Individuals usually make decisions regarding their healthcare treatment after their physician recommends a course of treatment and provides information about it. These decisions may be more difficult however, if a patient becomes unable to tell their doctors and loved ones what kind of healthcare treatment they want. 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. Below is general information about the four types of advance directives recognized under Texas law. Advance directives can be changed or cancelled at any time.
Directive to Physicians
A Directive to Physicians, also known as a living will, allows you to tell your physician not to use artificial methods to prolong the process of dying if you are terminally ill. This directive does not become effective until you have been diagnosed with a terminal or irreversible condition.
If you select this directive, discuss it with your physician and ask that it be made a part of your medical record. If for some reason you become unable to sign a written directive, you can issue this directive verbally or by other means of non-written communication in the presence of your physician.
If you have not issued this 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 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 guardian or if 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 healthcare decisions on your behalf should you become unable to make these decisions yourself.
You cannot choose your healthcare provider (a physician, hospital, nursing home or an employee of your health care provider) as your agent unless he/she is related to you.
The person you designate has the 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 decision yourself, or whether a medical power of attorney is in effect.
After consulting with your attending physician, your agent must make health care decisions according to their knowledge of your wishes, including your religious and moral beliefs. If your wishes are unknown, your agent must make a decision based on what he/she believes is in your best interest.
Out-of-Hospital Do-Not-Resuscitate Order
An Out-of-Hospital Do-Not-Resuscitate (OOH DNR) order allows you to refuse certain life-sustaining treatments in any setting outside of a hospital. This advance directive must be issued in conjunction with your attending physician.
Declaration for Mental Health Treatment
Another type of advance directive deals with mental health treatment issues 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.
Legal aspects of advance directives
An advance directive does not need to be notarized. Neither Good Shepherd 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 policies that you may have.
U.S. Living Will Registry
As a member of the U.S. Living Will Registry, the CHRISTUS St. Michael Health System can register patients’ advance directives. The U.S. Living Will Registry electronically stores advance directives and makes the confidential information available to member healthcare providers by Internet or fax. Good Shepherd personnel have instant access to documents such as advance directives, organ donor information and emergency contact information for any registered person 24 hours a day.
For more information on creating or registering an advance directive, call the CHRISTUS St. Michael Health System Social Work Department at 903.315.2443. Registering an advance directive is free, and, once registered, a person is registered for life.
More Information on the U.S. Living Will Registry
CHRISTUS St. Michael Health System Policies for Implementing Patient Rights
Formal policies have been adopted to assure that your rights to make medical treatment decisions will be honored to the extent permitted by law. CHRISTUS St. Michael Health System has adopted policies relating to informed consent and implementation and treatment decisions under the directive to physicians, the medical power of attorney, the Out-of-Hospital Do-Not-Resuscitate order, and the declaration for mental health treatment.
Complaints concerning advance directive requirements may be filed by calling the Texas Department of Health at 1.800.228.1570.