An advance directive is a legal document that communicates a person’s wishes about future medical care in case they become unable to make decisions. In Texas, the primary advance directive documents are: the Directive to Physicians (expressing wishes about life-sustaining treatment); the Medical Power of Attorney (designating a healthcare decision-maker); and the Out-of-Hospital Do Not Resuscitate (DNR) Order. These documents guide physicians, hospitals, and care facilities.

The Texas Directive to Physicians allows a person to state in advance whether they want life-sustaining treatment if they have a terminal condition, an irreversible condition, or are in an end-stage condition with no reasonable expectation of recovery. It is a written expression of values and wishes that guides the healthcare power of attorney agent and physicians when the person cannot speak for themselves.

A living will (Directive to Physicians) expresses the person’s specific wishes about particular medical treatments. A Medical Power of Attorney designates a trusted person (the agent) to make all healthcare decisions when the person cannot — decisions that the living will may not have specifically anticipated. Both documents complement each other: the agent uses the living will as a guide when making decisions.

A POLST (Physician Orders for Scope of Treatment) is a physician-signed medical order that specifies immediate treatment preferences for people with serious illness — particularly regarding CPR, hospital transfer, and artificial nutrition. Unlike a living will, a POLST is immediately actionable by emergency responders and care facility staff without requiring physician interpretation. It is appropriate for people with serious illness or advanced frailty, not for general advance planning.

Every adult in Texas should have advance directive documents, but they are especially important for: people 65 and older; anyone with a serious chronic illness; anyone with cognitive decline (advance directives must be executed while the person has capacity); and anyone undergoing major surgery or a serious medical procedure. There is no minimum age, and no requirement to be ill — these documents are planning tools for everyone.

Advance directives typically address: CPR (resuscitation); mechanical ventilation; artificial nutrition and hydration (feeding tubes); dialysis; hospitalization vs. comfort care; antibiotics for end-stage conditions; and other interventions. The Directive to Physicians can also express general values and quality-of-life priorities that guide all treatment decisions, not just specific interventions.

A DNR order instructs healthcare providers not to perform CPR if the patient’s heart stops or breathing ceases. In Texas, an in-hospital DNR is a physician order within the hospital. An Out-of-Hospital DNR (OOH-DNR) is an official Texas form signed by the patient (or surrogate) and physician that is valid outside the hospital — in assisted living, at home, in nursing homes, and for EMS responders. Ask your physician about obtaining an OOH-DNR if appropriate.

Yes. An advance directive can be revoked or changed at any time while the person has decision-making capacity — verbally, in writing, or by destroying the document. Revocation is immediate and does not require the same formalities as creating the original document. If wishes change — due to a new diagnosis, a change in values, or reassessment after a healthcare experience — update the documents and distribute the new version to all relevant parties.

Provide copies to: your primary care physician (request it be scanned into your medical record); your healthcare power of attorney agent; any specialist physicians who regularly treat you; your assisted living, memory care, or nursing home; your hospital if being admitted; and your attorney if you have one. Keep the original in an accessible location — not locked in a safe deposit box where it cannot be retrieved in an emergency. Some states have advance directive registries.

Without an advance directive, treatment decisions default to: the healthcare power of attorney agent (if one was named); family members according to the legal hierarchy in Texas (spouse, adult children, parents, siblings); or if no family is available, a physician making decisions in the patient’s best interest. Without documented wishes, family members may disagree about what the person would have wanted, leading to conflict and potentially unwanted treatments.

The Texas Directive to Physicians form is available through the Texas Medical Association website or physician offices. A Medical Power of Attorney form is available through the Texas advance directive coalition. Both documents must be signed before witnesses (two qualified adult witnesses — not the named agent, not a healthcare worker, not an heir to the estate). An elder law attorney can ensure the documents are valid and appropriately drafted for complex situations.

Most assisted living, memory care, and skilled nursing facilities ask for advance directive documents at admission. They are required to ask whether you have a directive and must document your wishes in the medical record. Providing these documents at admission ensures the facility can honor your wishes in a medical emergency without delay. If you do not have these documents at admission, the facility should provide resources to help you create them.