A Medical Power of Attorney is a type of “advance directive” that provides a simple way to name someone you trust (an agent) to speak to your health care providers and make health care decisions for you when you cannot make decisions for yourself.

The law says that certain people (such as your spouse, adult children, or parents) can make health care decisions as an “adult surrogate” on your behalf even if you do not have a Medical Power of Attorney. Read the law here:  Tex. Health and Safety Code § 313.004.

• With no agent in place, the following people can make decisions, in order of priority:
  • your spouse,
  • your adult child who has the waiver and consent of all other qualified adult children of yours to act as the sole decision-maker,
  • a majority of your reasonably available adult children,
  • your parents, or
  • an individual you clearly identified to act for you before you became incapacitated, your nearest living relative, or a member of the clergy

However, it is still important to name an agent even if you are married. For example you may want to:

• Name a back-up agent to make health care decisions for you if your spouse cannot.
  • You and your spouse could be involved in an accident together
  • Your spouse could be unavailable at the time you need an agent
• You may want to name someone other than your spouse to make health care decisions for you.
• You may want to limit the decision-making authority of your agent, and you can do this with a Medical Power of Attorney.
• Without a Medical Power of Attorney in place, the law controls what decision-making authority is allowed.
  • If you would like to control the scope of decision-making authority and people that can make health care decisions on your behalf, you should sign a Medical Power of Attorney.

The main difference is the range of medical treatments the documents cover.

An Out-of-Hospital Do-Not-Resuscitate Order (or OOH-DNR, for short) is limited to out-of-hospital settings (for example, long-term care facilities or care given in transport vehicles) to refuse the following life-sustaining treatments should you suffer from respiratory or cardiac arrest:

• Cardiopulmonary resuscitation (CPR),
• Advanced airway management,
• Artificial ventilation,
• Defibrillation,
• Transcutaneous cardiac pacing, and
• Other life-sustaining treatments.

The Medical Power of Attorney, however, is not limited to the above treatments. If your agent’s decision conflicts with your OOH-DNR, the OOH-DNR controls; if no OOH-DNR exists, your agent may make any decisions about an OOH-DNR and may even execute an OOH-DNR on your behalf.

An Advance Directive is strictly limited in scope to:

• Instructions about continuing or withholding life-sustaining treatment if you have a terminal condition (expected to die within six months), or
• Instructions about continuing or withholding life-sustaining treatment if you have an irreversible condition, you cannot care for or make decisions for yourself, and you are expected to die without life-sustaining treatment.

Note: The Medical Power of Attorney, however, is not limited to life-sustaining treatment. If your agent’s decision conflicts with your Advance Directive, the Advance Directive controls. If no Advance Directive exists, the agent’s decision controls.