Texas Living Will Form – Advance Directive to Physicians and Family or Surrogates

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The Texas living will, also known as an ‘advance directive’ and by the State as a ‘directive to physicians and family or surrogates’, it is a legal document that provides to a Declarant/Principal a way in which the Declarant/Principal may make their end of life decisions understood, prior to the time that the Declarant is no longer able to express their wishes on their own and so the medical team knows exactly how to honor the end of life decisions of their patient. This document may be revoked at any time as long as the Declarant remains competent to do so.

Laws – § 166.033

Medical Power of Attorney – Relationship that is created by a patient and a person that accepts the designation of being able to make health care decisions on their part.

Signing (§ 166.003) – The Declarant must sign a living will in Texas with two (2) witnesses. A medical facility may not require that it be signed with a Notary Public (§ 166.036)

How to Write

Step 1 – Download the document and carefully review the information contained therein so that all parties involved will better understand how the document serves the Declarant, Physicians and Family members

Step 2 – Directive – In establishment of the Declarant, enter the full legal name in the first line of the “Directive” section of the document

  • Read the following 2 paragraphs
  • The Declarant may then make their selection by initialing the line preceding one of the following four choices

Step 3 – Additional Requests – Once you’ve had and opportunity to  discuss your wishes with your physician, you may like to consider listing any particular treatments that perhaps you do or do not want in some specific circumstances, ie: you may decide against artificial nutrition and fluids or any type of intravenous antibiotics, etc. In the following lines provides, be certain to provide information with regard to treatments you do NOT wish to have implemented.

Step 4 – Understanding the Signatures with regard to the directive –

  • Once the directive has been signed this, should the representative or Declarant elect hospice care,  it must be understood and agree that only those treatments needed to keep the declarant comfortable would be provided and the declarant would not be given any available life-sustaining treatments. If the declarant does not have a Medical Power of Attorney, and is unable to make their wishes known, The declarant has designated the following person(s) to make treatment decisions with their physician compatible with the understood personal values of the declarant
  • Name of Designee 1
  • Name of Designee 2

Step 5 – Completion of Directive –

  • The Declarant and all involved must read the remainder of the document for clarity regarding further instructions as well as understanding the wishes of the Declarant
  • Once complete the Declarant must enter their signature
  • Enter the date of signature in mm/dd/yyyy format
  • Enter the declarant’s City, County and State of Residence

Step 6 – Witnesses – Two competent adult witnesses must sign below, acknowledging the signature of the declarant. The witness designated as Witness (1) may not be a person designated to make a treatment decision for the patient and may not be related to the declarant by blood or marriage. This witness may not be entitled to any part of the estate and may not have a claim against the estate of the patient. This witness may not be the attending physician or an employee of the attending physician.

Witness 1 –

  • Enter Signature

Witness 2 – 

  • Enter Signature