Patient Rights / FAQs
What does the term Advance Directives mean?
Advance Directives are requests made in advance that state your choices about your medical treatment, or designate a person to make the choices for you in the event you are unable to do so.
There are four types of Advance Directives:
- Directive to Physicians and Family or Surrogates
- Medical Power of Attorney
- Mental Health Treatment Declaration
- Out-of-Hospital Do Not Resuscitate Order
Is an Advance Directive required?
No. It is entirely up to you. If questions ever arise as to your healthcare, Advance Directives help to answer them.
If I choose not to make an Advance Directive, what will happen?
You will receive medical treatment regardless of whether you have an Advance Directive.
How can I know the treatment I want?
Your physician will inform you about your medical condition and what different treatments can do for you. Your physician cannot make the choice for you. The choice depends on what you want.
Who could I talk with about Advance Directives?
Discuss Advance Directives with the people to whom you are closest and with those who are concerned about your care and your feelings.
At what point do Advance Directives go into effect?
Advance Directives go into effect when you can no longer make your own healthcare decisions.
What does the term “informed consent” mean?
Informed Consent means that you have complete understanding and are able to discuss the nature, extent, and probable consequences of your treatment.
Will anyone know if I have an Advance Directive?
Yes. All hospitals, nursing homes, home health agencies, and all other healthcare facilities must ask if you have an Advance Directive and if so, it must be made a part of your medical record.
Will the instructions be followed in the Advance Directive?
Generally, yes; if they comply with Texas Law. Federal Law requires your healthcare providers to maintain written policies concerning Advance Directives. It is possible that a physician or other healthcare provider cannot or will not follow your Advance Directives for moral, religious, or professional reasons, even though they comply with Texas Law. If this occurs, they must immediately tell you. Then they must help you transfer to another physician or facility that will follow your Advance Directive.
What if I change my mind after completing an Advance Directive?
You can cancel or change any Advance Directive you have made at any time either by verbal order or by destroying the document.
Do I need an attorney to make an Advance Directive?
There is no legal requirement in Texas to have an attorney assist you in making an Advance Directive.
Will my Texas Advance Directive be accepted in another state?
Laws vary from state to state. If you are going to be spending a lot of time in another state, it would be a good idea to initiate a Directive based on that state’s laws concerning Advance Directives.
Can an Advance Directive from a different state be accepted in Texas?
Yes. It will be honored in Texas to the extent permitted by Texas law.
Where should I keep my Advance Directive documents?
Keep them in safe place where a family member can access them.
Directive To Physicians And Family Or Surrogates: Living Will
What is a living will?
A living will is a document that tells physicians or other healthcare providers whether or not you want life-sustaining treatments or procedures administered to you if you are in a terminal condition or an irreversible condition. It is called a living will because it takes effect while you are still living.
How is a living will different from a living trust?
Living trusts are financial documents which allow you to plan for the distribution of your financial assets and property after your death.
At what point does a living will go into effect?
A living will goes into effect when:
- Your physician has a copy of it.
- Your physician has concluded that you are no longer able to your own healthcare decisions.
- Your physician has determined that you are terminally ill or in an irreversible condition.
What does the term “life sustaining treatment” mean?
These are treatments or procedures that are not expected to cure your terminal condition or improve your condition. They only prolong death.
What is a terminal condition?
An incurable condition for which administration of medical treatment will only prolong the dying process and without administration of these treatments or procedures, death will occur within 6 months.
What is an irreversible condition?
A condition, illness or injury that:
- May be treated but is never cured.
- Leaves a person unable to care for himself/herself.
- Without life sustaining treatment is fatal.
Is a Do Not Resuscitate (DNR) order the same thing as a living will?
No. A DNR order is prepared by your physician at your direction and placed in your medical records. It states that if you suffer from cardiac arrest (your heart stops beating) or respiratory arrest (you stop breathing), your healthcare providers are not to try to revive you by any means.
Will I receive any pain medication?
Unless you state otherwise in the living will, medication for pain will be provided to make you comfortable.
If a woman is pregnant, does a Texas living will apply?
Provisions cannot go into effect under Texas Law.
Can a physician be sued or prosecuted for following provisions of a living will?
No. Texas Law states that no physician or a healthcare facility can be held civilly or criminally liable for carrying out the provisions of a valid Texas Living Will.
Is insurance affected by a Texas living will?
Does a living will in the state of Texas need to be signed and witnessed?
Yes. You must sign, or have someone sign the document in your presence and at your direction if you are unable to sign, and date the living will. It must be witnessed by two competent adult people.
At least one of the two people cannot be:
- Anyone you have designated to make treatment decisions for you.
- Anyone related to you by blood or marriage.
- Anyone entitled to your estate upon your death.
- Your attending physician.
- An employee of a healthcare facility in which you are the patient if that employee is providing you with direct patient care.
- An officer, director, partner, or business office employee of a healthcare facility in which you are a patient.
- Any person who has claim against any part of your estate.
Directive To Physicians And Family Or Surrogates:Medical Power Of Attorney (MPOA)
What is a Medical Power of Attorney?
A legal document which allows you to appoint another person to make medical decisions for you if you should become temporarily or permanently unable to make those decisions yourself. This person does not have to be a lawyer.
Can I choose whomever I want as my agent?
You can appoint almost any adult to be your agent.
People who cannot act as your agent are:
- Your treating healthcare provider.
- An employee of your treating healthcare provider, unless he or she is related to you.
- Your residential care provider.
- An employee of your residential care provider, unless he or she is related to you.
At what time does the Medical Power of Attorney take effect?
It becomes effective when you are temporarily or permanently unable to make your own healthcare decisions and your agent consents to begin making those decisions.
What healthcare decisions are appropriate for my agent to make?
Unless you limit his/her authority in the MPOA, your agent will be able to make almost every treatment decision in accordance with accepted medical practice that you could make. If your wishes are not known or cannot be determined, your agent has the duty to act in your best interest in the performance of his/her duties. These decisions can include authorizing, refusing, or withdrawal of treatment even if it means that you will die.
Are there some decisions my agent should not make?
Texas Law prohibits your agent from consenting to:
- Voluntary inpatient mental health services
- Convulsive treatment
- Omitting care intended primarily for your comfort
Should you designate more than one agent?
Yes. It is a good idea to designate alternates in case your primary agent is unavailable.
Is my agent legally responsible for decisions made for me?
No. Your healthcare agent or your alternate agents cannot be held liable for treatment decisions made in good faith or for costs incurred for your care.
Directive To Physicians And Family Or Surrogates:Mental Health Treatment Declaration (MHTD)
What is a Mental Health Treatment Declaration?
A legal document which allows you to tell your doctor and other healthcare providers about your preferences and instructions regarding your mental healthcare treatment, if you are no longer able to make these decisions.
What does the term “Mental Health Treatment” mean?
Examples are Electro-convulsive shock, Psychoactive drugs, Emergency mental health treatment.
At what point does the MHTD go into effect?
It goes into effect when a Texas court determines that you no longer understand the nature and consequences of proposed mental health treatment.
Is there any expiration date on the MHTD?
Yes. The expiration date is three (3) years from the date you sign it.
Directive To Physicians And Family Or Surrogates:Out-Of-Hospital (OOH) Do Not Resuscitate (DNR) Order
What is an OOH DNR order?
This is a document prepared by you and your attending physician that tells medical personnel in and out of the hospital setting that if you suffer cardiac arrest or respiratory arrest, they are not to revive you by any means.
What is considered an out-of-hospital setting?
Any setting outside of a hospital in which healthcare professionals are called for assistance.
Among these settings are:
- Home health
- Nursing Homes
- Hospital emergency rooms
Where can I obtain additional information about out-of-hospital DNR orders?
The Texas Department of Health (512) 834-6700 or the Texas Medical Association (512) 370-1306.