Advance Directives

Individuals usually make decisions regarding their healthcare treatment after their physician recommends a course of treatment and provides information about the treatment. Through documents, known as Advance Directives, individuals can express their treatment preferences before they actually need such care ensuring that their wishes will be carried out and that their families will not be faced with making these difficult decisions.

What is an Advance Directive?

“Advance Directives” are the documents written in advance of the time when you are unable to make health care decisions for yourself. You have a right to make important legal decisions in advance about your health care. By law, the lack of Advance Directives does not hamper your access to care. Baptist Health System employees and the physicians who practice within the system will abide by your advance directives in accordance with the law.

Here is some general information on the four types of Advance Directives recognized under Texas law.
The four Texas Advance Directives are:

Directive to Physicians and Family or Surrogates (Living Will)  - (En Español)

Medical Power of Attorney  - (En Español)

Out-of-Hospital Do-Not-Resuscitate (DNR)  - Instructions in En Español

Declaration for Mental Health Treatment - (En Español)

Advance Directives can be changed or cancelled at any time. If you wish to complete an Advance Directive please alert your nurse and/or another member of the Health Team. Forms and help in understanding what to do are available.

Directive to Physicians and Family or Surrogates (Living Will)

A Directive to Physicians and Family or Surrogates, also known as a “living will,” allows you to tell your physician not to decide in advance the type of care you desire should you become unable to make your own health care decisions.  This may include telling your physician not to use artificial methods to prolong the process of dying if you are terminally ill. A Directive becomes effective only after you have been diagnosed with a terminal or irreversible condition. If you are a woman and are pregnant, Texas Law cannot allow for the provisions of the living will to go into effect.

If you sign a Directive, talk it over with your physician and ask that it be made part of your medical record. If for some reason you become unable to sign a written Directive, you can issue a Directive verbally or by other means of non-written communication, in the presence of your physician.

If you have not issued a Directive and become unable to communicate after being diagnosed with a terminal or irreversible condition, your attending physician and legal guardian, or certain family members in the absence of a legal guardian, can make your decisions concerning withdrawing, withholding or providing life-sustaining treatment. Your attending physician and another physician not involved in your care also can make decisions to withdraw or withhold life-sustaining treatment if you do not have a legal guardian and certain family members are not available.

Medical Power of Attorney

Another type of advance directive is a Medical Power of Attorney, which allows you to designate someone you trust – an agent – to make health care decisions on your behalf should you become unable to make these decisions yourself.

This Power of Attorney is not valid unless it is signed in the presence of two competent adult witnesses. The following persons may not act as ONE of the witnesses:

• The person you have designated as your agent
• A person related to you by blood or marriage
• A person entitled to any part of your estate after your death under a will or codicil executed by you or by operation of law
• Your attending physician
• An employee of your attending physician
• An employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of a health care facility or of any parent organization of the health care facility
•  A person who, at the time this power of attorney is executed, has a claim against any part of your estate after your death

The person you designate has authority to make health care decisions on your behalf only when your attending physician certifies that you lack the capacity to make your own health care decisions. Your agent cannot make a health care decision if you object, regardless of whether you have the capacity to make the health care decision yourself, or whether a Medical Power of Attorney is in effect.

Your agent must make health care decisions after consulting with your attending physician, and according to the agent’s knowledge of your wishes, including your religious and moral beliefs. These decisions can include authorizing, refusing or withdrawing treatment, even if it means that you will die. If your wishes are unknown, your agent must make a decision based on what he/she believes is in your best interest.

Texas Law prohibits your agent from consenting to voluntary inpatient mental health services, convulsive treatment, psychosurgery, abortion, or omitting care intended primarily for your comfort.

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

An Out-of-Hospital DNR Order allows you to refuse certain life-sustaining treatments in any setting outside of a hospital. Among these settings are Home Health, Hospice, Nursing Homes, Ambulances, and Hospital emergency rooms. This Advance Directive must be issued in conjunction with your attending physician and signed by two witnesses.

Declaration for Mental Health Treatment

Another type of Advance Directive deals with mental hospital treatment only. A Declaration for Mental Health Treatment allows you to tell healthcare providers your choices for mental health treatment, in the event that you become incapacitated.

Unlike the living will and medical power of attorney, which do not expire, the DMHT expires 3 years from the date that you sign it. If you are incapacitated on that date, the document continues in effect until you are again able to make your own decisions.

Surrogate Decision-Maker

If you become unable to make your own health care decisions and do not have a legal guardian or someone designated under a Medical Power of Attorney, then certain family members and others can make medical treatment decisions on your behalf. The State of Texas designates specific persons to act in this capacity and you may seek this specific information from the hospital or from the State of Texas.

Legal Aspects of Advance Directives

An Advance Directive does not need to be notarized. Neither this hospital nor your physician may require you to execute an Advance Directive as a condition for admittance or receiving treatment in this or any other hospital. The fact that you have executed an Advance Directive will not affect any insurance coverage that you may have.

Ethics Consultation

Patients and families may participate in ethical questions that arise in the course of care, including issues of conflict resolution. The Baptist Health System has a formal process in place to address ethical issues and dilemmas in your care. Should you or your family desire an ethics consultation, please ask your nurse to contact the Hospital Ethics Consultation Team.

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Other Helpful Links

The National Healthcare Decisions Day
Texas Hospitals Association
Texas Department of Aging and Disability Services