Directive to physicians

Estate Planning · Advance Directives

It answers one question, in advance.

A directive to physicians records what you want done if you have a terminal or irreversible condition and can no longer speak for yourself: whether life-sustaining treatment should be provided, or whether care should be directed at comfort and allowing a natural death. Texas has a statutory form, and while the choices are stark, families consistently describe having it in writing as the thing that got them through the week.

The pieces that work together

• Directive to physicians — your treatment instructions for a terminal or irreversible condition.
• Medical power of attorney — the person who decides everything the directive does not cover.
• Out-of-hospital DNR — a specific Texas form, signed by a physician, that governs emergency responders outside a hospital setting. A directive alone does not do this.
• HIPAA authorisation — so the people you name can obtain the information they need.
• Anatomical gift and disposition instructions, including naming an agent to control burial or cremation arrangements.

What you can record in it

• How aggressively you want physicians to intervene if your condition is terminal or irreversible.
• Your position on artificial hydration and nutrition.
• Your preferences for pain management and comfort care.
• Any personal, religious or philosophical values that should guide the decisions made for you.

These are difficult things to write down and considerably harder for a family to decide without them.

It only helps if the right people have it

A directive locked in a safe deposit box does nothing. Give copies to your physician for the medical record, to your agent and alternates, and to the hospital on any admission. Take a copy when travelling. Review it after any significant diagnosis — instructions written in good health sometimes read differently once a condition has a name.

Pregnancy, and other Texas particulars

Texas law contains specific provisions affecting how a directive operates during pregnancy, and specific procedures where a physician or facility disagrees with a decision to withdraw treatment. These are the parts families are least likely to know about, and they are worth understanding at the time of signing rather than in a hospital corridor.

Common questions