(a) A DNR order issued for a patient is valid only if the patient’s attending physician issues the order, the order is dated, and the order:
(1) is issued in compliance with:
(A) the written and dated directions of a patient who was competent at the time the patient wrote the directions;
(B) the oral directions of a competent patient delivered to or observed by two competent adult witnesses, at least one of whom must be a person not listed under Section 166.003(2)(E) or (F);
(C) the directions in an advance directive enforceable under Section 166.005 or executed in accordance with Section 166.032, 166.034, or 166.035;
(D) the directions of a patient’s legal guardian or agent under a medical power of attorney acting in accordance with Subchapter D; or
(E) a treatment decision made in accordance with Section 166.039; or
(2) is not contrary to the directions of a patient who was competent at the time the patient conveyed the directions and, in the reasonable medical judgment of the patient’s attending physician:
(A) the patient’s death is imminent, regardless of the provision of cardiopulmonary resuscitation; and
(B) the DNR order is medically appropriate.
(b) The DNR order takes effect at the time the order is issued, provided the order is placed in the patient’s medical record as soon as practicable.

Terms Used In Texas Health and Safety Code 166.203

  • Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005
  • Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005

(c) Before placing in a patient’s medical record a DNR order issued under Subsection (a)(2), the physician, physician assistant, nurse, or other person acting on behalf of a health care facility or hospital shall:
(1) inform the patient of the order’s issuance; or
(2) if the patient is incompetent, make a reasonably diligent effort to contact or cause to be contacted and inform of the order’s issuance:
(A) the patient’s known agent under a medical power of attorney or legal guardian; or
(B) for a patient who does not have a known agent under a medical power of attorney or legal guardian, a person described by Section 166.039(b)(1), (2), or (3).
(d) To the extent a DNR order described by Subsection (a)(1) conflicts with a treatment decision or advance directive validly executed or issued under this chapter, the treatment decision made in compliance with this subchapter, advance directive validly executed or issued as described by this subchapter, or DNR order dated and validly executed or issued in compliance with this subchapter later in time controls.


Text of section effective on April 01, 2018