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Advance Directives

Advance care planning is an ongoing process that involves you discussing any of your wishes, values, and healthcare preferences. It is important to discuss advance care planning with your family, your caregivers, those who represent you, friends, and with your team of health care professionals. All patients have the right to make their own medical decisions.

What is an Advance Directive?

An advance directive is a legal document that tells your family, caregivers, those who represent you, friends, and healthcare professionals the care you would like to have if you become unable to make medical decisions. An advance directive allows you to make legally valid decisions about what you want and what you do not want for your future medical treatment.

An advance directive only becomes effective if the patient loses the capacity or competency to communicate.

You do not need a lawyer to complete your advance directives.

An advance directive may be revoked at any time subject to Texas Health & Safety Code Sec. 166.042.

Which Advance Directives are Recognized in the State of Texas?

The Texas Advance Directives Act is in Chapter 166 of the Texas Health & Safety Code.

The three advance directives recognized in Texas are:

The Texas Medical Power of Attorney
A Living Will
Out-of-Hospital Do-Not-Resuscitate Order (OOH-DNR)

Any competent adult may, at any time, execute a written advance directive.

What is a Medical Power of Attorney

The Texas Medical Power of Attorney is a document designating a person (“agent”) to speak for you if you are unable to make your own medical decisions. The individual chosen to act on your behalf is referred to as your “agent”.

Your agent may make medical decisions on your behalf only if your attending physician certifies in writing that you are unable to make your own medical decisions. Your attending physician must file the certificate in your medical record. Tex. Health & Safety Code §166.152(b).

Download the form (English) Download the form (spanish)

What is a Living Will/Directive to Physicians and Family or Surrogates?

A living will is officially known in Texas as the “Directive to Physicians and Family or Surrogates”. A Directive to Physicians and Family or Surrogates is a form that allows you to specify what kind of medical treatments or life-sustaining treatments you would desire for some time in the future if you were seriously or terminally ill or injured and are no longer able to make your own medical decisions. Tex. Health & Safety Code. §§ 166.031, 166.033. This Directive becomes effective if you are unable to communicate competently and you are in a terminal or irreversible condition.

A living will should be signed, dated and witnessed by two people. The witnesses should be individuals who you know well, and who are not related to you by blood or marriage. Witnesses may not be a potential heir. The full description of witness requirements is listed in the Living Will form (downloadable below).

Download the form (English) Download the form (Spanish)

What is an Out-Of-Hospital Do-Not-Resuscitate Order (OOH-DNR)?

An Out-of-Hospital Do-Not-Resuscitate Order (OOH-DNR) is a document that directs your health care professionals acting in an out-of-hospital setting not to initiate or continue the following life-sustaining treatment:. This document provides you the right to withhold or withdraw CPR (including the treatments listed below) and that the following resuscitation measures not be initiated or continued:

Cardiopulmonary resuscitation (CPR)
Transcutaneous cardiac pacing
Defibrillation
Advanced airway management
Artificial ventilation

Download the form (English) Download the form (Spanish)

Note on Signature Requirements

Texas law now allows an option for a person’s signature to be acknowledged by a notary instead of witness signatures and for digital or electronic signatures on the Medical Power of Attorney, Living Will, Out-of-Hospital Do-Not-Resuscitate Order (OOH-DNR), if certain requirements are met. For more details, please consult with your attorney to review the law in Texas Health and Safety Code Chapter 166 (“Texas Advance Directives Act”).

What Should I Do With These Documents After I Fill Them Out?

These are your documents, which should be kept in an easily accessible place, such as your home. These documents should be easily accessible in the case of an emergency, and you should keep extra copies to take to the hospital, if necessary.

Who Should Have Copies of My Advance Directive Documents?

Be sure to give copies of your Advance Directives to:

Your designated Medical Power of Attorney and designated alternates;
Your family members; and
Your primary care provider and other specialist care providers.

Always take copies with you to the hospital regardless of the reason for admittance so the documents can be scanned into your electronic medical record.

Will My Advance Directives Be Honored in Another State?

Each state has different advance directive laws. However, the American Bar Association states that no health care provider has ever refused to honor a properly executed Advance Directive from another state.

Texas does recognize legally valid advance directives executed in other states.

Do Not Resuscitate and Do Not Intubate Orders

You do not need to have an advance directive or a living will to have Do-Not-Resuscitate (DNR) or Do-Not-Intubate Orders (DNI) orders. To establish DNR or DNI orders, tell your physician about your preferences. Your physician will write the orders and put them in your medical record.

In-Hospital Do Not Resuscitate Orders

A Do-Not-Resuscitate (DNR Order) is an order instructing a health care professional not to attempt cardiopulmonary resuscitation (CPR) if your circulatory or respiratory function ceases. Tex. Health & Safety Code § 166.201

If you are in the hospital, you may ask your physician to add a DNR order to your medical record if you do not wish for the hospital staff to try to revive you in the event that your heart or breathing stopped.

Understanding Advance Directives

By having documentation known as advance directives in place, you are expressing your wishes about the kind of medical treatments you want, and you are instructing a person you trust with your preferences for your care in the event you are faced with a serious injury or serious illness. By creating an advance directive, you will ensure that your loved one(s) or designated agent will make health care treatment decisions according to your wishes, and you will spare your loved ones the stress of making these decisions without your guidance.

Any person 18 years of age or older can prepare an advance directive. In order to make your directive legally binding, you must sign your document, or direct another individual to sign the document, in the presence of two witnesses who must also sign it to show that they believe you to be at least 18 years of age, of sound mind, and under no constraint or undue influence.

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