Advanced Directives

livingwill

As a patient, you have the right to make your own informed decisions about medical care and to communicate these decisions to healthcare providers. If, however, through sickness or injury you become unable to make informed decisions about your medical care-including whether to accept or refuse treatment-how will your healthcare providers and family know your wishes?

An advance directive is a legal document that allows you to state your choices for medical treatment before you actually need such care. When you need medical care, certain decisions need to be made involving the kind of care to be given. These decisions may become harder if you become unable to tell your doctor and loved ones what kind of medical care you want. Taking the time to fill out an advance directive also gives you the opportunity to tell healthcare providers what your wishes are regarding your treatment and allows you to name a person to make treatment decisions for you in the event that you are unable to speak for yourself. A signed advance directive will only be followed in the event that you become mentally or physically unable to convey your wishes regarding medical care decisions.

This section contains information about the kinds of advance directives available and when they become effective, what the eligibility requirements are and the exceptions and considerations in making advance directives. Your physician, nurse or the University Health System Patient Satisfaction/Customer Service office can provide information and sample forms. They can also be downloaded below. You also have the option to learn more about advance directives at TexasLivingWill.org, which is a web site set up to assist you in completing your advance directive on line in English, or you can also choose your preferred language. TexasLivingWill.org also allows you and your witnesses the option to sign your advance directive documents electronically.

What are the advantages of "advance directives"?

Advance directives are a way to protect your rights as a patient. In the event you lose your ability to understand and appreciate the nature and consequences of health care decisions, an advance directive assures your wishes concerning treatment will be communicated to your physician, medical staff and hospital.

Must I execute an advance directive to receive medical care?

No. Federal law protects your right to choose whether or not you wish to execute an advance directive. The hospital is prohibited from conditioning the provision of care or discriminating against you based on your decision.

Do I give up quality medical care if I execute an advance directive?

No. Your healthcare team has the duty to provide quality care to you regardless of an advance directive. Your advance directive serves only to inform the team of your wishes or to appoint someone to speak for you if you are unable to communicate.

What kinds of advance directives are available for me to consider?

There are different types of Advance Directives that are recognized in Texas:

  • Directive to Physicians and Family or Surrogates - Download Form
    (commonly referred to as a Living Will)
  • Directive to Physicians for Minor Child or Ward - Download Form
  • Medical Power of Attorney - Download Form
    (formerly known as Durable Power of Attorney for Health Care)
  • Out-of-Hospital Do-Not Resuscitate Order - Download Form

The forms above are in PDF format and require Adobe Acrobat Reader to view. You can download Acrobat Reader for free from Adobe's website. Please follow the link below to download the program.

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Directive to Physicians and Family or Surrogates

(commonly referred to as a Living Will)

A Directive to Physicians and Family or Surrogates is a form that allows you to instruct physicians to administer, withdraw or withhold life-sustaining treatment when it has been determined by your physician that you have an irreversible or terminal condition and you are not able to communicate. Life-sustaining treatment is a treatment or procedure that includes life-sustaining medications and artificial life supports, such as mechanical breathing machines, kidney dialysis and artificial nutrition and hydration, that is not expected to cure your condition or make you better, and is only prolonging the moment of death.

  • Remember — A Directive to Physicians goes into effect ONLY when your physician has determined that you have a terminal or irreversible condition and are unable to make your own health care decisions. You can also change or cancel your Directive to Physician at any time for any reason. Discuss these matters with your physician, family and/or friends before signing - communicate what your choices are before you have a health crisis.

Medical Power of Attorney

(formerly known as Durable Power of Attorney for Health Care)

A Medical Power of Attorney is a form that allows you to appoint someone (your "agent") to make healthcare decisions for you if you are no longer able to make decisions for yourself. These decisions can include (1) agreeing to or refusing medical treatment; (2) deciding not to continue medical treatment; or (3) making decisions to stop or not start life-sustaining treatment.

  • Remember — The person you choose as your agent makes decision for you ONLY if you cannot make decisions for yourself.
  • Discuss this advance directive with the person you have chosen as your agent, your physician and/or attorney before you sign it. Also, give your physician, your agent and your attorney copies of your signed Medical Power of Attorney form. It only applies to health care decisions - not to financial matters.

An Out-of-Hospital Do Not Resuscitate (DNR) Order

An Out of Hospital DNR Order is a form completed by an individual person and his or her physician that allows the patient to refuse specific life-sustaining treatments outside of a hospital inpatient setting, such as your doctor's office or in the emergency center of University Hospital. An Out-of-Hospital DNR Order form or ID necklace or bracelet will tell healthcare providers, including emergency medical service personnel, not to use cardiopulmonary resuscitation (CPR) and other life-sustaining treatments.

  • To show that you have an Out-of-Hospital DNR Order, you must have the original or a copy of your form with you or wear an approved ID necklace or bracelet.
  • The Out-of-Hospital DNR Order form and bracelet must be obtained through a physician.
  • You may cancel the Out-of-Hospital DNR Order at any time.
  • Discuss the document with your physician, family, and/or friends before you sign it.

You are not required to complete any of the above referenced documents should you choose not to do so. They are not required for receiving medical care. They are simply the tools that are available to you to make your wishes known regarding your medical treatment in the event that you are unable to speak for yourself. Please consult your legal professional and/or healthcare provider if you have additional questions about any of the information provided.

Who is eligible to make a Directive to Physicians or Medical Power of Attorney? Who makes these decisions for children?

Competent persons age 18 or older may make either type of advance directive. Parents and legal guardians speak for minor children and need no directive for treatment. However, parents should execute a Directive to Physicians if they choose to withhold or withdraw treatment from their terminally ill minor.

What is "competent"?

You are competent if you have the ability to understand and appreciate the nature and consequences of a healthcare decision, including significant benefits and risks of treatment.

When does an advance directive take effect?

A Directive to Physicians becomes effective only when (1) your attending physician certifies that you have a terminal or irreversible condition that requires life-sustaining treatment and which may result in your death within a relatively short time, and (2) you are comatose, incompetent or otherwise unable to communicate.

A person designated by you pursuant to a Medical Power of Attorney is authorized to make medical decisions on your behalf when your attending physician certifies in writing that you lack capacity to make healthcare decisions for yourself.

Is an advance directive a legal document? Must it be drawn up by a lawyer and notarized?

An advance directive is a legal document but, according to Texas law, it does not have to be drawn up by a lawyer or notarized. You are allowed to have your advance directive witnessed by two qualified witnesses as described in more detail below instead of a notary. However, if you would prefer for your directive to be notarized, this option is available to you. Each directive must be completed and witnessed or notarized according to Texas law to be effective. Advance directive forms are available free of charge at all University Health System facilities.

Can a non-written (oral) statement qualify as an advance directive?

Yes. A non-written Directive to Physicians is valid, but the requirements differ from a written directive. To be legally binding, the oral directive must be stated in the presence of two qualified witnesses as described below and the attending physician. It must also be documented in your medical record.

Who witnesses an advance directive?

The qualifications for witnessing are the same for each type of directive. Two witnesses are required, one of which must be impartial or disinterested. Under Texas law, physicians, nurses, other hospital staff caring for you and the hospital's business office employees do not qualify as impartial or disinterested witnesses, nor do persons related to you by blood or marriage. Additionally, persons entitled to any part of your estate by will, deed or operation of law, or persons who have any claim against your estate do not qualify as impartial witnesses. Generally, friends, neighbors or hospital volunteers make good witnesses.

What happens in an emergency situation or if the person is admitted to another hospital?

If properly executed, your advance directive should be honored in any hospital in Texas. To assure that healthcare providers are aware of your advance directive, send the original to your personal physician or keep a copy at home and tell your family where to find your advance directive in case of an emergency.

Can an advance directive be changed or even cancelled?

Yes. A Directive to Physician, a Medical Power of Attorney and an Out-of-Hospital, Do-Not-Resuscitate may be revoked or cancelled. Generally, each may be revoked by defacing or tearing up the directive, or by an oral or written statement canceling the directive, which is then given to the healthcare provider or person authorized to make your healthcare decisions.

When should I execute an advance directive?

Any time is a good time to make an advance directive, but it is especially important when you are ill and seeking medical care. Remember, let your values and beliefs be your guide. Discuss your wishes with your family and friends, your physician, clergy and other important people in your life.

Where can I learn more?

You can talk to your physician, healthcare provider or attorney and you can also visit TexasLivingWill.org for more information about Advance Directives and Living Wills.