Texas Living Will Form

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The Texas living will is a directive that informs medical staff to pursue specific treatment preferences in the event of incapacitation. It allows a person to select whether to promote all life-sustaining treatments or to end life-support if a condition is deemed terminal. The principal can also make special instructions in order to make their wishes be known. The form must be signed with at least two (2) witnesses.

Definition

“Directive” means an instruction made under Section 166.032, 166.034, or 166.035 to administer, withhold, or withdraw life-sustaining treatment in the event of a terminal or irreversible condition.

Laws

  • Statute§ 166.033
  • Signing Requirements (§ 166.003) – The Declarant must sign a living will in Texas with two (2) witnesses. The witnesses cannot be any of the following:
    1. A person designated by the declarant to make a health care or treatment decision;
    2. A person related to the declarant by blood or marriage;
    3. A person entitled to any part of the declarant’s estate after the declarant’s death under a will or codicil executed by the declarant or by operation of law;
    4. The attending physician;
    5. An employee of the attending physician;
    6. An employee of a health care facility in which the declarant is a patient if the employee is providing direct patient care to the declarant or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or
    7. A person who, at the time the written advance directive is executed or, if the directive is a nonwritten directive issued under this chapter, at the time the nonwritten directive is issued, has a claim against any part of the declarant’s estate after the declarant’s death.

How to Write

Download: Adobe PDF, MS Word, OpenDocument

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 the 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 an 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, 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