Texas Living Will Requirements

The Texas Advance Directives Act defines 'advance directive' as an umbrella term covering three separate instruments under three separate subchapters: a directive to physicians (Sections 166.031 to 166.054, the living will), an out-of-hospital DNR order (Sections 166.081 to 166.102), and a medical power of attorney (Sections 166.151 to 166.166). Texas's living will is its own instrument, fully separate from its Medical Power of Attorney, not one combined document.

Section 166.032 lets any competent adult execute a written directive at any time. It does not itself state a specific age or an emancipated minor rule; while this section does not define 'adult,' the related Medical Power of Attorney law (Section 166.151) defines it as a person 18 or older or an emancipated minor.

Both signing witnesses must be competent adults, but only one of the two must additionally clear the full disqualification list: not the declarant's named decision maker, not related by blood or marriage, not entitled to any part of the estate, not the attending physician or the physician's employee, and not a facility employee providing the declarant direct care. The second witness only needs to be a competent adult, nothing more.

As an alternative to two witnesses, a declarant may sign the directive and have the signature acknowledged before a notary public instead.

A terminal condition is an incurable condition that, according to reasonable medical judgment, will produce death within six months even with available life sustaining treatment. A patient already admitted to hospice care through a licensed home and community support services agency is presumed to have a terminal condition for purposes of the entire chapter, without a separate physician certification being required to trigger that presumption.

An irreversible condition is one that may be treated but is never cured or eliminated, that leaves a person unable to care for or make decisions for themselves, and that is fatal without life sustaining treatment provided under the prevailing standard of medical care.

Naming specific treatments such as artificial nutrition and hydration, mechanical ventilation, dialysis, or antibiotics is optional, not mandatory. Section 166.002(10) already includes all of these within its general definition of life sustaining treatment, and the Section 166.033 form's Additional Requests section only offers them as examples if a declarant wants to single one out.

A declarant may revoke a directive at any time, regardless of mental state or competency, by destroying it, by signing a dated written revocation, or by orally stating an intent to revoke. A written or oral revocation takes effect once the attending physician is notified of it.

Life sustaining treatment may not be withdrawn or withheld under this subchapter from a patient diagnosed as pregnant. The statute contains no exception tied to how far the pregnancy has progressed, and the declarant acknowledges this directly on the statutory form.

This section provides the default priority list for surrogate decision-making that Texas law uses only when a patient has not executed a directive and has no legal guardian or Medical Power of Attorney agent. The attending physician and, in order, the patient's spouse, reasonably available adult children, parents, or nearest living relative may make the treatment decision instead.

The Out-of-Hospital DNR Order is its own instrument under its own subchapter, requiring its own physician signature, and it directs emergency personnel outside a hospital not to attempt resuscitation. It is not part of, and does not need to be addressed within, the Directive to Physicians this page covers.

If an attending physician refuses to honor a directive, the refusal must be reviewed by an ethics or medical committee that the physician cannot sit on, and life sustaining treatment continues throughout that review. If the physician does not want to go through that committee review, life sustaining treatment must instead be provided only until the patient can reasonably be transferred to a physician or facility willing to comply.

Federal HIPAA regulations govern how a health care agent can be authorized to access protected health information once that agent's authority is in effect. This authorization supports the agent decision maker role under a separate Medical Power of Attorney; it does not change or expand your own treatment wishes under a Directive to Physicians.

Federal law requires Medicare and Medicaid participating hospitals, nursing homes, and other facilities to inform patients in writing of their right under Texas law to make an advance directive, including stating their own treatment wishes.

Chapter 166 has its own dedicated digital or electronic signature rule specific to advance directives, letting a declarant, witness, or notary sign using a department approved digital signature or a qualifying electronic signature that is verifiable, under the signer's sole control, and tamper evident. This specific rule in Chapter 166 is the controlling authority for electronic signatures on Texas advance directives.

The Revised Uniform Anatomical Gift Act lets a person authorize organ and tissue donation, a separate but related wish many declarants also want to record alongside their treatment preferences.

Texas's definition of life sustaining treatment expressly excludes pain management medication and any medical procedure necessary to provide comfort care. Comfort care and pain relief remain available regardless of what the declarant elects about life sustaining treatment generally, and the statutory form separately confirms that electing hospice care means only comfort focused treatment will be given.

Texas does not operate a registry where an individual can file or register their own signed living will, unlike some other states. Section 166.053 only creates a registry of health care providers and referral groups who have voluntarily told the department they may accept transfer of a patient whose directive a physician will not honor. It says nothing about, and has no bearing on, the validity of a declarant's own executed directive.