If you are planning your estate, you may need to sign a medical advance directive. Texas law governs four different types of advance directives relating to medical treatment. Each type of directive affects different medical situations. It is important to understand how each agreement could impact decision-making for you in an emergency or for end-of-life care.
What Is an Advance Directive?
Advance directives are legally binding documents that explain people’s decisions on end-of-life medical care, as well as medical care in case of incapacity. The documents explain to doctors, other medical professionals, and family how to handle difficult medical situations for you. Many people sign an advance directive while they are making an estate plan. There are four types of advance directives recognized in Texas: a living will, a medical power of attorney, a do not resuscitate order, and a declaration for mental health treatment.
A living will explains to doctors which kinds of medical treatment you want to receive, especially at the end of life. It is also referred to as a directive to physicians. Living wills apply when you are receiving “life-sustaining treatment”, which is defined as “any treatment that is absolutely necessary to continue the life of the patient.” These treatments include artificial life support and life-sustaining medications.
People often use their living will to communicate which treatments they specifically do not want administered. For example, some people would prefer not to be on a feeding tube or ventilator at the end of their life.
A living will is helpful because it allows you to directly share your preferences for medical care with doctors. If you’re in a situation where you need life-saving medical treatment, you may not be able to communicate with medical professionals. You may not have someone present who can speak on your behalf. The living will tells the doctors what you want, from your own mouth. It does not allow a representative to make decisions for you.
Medical Power of Attorney
A medical power of attorney allows someone else to make medical decisions on your behalf. It applies if you are incapacitated, meaning unable to make your own medical decisions. You decide who you want to make the decisions for you. Should you become incapacitated, the person with medical power of attorney can speak to your doctors and make treatment decisions. A medical power of attorney is different than a living will because you cannot list treatments that you want or do not want in it. Instead, you appoint someone else to decide whether to accept or reject those treatments. The appointment lasts until you regain capacity, the power of attorney is revoked, or it expires (if there is an expiration date listed).
As part of your estate plan, you may decide to sign a medical power of attorney along with other powers of attorney. For example, you might sign a financial power of attorney, which allows you to appoint someone else to handle your money and finances.
Do Not Resuscitate Order
A do not resuscitate order (DNR order) tells EMTs and other emergency medical providers that you do not want to receive certain life-saving medical treatments. Several kinds of medical treatments are covered by a DNR order:
- artificial ventilation
- advanced airway management
- transcutaneous cardiac pacing
- other life-sustaining treatment listed in the law
A do not resuscitate order does not cover other treatments deemed medically necessary, such as providing water and food or providing comfort care. Further, this kind of directive applies only in “out of hospital” situations, which include:
- Emergency rooms and hospital outpatient care
- Hospice care
- Long-term care facilities
- Doctors’ offices
- Ambulances and transport vehicles
- Private homes
Declaration for Mental Health Treatment
Finally, a declaration for mental health treatment is a legal document that describes your wishes for mental health care. You can sign this document if you would like to affirmatively consent to or specifically decline to receive certain kinds of mental health treatment. The types of treatment covered by the declaration include emergency mental health treatment, taking psychoactive medications, and electroshock treatment.
Declarations for mental health treatment only last for three years after they are signed. Once a declaration expires, you must sign a new one. You also can revoke a declaration before three years have passed. If at the end of the three-year period, you are incapacitated for purposes of making mental health treatment decisions, then the declaration is automatically extended until you regain capacity.
Let Us Help with Your Estate Planning
Do you need to sign an advance directive? Our Houston law firm helps clients with their estate planning needs. We can advise you on which advance directive is right for you. If you think you need an estate plan in place, give Henke & Williams a call. Our advice is not “one-size-fits-all,” but is tailored to your unique situation. To set up a consultation, call 713-940-4500 or use our convenient Contact Form.