordance with Chapter 672,
the physician may rely on the directive as the person's
instructions to issue an out-of-hospital DNR order and shall
place a copy of the directive in the person's medical record.
The physician shall sign the order in lieu of the person signing
under Subsection (b).
(e) If the person is incompetent but previously executed or
issued a directive to physicians in accordance with Chapter 672
designating a proxy, the proxy may make any decisions required of
the designating person as to an out-of-hospital DNR order and
shall sign the order in lieu of the person signing under
Subsection (b).
(f) If the person is now incompetent but previously executed or
issued a durable power of attorney for health care in accordance
with Chapter 135, Civil Practice and Remedies Code, designating
an agent, the agent may make any decisions required of the
designating person as to an out-of-hospital DNR order and shall
sign the order in lieu of the person signing under Subsection
(b).
(g) The board, on the recommendation of the department, shall
by rule adopt procedures for the disposition and maintenance of
records of an original out-of-hospital DNR order and any copies
of the order.
(h) An out-of-hospital DNR order is effective on its execution.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.003. Form of Out-of-Hospital DNR Order.
(a) A written out-of-hospital DNR order shall be in the
standard form specified by board rule as recommended by the
department.
(b) The standard form of an out-of-hospital DNR order specified
by the board must, at a minimum, contain the following:
(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
out-of-hospital DNR order;
(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, that the physician has
diagnosed the person as having a terminal condition, and that
the physician is directing health care professionals acting in
out-of-hospital settings not to initiate or continue certain
life-sustaining procedures 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) places for the printed names and signatures of the
witnesses and attending physician of the person and the medical
license number of the attending physician;
(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 durable power of attorney for health care,
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
674.002(d) that includes the following:
(A) a statement that the legal guardian, the proxy, the
agent, the person by nonwritten means of communication, or
the physician directs that the listed life-sustaining
procedures 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,
agent, or physician;
(8) a separate section for execution of the document by at
least two qualified relatives of the person when the person
does not have a legal guardian, proxy, or agent having a
durable power of attorney for health care and is comatose,
incompetent, or otherwise mentally or physically incapable of
communication, including:
(A) a statement that the relatives of the person are
qualified to make a treatment decision to withhold
cardiopulmonary resuscitation and certain other designated
life-sustaining procedures under Section 674.008 and, based
on the known desires of the person or a determination of the
best interest of the person, direct that the listed
life-sustaining procedures 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 relatives of the person;
(9) a place for entry of the date of execution of the
document;
(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;
(11) a statement that the document must accompany the person
during transport;
(12) a statement regarding the proper disposition of the
document or copies of the document, as the board determines
appropriate; and
(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.
(c) The board may, by rule and as recommended by the
department, modify the standard form of the out-of-hospital DNR
order described by Subsection (b) in order to accomplish the
purposes of this chapter.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.004. Issuance of Out-of-Hospital DNR Order by Nonwritten
Communication.
(a) A competent person who is an adult may issue an
out-of-hospital DNR order by nonwritten communication.
(b) A declarant must issue the nonwritten out-of-hospital DNR
order in the presence of the attending physician and two
witnesses. The witnesses must possess the same qualifications as
those provided by Section 672.003(c).
(c) The attending physician and witnesses shall sign the
out-of-hospital DNR order in that place of the document provided
by Section 674.003(b)(7) and the attending physician shall sign
the document in the place required by Section 674.003(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 witnesses shall sign that entry in the medical
record.
(d) An out-of-hospital DNR order issued in the manner provided
by this section is valid and shall be honored by responding
health care professionals as if executed in the manner provided
by Section 674.002.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.005. Execution of Out-of-Hospital DNR Order on Behalf of a
Minor.
The following persons may execute an out-of-hospital DNR order
on behalf of a minor:
(1) the minor's parents;
(2) the minor's legal guardian; or
(3) the minor's managing conservator.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.006. Desire of Person Supersedes Out-of-Hospital DNR Order.
The desire of a competent person, including a competent minor,
supersedes the effect of an out-of-hospital DNR order executed or
issued by or on behalf of the person when the desire is
communicated to responding health care professionals as provided
by this chapter.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.007. Procedure when Declarant is Incompetent or Incapable of
Communication.
(a) This section applies when a person 18 years of age or older
has executed or issued an out-of-hospital DNR order and
subsequently becomes comatose, incompetent, or otherwise mentally
or physically incapable of communication.
(b) If the adult person has designated a person to make a
treatment decision as authorized by Section 672.003(d), the
attending physician and the designated person shall comply with
the out-of-hospital DNR order.
(c) If the adult person has not designated a person to make a
treatment decision as authorized by Section 672.003(d), the
attending physician shall comply with the out-of-hospital DNR
order unless the physician believes that the order does not
reflect the person's present desire.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.008. Procedure when Person has Not Executed or Issued
Out-of-Hospital DNR Order and Is Incompetent or Incapable of Communication.
(a) If an adult person has not executed or issued an
out-of-hospital DNR order and is comatose, incompetent, or
otherwise mentally or physically incapable of communication, the
attending physician and the person's legal guardian, proxy, or
agent having a durable power of attorney for health care may
execute an out-of-hospital DNR order on behalf of the person.
(b) If the person does not have a legal guardian, proxy, or
agent, the attending physician and at least two qualified
relatives may execute an out-of-hospital DNR order in the same
manner as a treatment decision made under Section 672.009(b).
(c) A decision to execute an out-of-hospital DNR order made
under Subsection (a) or (b) must be based on knowledge of what
the person would desire, if known.
(d) An out-of-hospital DNR order executed under Subsection (b)
must be made in the presence of at least two witnesses who
possess the same qualifications that are required by Section
672.003(c).
(e) The fact that an adult person has not executed or issued an
out-of-hospital DNR order does not create a presumption that the
person does not want a treatment decision made to withhold
cardiopulmonary resuscitation and certain other designated
life-sustaining procedures designated by the board.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.009. Compliance with Out-of-Hospital DNR Order.
(a) When responding to a call for assistance, health care
professionals shall honor an out-of-hospital DNR order in
accordance with the statewide out-of-hospital DNR protocol and,
where applicable, locally adopted out-of-hospital DNR protocols
not in conflict with the statewide protocol if:
(1) the responding health care professionals discover an
executed or issued out-of-hospital DNR order form on their
arrival at the scene; and
(2) the responding health care professionals comply with
this section.
(b) If the person is wearing a DNR identification device, the
responding health care professionals must comply with Section
674.010.
(c) The responding health care professionals must establish the
identity of the person as the person who executed or issued the
out-of-hospital DNR order or for whom the out-of-hospital DNR
order was executed or issued.
(d) The responding health care professionals must determine
that the out-of-hospital DNR order form appears to be valid in
that it includes:
(1) written responses in the places designated on the form
for the names, signatures, and other information required of
persons executing or issuing, or witnessing the execution or
issuance of, the order;
(2) a date in the place designated on the form for the date
the order was executed or issued; and
(3) the signature of the declarant or persons executing or
issuing the order and the attending physician in the
appropriate places designated on the form for indicating that
the order form has been properly completed.
(e) If the conditions prescribed by Subsections (a) through (d)
are not determined to apply by the responding health care
professionals at the scene, the out-of-hospital DNR order may not
be honored and life-sustaining procedures otherwise required by
law or local emergency medical services protocols shall be
initiated or continued. Health care professionals acting in
out-of-hospital settings are not required to accept or interpret
an out-of-hospital DNR order that does not meet the requirements
of this chapter.
(f) The out-of-hospital DNR order form, when available, must
accompany the person during transport.
(g) A record shall be made and maintained of the circumstances
of each emergency medical services response in which an
out-of-hospital DNR order or DNR identification device is
encountered, in accordance with the statewide out-of-hospital DNR
protocol and any applicable local out-of-hospital DNR protocol
not in conflict with the statewide protocol.
(h) An out-of-hospital DNR order executed or issued and
documented or evidenced in the manner prescribed by this chapter
is valid and shall be honored by responding health care
professionals unless the person or persons found at the scene:
(1) identify themselves as the declarant or as the attending
physician, legal guardian, qualified relative, or agent of the
person having a durable power of attorney for health care who
executed or issued the out-of-hospital DNR order on behalf of
the person; and
(2) request that cardiopulmonary resuscitation or certain
other life-sustaining procedures designated by the board be
initiated or continued.
(i) If the policies of a health care facility preclude
compliance with the out-of-hospital DNR order of a person or an
out-of-hospital DNR order issued by an attending physician on
behalf of a person who is admitted to or a resident of the
facility, or if the facility is unwilling to accept DNR
identification devices as evidence of the existence of an
out-of-hospital DNR order, that facility shall take all
reasonable steps to notify the person or, if the person is
incompetent, the person's guardian or the person or persons
having authority to make health care treatment decisions on
behalf of the person, of the facility's policy and shall take all
reasonable steps to effect the transfer of the person to the
person's home or to a facility where the provisions of this
chapter can be carried out.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.010. DNR Identification Device.
(a) A person who has a valid out-of-hospital DNR order under
this chapter may wear a DNR identification device around the neck
or on the wrist as prescribed by board rule adopted under Section
674.023.
(b) The presence of a DNR identification device on the body of
a person is conclusive evidence that the person has executed or
issued a valid out-of-hospital DNR order or has a valid
out-of-hospital DNR order executed or issued on the person's
behalf. Responding health care professionals shall honor the DNR
identification device as if a valid out-of-hospital DNR order
form executed or issued by the person were found in the
possession of the person.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.011. Duration of Out-of-Hospital DNR Order.
An out-of-hospital DNR order is effective until it is revoked
as prescribed by Section 674.012.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.012. Revocation of Out-of-Hospital DNR Order.
(a) A declarant may revoke an out-of-hospital DNR order at any
time without regard to the declarant's mental state or
competency. An order may be revoked by:
(1) the declarant or someone in the declarant's presence and
at the declarant's direction destroying the order form and
removing the DNR identification device, if any;
(2) a person who identifies himself or herself as the legal
guardian, as a qualified relative, or as the agent of the
declarant having a durable power of attorney for health care
who executed the out-of-hospital DNR order or another person in
the person's presence and at the person's direction destroying
the order form and removing the DNR identification device, if
any;
(3) the declarant communicating the declarant's intent to
revoke the order; or
(4) a person who identifies himself or herself as the legal
guardian, a qualified relative, or the agent of the declarant
having a durable power of attorney for health care who executed
the out-of-hospital DNR order orally stating the person's
intent to revoke the order.
(b) An oral revocation under Subsection (a)(3) or (a)(4) takes
effect only when the declarant or a person who identifies himself
or herself as the legal guardian, a qualified relative, or the
agent of the declarant having a durable power of attorney for
health care who executed the out-of-hospital DNR order
communicates the intent to revoke the order to the responding
health care professionals or the attending physician at the
scene. The responding health care professionals shall record the
time, date, and place of the revocation in accordance with the
statewide out-of-hospital DNR protocol and rules adopted by the
board and any applicable local out-of-hospital DNR protocol. The
attending physician or the physician's designee shall record in
the person'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 designee shall also enter the word
"VOID" on each page of the copy of the order in the person's
medical record.
(c) 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.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16
1995.
Sec. 674.013. Reexecution of Out-of-Hospital DNR Order.
A declarant may at any time reexecute or reissue an
out-of-hospital DNR order in accordance with the procedures
prescribed by Section 674.002, including reexecution or
reissuance after the declarant is diagnosed as having a terminal
condition.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.014. Conflict with Natural Death Act or Durable Power of Attorney
for Health Care.
To the extent that an out-of-hospital DNR order conflicts with
a directive or treatment decision executed or issued under
Chapter 672 or a durable power of attorney for health care
executed or issued in accordance with Chapter 135, Civil Practice
and Remedies Code, the instrument executed later in time
controls.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.015. Effect of Out-of-Hospital DNR Order on Insurance Policy and
Premiums.
(a) The fact that a person has executed or issued an
out-of-hospital DNR order 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 cardiopulmonary resuscitation or certain other
life-sustaining procedures designated by the board are withheld
from an insured person under this chapter does not legally impair
or invalidate that person's life insurance policy and may not be
a factor for the purpose of determining the payability of
benefits or the cause of death under the life insurance policy.
(c) A physician, health facility, health care provider,
insurer, or health care service plan may not require a person to
execute or issue an out-of-hospital DNR order 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 an out-of-hospital DNR order under this chapter
may not be considered in any way in establishing insurance
premiums.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.016. Limitation on Liability for Withholding Cardiopulmonary
Resuscitation and Certain Other Life-Sustaining Procedures.
(a) A health care professional or health care facility or
entity that in good faith causes cardiopulmonary resuscitation or
certain other life-sustaining procedures designated by the board
to be withheld from a person in accordance with this chapter is
not civilly liable for that action.
(b) A health care professional or health care facility or
entity that in good faith participates in withholding
cardiopulmonary resuscitation or certain other life-sustaining
procedures designated by the board from a person in accordance
with this chapter is not civilly liable for that action.
(c) A health care professional or health care facility or
entity that in good faith participates in withholding
cardiopulmonary resuscitation or certain other life-sustaining
procedures designated by the board from a person in accordance
with this chapter is not criminally liable or guilty of
unprofessional conduct as a result of that action.
(d) A health care professional or health care facility or
entity that in good faith causes or participates in withholding
cardiopulmonary resuscitation or certain other life-sustaining
procedures designated by the board from a person in accordance
with this chapter and rules adopted under this chapter is not in
violation of any other licensing or regulatory laws or rules of
this state and is not subject to any disciplinary action or
sanction by any licensing or regulatory agency of this state as a
result of that action.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.017. Limitation on Liability for Failure to Effectuate
Out-of-Hospital DNR Order.
(a) A health care professional or health care facility or
entity that has no actual knowledge of an out-of-hospital DNR
order is not civilly or criminally liable for failing to act in
accordance with the order.
(b) A health care professional or health care facility or
entity is not civilly or criminally liable for failing to
effectuate an out-of-hospital DNR order.
(c) If an attending physician refuses to execute or comply with
an out-of-hospital DNR order, the physician shall inform the
person, the legal guardian or qualified relatives of the person,
or the agent of the person having a durable power of attorney for
health care and, if the person or another authorized to act on
behalf of the person so directs, shall make a reasonable effort
to transfer the person to another physician who is willing to
execute or comply with an out-of-hospital DNR order.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.018. Honoring Out-of-Hospital DNR Order Does Not Constitute
Offense of Aiding Suicide.
A person does not commit an offense under Section 22.08, Penal
Code, by withholding cardiopulmonary resuscitation or certain
other life-sustaining procedures designated by the board from a
person in accordance with this chapter.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.019. Criminal Penalty; Prosecution.
(a) A person commits an offense if the person intentionally
conceals, cancels, defaces, obliterates, or damages another
person's out-of-hospital DNR order or DNR identification device
without that person's consent or the consent of the person or
persons authorized to execute or issue an out-of-hospital DNR
order on behalf of the person under this chapter. 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 cardiopulmonary resuscitation or certain other
life-sustaining procedures designated by the board to be withheld
from another person contrary to the other person's desires,
falsifies or forges an out-of-hospital DNR order or intentionally
conceals or withholds personal knowledge of a revocation and
thereby directly causes cardiopulmonary resuscitation and certain
other life-sustaining procedures designated by the board to be
withheld from the other person with the result that the other
person's death is hastened.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.020. Pregnant Persons.
A person may not withhold cardiopulmonary resuscitation or
certain other life-sustaining procedures designated by the board
under this chapter from a person known by the responding health
care professionals to be pregnant.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.021. 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.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.022. Legal Right or Responsibility Not Affected.
This chapter does not impair or supersede any legal right or
responsibility a person may have under a constitution, other
statute, regulation, or court decision to effect the withholding
of cardiopulmonary resuscitation or certain other life-sustaining
procedures designated by the board.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.023. Duties of Department and Board.
(a) The board shall, on the recommendation of the department,
adopt all reasonable and necessary rules to carry out the
purposes of this chapter, including rules:
(1) adopting a statewide out-of-hospital DNR order protocol
that sets out standard procedures for the withholding of
cardiopulmonary resuscitation and certain other life-sustaining
procedures by health care professionals acting in
out-of-hospital settings;
(2) designating life-sustaining procedures that may be
included in an out-of-hospital DNR order, including all
procedures listed in Section 674.001(14)(A)(i) through (vi);
and
(3) governing recordkeeping in circumstances in which an
out-of-hospital DNR order or DNR identification device is
encountered by responding health care professionals.
(b) The rules adopted by the board under Subsection (a) are not
effective until approved by the Texas State Board of Medical
Examiners.
(c) Local emergency medical services authorities may adopt
local out-of-hospital DNR order protocols if the local protocols
do not conflict with the statewide out-of-hospital DNR order
protocol adopted by the board.
(d) The board by rule shall specify a distinctive standard
design for a necklace and a bracelet DNR identification device
that signifies, when worn by a person, that the possessor has
executed or issued a valid out-of-hospital DNR order under this
chapter or is a person for whom a valid out-of-hospital DNR order
has been executed or issued.
(e) The department shall report to the board from time to time
regarding issues identified in emergency medical services
responses in which an out-of-hospital DNR order or DNR
identification device is encountered. The report may contain
recommendations to the board for necessary modifications to the
form of the standard out-of-hospital DNR order or the designated
life-sustaining procedures listed in the standard out-of-hospital
DNR order, the statewide out-of-hospital DNR order protocol, or
the DNR identification devices.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
1995.
Sec. 674.024. Recognition of Out-of-Hospital DNR Order Executed or Issued
in Other State.
An out-of-hospital DNR order executed, issued, or authorized in
another state or a territory or possession of the United States
in compliance with the law of that jurisdiction is effective for
purposes of this chapter.
Added by Acts 1995, 74th Leg., ch. 965, Sec. 10, eff. June 16,
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