End-of-Life Documents and TADA
TADA Disagreements
Review, Transfer, and Conditional Timing
The requested-life-sustaining-treatment branch has committee, notice, transfer, start/delay, continued-care, and court-extension safeguards; it is not an automatic treatment outcome.
Structured Visual
Jurisdiction: TX; as of 2026-09-11; not legal advice; Render structure, refuse interpretation, cite, abstain, and hand off.
RENDER STRUCTURE · REFUSE INTERPRETATION · CITE · ABSTAIN · HAND-OFF: render structure, refuse interpretation, cite provenance, abstain when unsupported, and hand off to human review.
Scope and honesty note
Jurisdiction: Texas medical-practice statutes, as of 2026-09-11. This classroom page provides legal information, not legal or medical advice. It does not assess a patient, clinician, license, report, prescription, disclosure, privilege, disciplinary ground, offense, or outcome. Current statutes, agency rules, facts, procedure, and professional standards may differ. Render only pinned structure; refuse unsupported interpretation or action; cite, abstain, and hand off to qualified legal, medical, regulatory, or emergency professionals.
The rule in plain terms
Section 166.046 applies to a patient determined incompetent or otherwise mentally or physically incapable of communication. A physician's refusal to honor a directive or treatment decision receives ethics or medical committee review; the attending physician cannot sit on that review committee, and life-sustaining treatment continues during review. Written meeting notice is ordinarily required at least seven calendar days beforehand, subject to mutual written waiver, with specified materials and participation rights. Transfer efforts begin after that notice, so they overlap the review rather than waiting until a final decision. The requested-life-sustaining-treatment branch additionally requires the attending physician's medical-inappropriateness decision and committee affirmation. Its 25-day mechanism depends on the statutory start notice or qualifying procedure for which a delay notice was given, not merely receipt of the committee decision.
Definitions and comfort-care boundary
The chapter's definitions distinguish incompetence, life-sustaining treatment, and care intended for pain or comfort. Verbatim statutory text: “In this chapter: (1) "Advance directive" means: (A) a directive, as that term is defined by Section 166.031; (B) an out-of-hospital DNR order, as that term is defined by Section 166.081; or (C) a medical power of attorney under Subchapter D. (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 gastrointestinal tract. (3) "Attending physician" means a physician selected by or assigned to a patient who has primary responsibility for a patient's treatment and care. (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 a directive under this chapter. (5-a) "Digital signature" means an electronic identifier intended by the person using it to have the same force and effect as the use of a manual signature. (5-b) "Electronic signature" means a facsimile, scan, uploaded image, computer-generated image, or other electronic representation of a manual signature that is intended by the person using it to have the same force and effect of law as a manual signature. (6) "Ethics or medical committee" means a committee established under Sections 161.031-161.033. (7) "Health care or treatment decision" means consent, refusal to consent, or withdrawal of consent to health care, treatment, service, or a procedure to maintain, diagnose, or treat an individual's physical or mental condition, including such a decision on behalf of a minor. (8) "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. (9) "Irreversible condition" means a condition, injury, or illness: (A) that may be treated but is never cured or eliminated; (B) that leaves a person unable to care for or make decisions for the person's own self; and (C) that, without life-sustaining treatment provided in accordance with the prevailing standard of medical care, is fatal. (10) "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 or the performance of a medical procedure considered to be necessary to provide comfort care, or any other medical care provided to alleviate a patient's pain. (11) "Medical power of attorney" means a document delegating to an agent authority to make health care decisions executed or issued under Subchapter D. (12) "Physician" means: (A) a physician licensed by the Texas Medical Board; or (B) 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. (13) "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. A patient who has been admitted to a program under which the person receives hospice services provided by a home and community support services agency licensed under Chapter 142 is presumed to have a terminal condition for purposes of this chapter. (14) "Witness" means a person who may serve as a witness under Section 166.003. (15) "Cardiopulmonary resuscitation" means any medical intervention used to restore circulatory or respiratory function that has ceased.” Legal citation: Tex. Health Safety Code § 166.002. Pinned source: https://www.neochart.com/catalog/texas/health_safety/chapter_166/section_166_002/tex_hs_166_002_ffd559a5cb42/tex_health_safety_code_sec_166_002_definitions_in_this_chapt_0001/index.html; data via neochart.com, snapshot 2026-09-11.
Refusal and alternative procedure
The source preserves the distinct refusal route, reasonable transfer opportunity, and qualified liability provisions. Verbatim statutory text: “(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 subject to review and disciplinary action by the appropriate licensing board for failing to effectuate a qualified patient's directive in violation of this subchapter or other laws of this state. This subsection does not limit remedies available under other laws of this state. (c) If an attending physician refuses to comply with a directive or treatment decision and does not wish to follow the procedure established under Section 166.046, life-sustaining treatment shall be provided to the patient, but only until a reasonable opportunity has been afforded for the transfer of the patient to another physician or health care facility willing to comply with the directive or treatment decision. (d) A physician, health professional acting under the direction of a physician, or health care facility is not civilly or criminally liable or subject to review or disciplinary action by the person's appropriate licensing board if the person has complied with the procedures outlined in Section 166.046.” Legal citation: Tex. Health Safety Code § 166.045. Pinned source: https://www.neochart.com/catalog/texas/health_safety/chapter_166/section_166_045/tex_hs_166_045_2d69c16f74f7/tex_health_safety_code_sec_166_045_liability_for_failure_to_0001/index.html; data via neochart.com, snapshot 2026-09-11.
Committee review and conditional period
The full provision supplies patient scope, notice and participation, transfer, start/delay conditions, continued care, exceptions, and the court-extension standard. Verbatim statutory text: “(a) This section applies only to health care and treatment for a patient who is determined to be incompetent or is otherwise mentally or physically incapable of communication. (a-1) If an attending physician refuses to honor an advance directive of or health care or treatment decision made by or on behalf of a patient to whom this section applies, the physician's refusal shall be reviewed by an ethics or medical committee. The attending physician may not be a member of that committee during the review. The patient shall be given life-sustaining treatment during the review. (a-2) An ethics or medical committee that reviews a physician's refusal to honor an advance directive or health care or treatment decision under Subsection (a-1) shall consider the patient's well-being in conducting the review but may not make any judgment on the patient's quality of life. For purposes of this section, a decision by the committee based on any of the considerations described by Subdivisions (1) through (5) is not a judgment on the patient's quality of life. If the review requires the committee to determine whether life-sustaining treatment requested in the patient's advance directive or by the person responsible for the patient's health care decisions is medically inappropriate, the committee shall consider whether provision of the life-sustaining treatment: (1) will prolong the natural process of dying or hasten the patient's death; (2) will result in substantial, irremediable, and objectively measurable physical pain that is not outweighed by the benefit of providing the treatment; (3) is medically contraindicated such that the provision of the treatment seriously exacerbates life-threatening medical problems not outweighed by the benefit of providing the treatment; (4) is consistent with the prevailing standard of care; or (5) is contrary to the patient's clearly documented desires. (b) The person responsible for the patient's health care decisions: (1) shall be informed in writing not less than seven calendar days before the meeting called to discuss the patient's directive, unless the period is waived by written mutual agreement, of: (A) the ethics or medical committee review process and any other related policies and procedures adopted by the health care facility, including any policy described by Subsection (b-1); (B) the rights described in Subdivisions (3)(A)-(D); (C) the date, time, and location of the meeting; (D) the work contact information of the facility's personnel who, in the event of a disagreement, will be responsible for overseeing the reasonable effort to transfer the patient to another physician or facility willing to comply with the directive; (E) the factors the committee is required to consider under Subsection (a-2); and (F) the language in Section 166.0465; (2) at the time of being informed under Subdivision (1), shall be provided: (A) a copy of the appropriate statement set forth in Section 166.052; and (B) a copy of the registry list of health care providers and referral groups that have volunteered their readiness to consider accepting transfer or to assist in locating a provider willing to accept transfer that is posted on the website maintained by the department under Section 166.053; and (3) is entitled to: (A) attend and participate in the meeting as scheduled by the committee; (B) receive during the meeting a written statement of the first name, first initial of the last name, and title of each committee member who will participate in the meeting; (C) subject to Subsection (b-1): (i) be accompanied at the meeting by the patient's spouse, parents, adult children, and not more than four additional individuals, including legal counsel, a physician, a health care professional, or a patient advocate, selected by the person responsible for the patient's health care decisions; and (ii) have an opportunity during the open portion of the meeting to either directly or through another individual attending the meeting: (a) explain the justification for the health care or treatment request made by or on behalf of the patient; (b) respond to information relating to the patient that is submitted or presented during the open portion of the meeting; and (c) state any concerns of the person responsible for the patient's health care decisions regarding compliance with this section or Section 166.0465, including stating an opinion that one or more of the patient's disabilities are not relevant to the committee's determination of whether the medical or surgical intervention is medically appropriate; (D) receive a written notice of: (i) the decision reached during the review process accompanied by an explanation of the decision, including, if applicable, the committee's reasoning for affirming that requested life-sustaining treatment is medically inappropriate; (ii) the patient's major medical conditions as identified by the committee, including any disability of the patient considered by the committee in reaching the decision, except the notice is not required to specify whether any medical condition qualifies as a disability; (iii) a statement that the committee has complied with Subsection (a-2) and Section 166.0465; and (iv) the health care facilities contacted before the meeting as part of the transfer efforts under Subsection (d) and, for each listed facility that denied the request to transfer the patient and provided a reason for the denial, the provided reason; (E) receive a copy of or electronic access to the portion of the patient's medical record related to the treatment received by the patient in the facility for the period of the patient's current admission to the facility; and (F) receive a copy of or electronic access to all of the patient's reasonably available diagnostic results and reports related to the medical record provided under Paragraph (E). (b-1) A health care facility may adopt and implement a written policy for meetings held under this section that is reasonable and necessary to: (1) facilitate information sharing and discussion of the patient's medical status and treatment requirements, including provisions related to attendance, confidentiality, and timing regarding any agenda item; and (2) preserve the effectiveness of the meeting, including provisions disclosing that the meeting is not a legal proceeding and the committee will enter into an executive session for deliberations. (b-2) Notwithstanding Subsection (b)(3), the following individuals may not attend or participate in the executive session of an ethics or medical committee under this section: (1) the physicians or health care professionals providing health care and treatment to the patient; or (2) the person responsible for the patient's health care decisions or any person attending the meeting under Subsection (b)(3)(C)(i). (b-3) If the health care facility or person responsible for the patient's health care decisions intends to have legal counsel attend the meeting of the ethics or medical committee, the facility or person, as applicable, shall make a good faith effort to provide written notice of that intention not less than 48 hours before the meeting begins. (c) The written notice required by Subsection (b)(3)(D)(i) must be included in the patient's medical record. (d) After written notice is provided under Subsection (b)(1), the patient's attending physician shall make a reasonable effort to transfer the patient to a physician who is willing to comply with the directive. The health care facility's personnel shall assist the physician in arranging the patient's transfer to: (1) another physician; (2) an alternative care setting within that facility; or (3) another facility. (d-1) If another health care facility denies the patient's transfer request, the personnel of the health care facility assisting with the patient's transfer efforts under Subsection (d) shall make a good faith effort to inquire whether the facility that denied the patient's transfer request would be more likely to approve the transfer request if a medical procedure, as that term is defined in this section, is performed on the patient. (d-2) If the patient's advance directive or the person responsible for the patient's health care decisions is requesting life-sustaining treatment that the attending physician has decided and the ethics or medical committee has affirmed is medically inappropriate: (1) the attending physician or another physician responsible for the care of the patient shall perform on the patient each medical procedure that satisfies all of the following conditions: (A) in the attending physician's judgment, the medical procedure is reasonable and necessary to help effect the patient's transfer under Subsection (d); (B) an authorized representative for another health care facility with the ability to comply with the patient's advance directive or the health care or treatment decision made by or on behalf of the patient has expressed to the personnel described by Subsection (b)(1)(D) or the attending physician that the facility is more likely to accept the patient's transfer to the other facility if the medical procedure is performed on the patient; (C) in the medical judgment of the physician who would perform the medical procedure, performing the medical procedure is: (i) within the prevailing standard of medical care; and (ii) not medically contraindicated or medically inappropriate under the circumstances; (D) in the medical judgment of the physician who would perform the medical procedure, the physician has the training and experience to perform the medical procedure; (E) the physician who would perform the medical procedure has medical privileges at the facility where the patient is receiving care authorizing the physician to perform the medical procedure at the facility; (F) the facility where the patient is receiving care has determined the facility has the resources for the performance of the medical procedure at the facility; and (G) the person responsible for the patient's health care decisions provides consent on behalf of the patient for the medical procedure; and (2) the person responsible for the patient's health care decisions is entitled to receive: (A) a delay notice: (i) if, at the time the written decision is provided as required by Subsection (b)(3)(D)(i), a medical procedure satisfies all of the conditions described by Subdivision (1); or (ii) if: (a) at the time the written decision is provided as required by Subsection (b)(3)(D)(i), a medical procedure satisfies all of the conditions described by Subdivision (1) except Subdivision (1)(G); and (b) the person responsible for the patient's health care decisions provides to the attending physician or another physician or health care professional providing direct care to the patient consent on behalf of the patient for the medical procedure within 24 hours of the request for consent; (B) a start notice: (i) if, at the time the written decision is provided as required by Subsection (b)(3)(D)(i), no medical procedure satisfies all of the conditions described by Subdivisions (1)(A) through (F); or (ii) if: (a) at the time the written decision is provided as required by Subsection (b)(3)(D)(i), a medical procedure satisfies all of the conditions described by Subdivision (1) except Subdivision (1)(G); and (b) the person responsible for the patient's health care decisions does not provide to the attending physician or another physician or health care professional providing direct care to the patient consent on behalf of the patient for the medical procedure within 24 hours of the request for consent; and (C) a start notice accompanied by a statement that one or more of the conditions described by Subdivisions (1)(A) through (G) are no longer satisfied if, after a delay notice is provided in accordance with Subdivision (2)(A) and before the medical procedure on which the delay notice is based is performed on the patient, one or more of those conditions are no longer satisfied. (d-3) After the 25-day period described by Subsection (e) begins, the period may not be suspended or stopped for any reason. This subsection does not limit or affect a court's ability to order an extension of the period in accordance with Subsection (g). Subsection (d-2) does not require a medical procedure to be performed on the patient after the expiration of the 25-day period. (e) If the patient's advance directive or the person responsible for the patient's health care decisions is requesting life-sustaining treatment that the attending physician has decided and the ethics or medical committee has affirmed is medically inappropriate treatment, the patient shall be given available life-sustaining treatment pending transfer under Subsection (d). This subsection does not authorize withholding or withdrawing pain management medication, medical interventions necessary to provide comfort, or any other health care provided to alleviate a patient's pain. The patient is responsible for any costs incurred in transferring the patient to another health care facility. The attending physician, any other physician responsible for the care of the patient, and the health care facility are not obligated to provide life-sustaining treatment after the 25th calendar day after a start notice is provided in accordance with Subsection (d-2)(2)(B) or (C) to the person responsible for the patient's health care decisions or a medical procedure for which a delay notice was provided in accordance with Subsection (d-2)(2)(A) is performed, whichever occurs first, unless ordered to extend the 25-day period under Subsection (g), except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would: (1) hasten the patient's death; (2) be medically contraindicated such that the provision of the treatment seriously exacerbates life-threatening medical problems not outweighed by the benefit of providing the treatment; (3) result in substantial, irremediable, and objectively measurable physical pain not outweighed by the benefit of providing the treatment; (4) be medically ineffective in prolonging life; or (5) be contrary to the patient's or surrogate's clearly documented desire not to receive artificially administered nutrition or hydration. (e-1) If during a previous admission to a facility a patient's attending physician and the review process under Subsection (b) have determined that life-sustaining treatment is inappropriate, and the patient is readmitted to the same facility within six months from the date of the decision reached during the review process conducted upon the previous admission, Subsections (b) through (e) need not be followed if the patient's attending physician and a consulting physician who is a member of the ethics or medical committee of the facility document on the patient's readmission that the patient's condition either has not improved or has deteriorated since the review process was conducted. (f) Life-sustaining treatment under this section may not be entered in the patient's medical record as medically unnecessary treatment until the time period provided under Subsection (e) has expired. (g) At the request of the person responsible for the patient's health care decisions, the appropriate district or county court shall extend the period provided under Subsection (e) only if the court finds, by a preponderance of the evidence, that there is a reasonable expectation that a physician or health care facility that will honor the patient's directive will be found if the time extension is granted. (h) This section may not be construed to impose an obligation on a facility or a home and community support services agency licensed under Chapter 142 or similar organization that is beyond the scope of the services or resources of the facility or agency. This section does not apply to hospice services provided by a home and community support services agency licensed under Chapter 142. (i) In this section: (1) "Delay notice" means a written notice that the first day of the 25-day period provided under Subsection (e), after which life-sustaining treatment may be withheld or withdrawn unless a court has granted an extension under Subsection (g), will be delayed until the calendar day after a medical procedure required by Subsection (d-2)(1) is performed unless, before the medical procedure is performed, the person receives written notice of an earlier first day because one or more conditions described by that subdivision are no longer satisfied. (2) "Medical procedure" means only a tracheostomy or a percutaneous endoscopic gastrostomy. (3) "Start notice" means a written notice that the 25-day period provided under Subsection (e), after which life-sustaining treatment may be withheld or withdrawn unless a court has granted an extension under Subsection (g), will begin on the first calendar day after the date the notice is provided.” Legal citation: Tex. Health Safety Code § 166.046. Pinned source: https://www.neochart.com/catalog/texas/health_safety/chapter_166/section_166_046/tex_hs_166_046_69719792838a/tex_health_safety_code_sec_166_046_procedure_if_not_effectua_0001/index.html; data via neochart.com, snapshot 2026-09-11.
Disability relevance safeguard
A pre-admission disability may not be considered unless relevant to whether the intervention is medically appropriate. Verbatim statutory text: “(a) In this section, "disability" has the meaning assigned by the Americans with Disabilities Act of 1990 in 42 U.S.C. Section 12102. (b) During the review process under Section 166.046(b), the ethics or medical committee may not consider a patient's disability that existed before the patient's current admission unless the disability is relevant in determining whether the medical or surgical intervention is medically appropriate.” Legal citation: Tex. Health Safety Code § 166.0465. Pinned source: https://www.neochart.com/catalog/texas/health_safety/chapter_166/section_166_0465/tex_hs_166_0465_369e860a8cb2/tex_health_safety_code_sec_166_0465_ethics_or_medical_commit_0001/index.html; data via neochart.com, snapshot 2026-09-11.
Required patient statements
Different statements accompany the requested-treatment and withholding-or-withdrawal disagreement contexts. Verbatim statutory text: “(a) In cases in which the attending physician refuses to honor an advance directive or health care or treatment decision requesting the provision of life-sustaining treatment for a patient who is determined to be incompetent or is otherwise mentally or physically incapable of communication, the statement required by Section 166.046(b)(2)(A) shall be in substantially the following form: When There Is A Disagreement About Medical Treatment: The Physician Recommends Against Certain Life-Sustaining Treatment That You Wish To Continue You have been given this information because the patient has requested through an advance directive or you have requested on behalf of the patient that life-sustaining treatment* be provided to the patient, which the attending physician believes is not medically appropriate. This information is being provided to help you understand state law, your rights, and the resources available to you in such circumstances. It outlines the process for resolving disagreements about treatment among patients, families, and physicians. It is based upon Section 166.046 of the Texas Advance Directives Act, codified in Chapter 166, Texas Health and Safety Code. When an attending physician refuses to comply with an advance directive or other request for life-sustaining treatment for a patient who is determined to be incompetent or is otherwise mentally or physically incapable of communication because of the physician's judgment that the treatment would be medically inappropriate, the case will be reviewed by an ethics or medical committee. Life-sustaining treatment will be provided through the review. You will receive notification of this review at least seven calendar days before a meeting of the committee related to your case. You are entitled to attend the meeting. With your agreement, the meeting may be held sooner than seven calendar days, if possible. You are entitled to receive a written explanation of the decision reached during the review process. If after this review process both the attending physician and the ethics or medical committee conclude that life-sustaining treatment is medically inappropriate and yet you continue to request such treatment, then the following procedure will occur: 1. The physician, with the help of the health care facility, will assist you in trying to find a physician and facility willing to provide the requested treatment. 2. You are being given a list of health care providers, licensed physicians, health care facilities, and referral groups that have volunteered their readiness to consider accepting transfer, or to assist in locating a provider willing to accept transfer, maintained by the Department of State Health Services. You may wish to contact providers, facilities, or referral groups on the list or others of your choice to get help in arranging a transfer. 3. The patient will continue to be given life-sustaining treatment until the patient can be transferred to a willing provider for up to 25 calendar days from the time you were given a written notice of the first day of the 25-day period or a medical procedure is performed that delayed the 25-day period and for which you received notice, whichever occurs first. The patient will continue to be given after the 25-day period treatment to enhance pain management and reduce suffering, including artificially administered nutrition and hydration, unless, based on reasonable medical judgment, providing artificially administered nutrition and hydration would hasten the patient's death, be medically contraindicated such that the provision of the treatment seriously exacerbates life-threatening medical problems not outweighed by the benefit of the provision of the treatment, result in substantial irremediable physical pain not outweighed by the benefit of the provision of the treatment, be medically ineffective in prolonging life, or be contrary to the patient's or surrogate's clearly documented desires. 4. If a transfer can be arranged, the patient will be responsible for the costs of the transfer. 5. If a provider cannot be found willing to give the requested treatment within 25 calendar days, life-sustaining treatment may be withdrawn unless a court of law has granted an extension. 6. You may ask the appropriate district or county court to extend the 25-day period if the court finds that there is a reasonable expectation that you may find a physician or health care facility willing to provide life-sustaining treatment if the extension is granted. Patient medical records will be provided to the patient or surrogate in accordance with Section 241.154, Texas Health and Safety Code. *"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 or the performance of a medical procedure considered to be necessary to provide comfort care, or any other medical care provided to alleviate a patient's pain. (b) In cases in which the attending physician refuses to comply with an advance directive or a health care or treatment decision requesting the withholding or withdrawal of life-sustaining treatment for a patient who is determined to be incompetent or is otherwise mentally or physically incapable of communication, the statement required by Section 166.046(b)(2)(A) shall be in substantially the following form: When There Is A Disagreement About Medical Treatment: The Physician Recommends Life-Sustaining Treatment That You Wish To Stop You have been given this information because the patient has requested through an advance directive or you have requested on behalf of the patient that life-sustaining treatment* be withdrawn or withheld from the patient, and the attending physician disagrees with and refuses to comply with that request. The information is being provided to help you understand state law, your rights, and the resources available to you in such circumstances. It outlines the process for resolving disagreements about treatment among patients, families, and physicians. It is based upon Section 166.046 of the Texas Advance Directives Act, codified in Chapter 166, Texas Health and Safety Code. When an attending physician refuses to comply with an advance directive or other request for withdrawal or withholding of life-sustaining treatment for any reason, the case will be reviewed by an ethics or medical committee. Life-sustaining treatment will be provided through the review. You will receive notification of this review at least seven calendar days before a meeting of the committee related to your case. You are entitled to attend the meeting. With your agreement, the meeting may be held sooner than seven calendar days, if possible. You are entitled to receive a written explanation of the decision reached during the review process. If you or the attending physician do not agree with the decision reached during the review process, and the attending physician still refuses to comply with your request to withhold or withdraw life-sustaining treatment, then the following procedure will occur: 1. The physician, with the help of the health care facility, will assist you in trying to find a physician and facility willing to withdraw or withhold the life-sustaining treatment. 2. You are being given a list of health care providers, licensed physicians, health care facilities, and referral groups that have volunteered their readiness to consider accepting transfer, or to assist in locating a provider willing to accept transfer, maintained by the Department of State Health Services. You may wish to contact providers, facilities, or referral groups on the list or others of your choice to get help in arranging a transfer. *"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 or the performance of a medical procedure considered to be necessary to provide comfort care, or any other medical care provided to alleviate a patient's pain. (c) An attending physician or health care facility may, if it chooses, include any additional information concerning the physician's or facility's policy, perspective, experience, or review procedure.” Legal citation: Tex. Health Safety Code § 166.052. Pinned source: https://www.neochart.com/catalog/texas/health_safety/chapter_166/section_166_052/tex_hs_166_052_3b35888bd150/tex_health_safety_code_sec_166_052_statements_explaining_pat_0001/index.html; data via neochart.com, snapshot 2026-09-11.
Transfer registry and disclaimer
Voluntary registry participation identifies possible assistance without obligating acceptance of a particular patient. Verbatim statutory text: “(a) The department shall maintain a registry listing the identity of and contact information for health care providers and referral groups, situated inside and outside this state, that have voluntarily notified the department they may consider accepting or may assist in locating a provider willing to accept transfer of a patient under Section 166.045 or 166.046. (b) The listing of a provider or referral group in the registry described in this section does not obligate the provider or group to accept transfer of or provide services to any particular patient. (c) The department shall post the current registry list on its website in a form appropriate for easy comprehension by patients and persons responsible for the health care decisions of patients. The list shall separately indicate those providers and groups that have indicated their interest in assisting the transfer of: (1) those patients on whose behalf life-sustaining treatment is being sought; (2) those patients on whose behalf the withholding or withdrawal of life-sustaining treatment is being sought; and (3) patients described in both Subdivisions (1) and (2). (d) The registry list described in this section shall include the following disclaimer: "This registry lists providers and groups that have indicated to the Department of State Health Services their interest in assisting the transfer of patients in the circumstances described, and is provided for information purposes only. Neither the Department of State Health Services nor the State of Texas endorses or assumes any responsibility for any representation, claim, or act of the listed providers or groups."” Legal citation: Tex. Health Safety Code § 166.053. Pinned source: https://www.neochart.com/catalog/texas/health_safety/chapter_166/section_166_053/tex_hs_166_053_b063638a81ab/tex_health_safety_code_sec_166_053_registry_to_assist_transf_0001/index.html; data via neochart.com, snapshot 2026-09-11.
Work the pinned classroom record
A synthetic audit packet first establishes the section's incapacity and refusal predicates, then retains the meeting notice, any mutual written waiver, committee composition, provided materials, participation record, written decision, and transfer contacts. A distinct timing ledger records the applicable start notice or qualifying tracheostomy/PEG procedure and any delay notice; the first counted calendar day follows the applicable event under the full statute. If the statutory start notice is the relevant event, it is retained as the clock's source rather than replacing it with the meeting date. The record separately tracks available life-sustaining treatment pending transfer, pain and comfort care, nutrition/hydration review, and any requested court extension. No classroom date calculation or committee label authorizes withholding or withdrawal.
Limits and authored cross-references
A qualifying procedure can affect the start under subsection (d-2), whose consent, medical judgment, privileges, resources, and transfer predicates all matter. Once the 25-day period begins, subsection (d-3) does not permit suspension or stopping; subsection (g) preserves a court-ordered extension on request and the stated preponderance/reasonable-expectation finding. Subsection (e) preserves pain/comfort care and supplies separate artificial-nutrition-and-hydration exceptions. The six-month readmission provision and the specified hospice-services exclusion are separate conditions, not universal shortcuts. Committee review cannot use a quality-of-life judgment forbidden by subsection (a-2), and Section 166.0465 limits reliance on pre-existing disability. Registry listing does not guarantee transfer. The distinct Section 166.045(c) refusal route uses its reasonable-opportunity standard and must not be relabeled as the 25-day branch. Actual care, disputes, rights, and court proceedings require qualified human review.
Read the glanceable structure
The seven-node preview names the requested-treatment branch and ends with transfer and qualified review. The detailed source preserves overlapping transfer efforts, start/delay predicates, continuing-care protections, and judicial oversight. The diagram contains 7 deliberately limited nodes. It is a navigation aid, not law or advice; the words and pinned sources below control the classroom explanation.
Jurisdiction: TX; as of 2026-09-11; not legal advice; Render structure, refuse interpretation, cite, abstain, and hand off.
RENDER STRUCTURE · REFUSE INTERPRETATION · CITE · ABSTAIN · HAND-OFF: render structure, refuse interpretation, cite provenance, abstain when unsupported, and hand off to human review.
Narrow summary
Identify the exact disagreement branch, keep notice and transfer work distinct from the conditional clock trigger, preserve continuing-care safeguards, and never turn the end of a modeled period into a treatment instruction.