Texas New DNR Law


Texas has enacted a new DNR law and all physicians are subject to new penalties. But first, let’s get the legalities specified:

NOTICE: This information is provided with the express understanding that 1) no attorney-client relationship exists, 2) neither I nor my attorneys are engaged in providing legal advice and 3) that the information is of a general character. This is not a substitute for the advice of an attorney. While every effort is made to ensure that content is complete, accurate and timely, I cannot guarantee the accuracy and totality of the information contained in this publication and assumes no legal responsibility for loss or damages resulting from the use of this content. You should not rely on this information when dealing with personal legal matters; rather legal advice from retained legal counsel should be sought.


Background – 85th Legislature (1st) 2017
Regulates a DNR order issued by a physician in a facility

Limits circumstances in which they can be issued

Requires notice in certain circumstances

Establishes criminal penalties for health care providers

Contains limited liability protections

Effective April 1, 2018


Advance Directives Act, TX Health & Safety Code, Chapter 166
Texas statute allows for four types of advanced directive instruments:

  1. Directives to Physicians and Family or Surrogates;
  2. Medical Powers of Attorney;
  3. Out-of-Hospital Do Not Resuscitate Orders; and,
  4. Effective April 1, 2018: DNR Orders (“In-hospital DNR Orders”).


It Adds Subsection (e) “Health Care Facility Do Not Resuscitate Orders”
Chapter 166, TX Health & Safety Code

The new law defines an order as instructing health care professionals not to attempt cardiopulmonary resuscitation (CPR) on a patient whose circulatory or respiratory function ceased.

The new requirements only apply to orders issued in a health care facility or hospital and do not apply to an out-of-hospital DNR (Ch. 166, Subchapter C).


For an Order to be Valid in an In-Patient Setting:
The order must be dated and issued by the patient’s Attending Physician
These duties belong only to the Attending Physician, and cannot be delegated. No other individual may issue or sign the Order on the physician’s behalf.


For an Order to be Valid in an In-Patient Setting:
The order must be dated and issued by the patient’s Attending Physician
comply with a competent patient’s written and dated directions; or

comply with a competent patient’s oral directions delivered to or observed by two competent adults witnesses (at least on of whom cannot be an employee of the attending physician or the facility); or

be issued pursuant to the patient’s directions set forth in a properly executed advance directive (Ch. 166, Subchapter B; or

be issued pursuant to the directions of a patient’s legal guardian or an agent who has been given medical power of attorney over the patient; or

be issued pursuant to a treatment decision that follows the procedures under state law for when a person has not executed or issued a directive and is incompetent or incapable or communications; or

be medically appropriate and not contrary to the directions given by a competent patient whose death is imminent, regardless of CPR. (Sec. 166.203(a)(2)).


When Does An Order Take Effect?
The order can take effect at the time of issuance, as long as the order is placed in the patient’s medical record as soon as practicable.

However, efforts to notify the patient (or, if incompetent, an appropriate surrogate) of an order issued under 166.203(a)(2) must be attempted before placing such order in the medical record.


Notification Requirements
“Reasonably diligent” efforts must be made to notify an incompetent patient’s healthcare agent, the patient’s guardian, spouse, adult children or patents (in that order) of the existence of an order issued under Sec. 166.203(a)(2). This statutory requirement lists only these individuals.

Post-issuance notice may also be required.


The attending physician must revoke an order if the patient, or, if incompetent, their proper agent or guardian revoke the underlying consent for the order. The attending physician may revoke an order at any time, without a request.

If the intent to revoke consent is relayed to another person providing direct care to the patient, the attending physician must be notified.


Failure to Comply with Notice Requirements
As long as the healthcare provider attempts, IN GOOD FAITH, to notify the patient or their healthcare agent, guardian, spouse, adult child, or parents, no civil, criminal, or board action can be taken against them for failure to comply with notice requirements.

This protection is ONLY available if the healthcare provider contemporaneously documents his/her attempts to comply with the notice provision in the patient’s medical record.


Liability Protections for Healthcare Providers
Healthcare providers are immune from liability if they follow an order or withhold CPR, so long as the provider is acting IN GOOD FAITH.

Actual knowledge of an order or revocation is required.

It is a crime to conceal, cancel, effectuate, or falsify another’s DNR order, or intentionally withhold personal knowledge.



Senate Bill 11 – Click Here

Texas Medical Association – Click Here

March 2018 edition of Texas Medicine magazine – Click Here

Alfred Ricks Jr., M.D.



Dr. Ricks is a native Texan, born in Liberty Texas. He graduated from University of Texas Southwestern Medical School and has been a medical doctor for 42 years. Specializing in Internal Medicine, Emergency Medicine, and Hospital Care (Hospitalist). He has produced numerous medical educational videos for aspiring school students and the general public. Dr. Ricks is currently sharing his experience as a physician with other healthcare professionals to improve their relationship with patients, patient satisfaction, and patient retention.

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