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Advance Directives: Your Choice About YOUR Medical Care

Authored By: Legal Hotline For Texans
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What are Advance Directives?

Advance Directives are documents that communicate your wishes about medical care if, at some point in the future, you are unable to speak for yourself.


Three of the TexasAdvance Directive documents are set out in Chapter 166 of the Health & Safety Code:

o   Directive to Physicians and Family or Surrogates (“living will”)

o   Medical Power of Attorney

Out of Hospital DNR (Do Not Resuscitate) Order

Why do I need Advance Directives?

You have the legal right to make choices about your health care. Treatment decisions are personal and based on your values. But if you are in a serious accident or very ill, you may not be able to communicate your wishes, and your family members may not agree on what’s best for you. Sometimes the court will step in and appoint a guardian to make those decisions for you.

Accidents or terminal illness or irreversible injury can happen to anyone at any age. Because of this, advance directives are for everyone, not just people who are older or chronically ill. Advance directives also remove the burden from your family (or the court) of making difficult medical choices for you. And your health care providers will have guidance on what to do next based on your advance directives.

If you become incompetent or cannot communicate what you want because you are very sick or injured, someone else will decide for you. Family members often have different opinions about what they think is best for you under the circumstances.   Completing these simple documents can help you avoid guardianship and lessen conflict among your family members.

With a Directive to Physician you may state your wishes to your doctor about withdrawing or withholding life sustaining procedures if you have a terminal or irreversible condition and death is imminent.  Your family won’t be burdened with making this important choice for you, and your doctor will have guidance on what to do next. In the Directive to Physician you have the option to name a person you want to help make this difficult decision.

With a Medical Power of Attorney, you can choose the person in charge of your care before you have a serious accident or illness. That person, the agent, can confer with your doctor about your medical care or life sustaining treatment, and must follow your health care requests that are in your Medical Power of Attorney.

With an Out of Hospital Do Not Resuscitate Order you can direct emergency medical services staff, hospital emergency room personnel, and other health care professionals acting in an out-of-hospital setting, to withhold cardiopulmonary resuscitation and certain other life-sustaining treatment.

What if I don’t have a Directive to Physician?

If you do not have a Directive to Physician, Medical Power of Attorney or guardian, your doctor will base the decision of life sustaining treatment on your wishes, if s/he knows what your wishes are.   


If your wishes are unknown, your doctor and at least one other person will decide. Under Texas law, the person will be, in order of priority:

o   your spouse

o   your reasonably available adult children

o   your parents

o   your nearest living relative, or

o   your doctor, with the agreement of another doctor who is not involved in your care.

If there is a conflict, the court will decide.

Will Advance Directives affect my will or my insurance?


When do Advance Directives take effect?

Your Advance Directives take effect only when you can’t express your wishes and are deemed incapacitated (incompetent) by medical professionals.

What do I need for my Advance Directive to be valid?

You must sign your Advance Directive in front of two witnesses. Both witnesses must be at least 18 years old, and competent (in good mental health). At least one of the witnesses must be disinterested. That means, one of the witnesses cannot be:

o   Your relative (by blood or marriage)

o   Someone who will inherit from you or has a claim against your estate after your death

o   Anyone you have named to make a treatment decision for you

o   Your doctor or your doctor’s employee

o   An employee who cares for you at the health care facility where you are a patient, or

o   An owner or admissions officer of the health care facility where you are a patient.


If you are signing a DNR, your doctor must also sign.


What do I do with the completed Directives?

Keep the originals. Make several copies. Give one copy to your doctor and/or health care professional to put in your file. Let a trusted friend, agent or relative know where the original is kept.  Give a copy of the Medical Power of Attorney to the agent.  If you named a person in the Directive to Physician, give that person a copy of the Directive to Physician. 

What if I change my mind?

Advanced directives can be reversed (revoked) at any time regardless of mental competency. Just tell your health care provider that you have changed your mind. You can always make out a new Directive to replace the old one(s) if you have mental competency.

Other things to keep in mind

Advance Directives:

o   are free

o   do not involve decisions about your money or your property

o   only cover medical treatment decisions

o   do not restrict procedures, treatments or medications intended to make you more comfortable or to manage your pain


For more information…

Texas Law Help has useful information on many areas of the law. Go to www.texaslawhelp.org.

Legal Hotline for Texans:  (800) 622-2520 or (512) 477-3950

Call our attorney-staffed legal hotline. Advice is free for Texans 60 and over or for anyone eligible for Medicare.

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