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7.1.6.3 Advance Directives
Federal and state law require providers to maintain written policies and procedures for informing and providing written information to all adult clients 18 years of age and older about their rights under state and federal law, in advance of their receiving care (Social Security Act §§1902[a][57] and 1903[m][1][A]). The written policies and procedures must contain procedures for providing written information regarding the client's right to refuse, withhold, or withdraw medical treatment advance directives. These policies and procedures must comply with provisions contained in 42 Code of Federal Regulations (CFR) §§434.28 and 489, SubPart I, relating to the following state laws and rules:
• A client's right to self-determination in making health-care decisions.
•The Advance Directives Act, Chapter 166, Texas Health and Safety Code, which includes:
•A client's right to execute an advance written directive to physicians and family or surrogates, or to make a non-written directive to administer, withhold or withdraw life-sustaining treatment in the event of a terminal or irreversible condition.
•A client's right to make written and non-written Out-of-Hospital Do-Not-Resuscitate Orders.
•A client's right to execute a Medical Power of Attorney to appoint an agent to make health-care decisions on the client's behalf if the client becomes incompetent.
These policies can include a clear and precise statement of limitation if a participating provider cannot or will not implement a client's advance directive. A statement of limitation on implementing a client's advance directive should include at least the following information:
•A clarification of the provider's conscience objections.
•Identification of the state legal authority permitting a provider's conscience objections to carrying out an advance directive.
•A description of the range of medical conditions or procedures affected by the conscience objection.
A provider cannot require a client to execute or issue an advance directive as a condition for receiving health-care services. A provider cannot discriminate against a client based on whether or not the client has executed or issued an advance directive.
A provider's policies and procedures must require the provider to comply with the requirements of state and federal law relating to advance directives.
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