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The Texas Directive to Physician

The Texas Directive to Physician is Texas’ version of a Living Will. It is a document that allows you to declare to your physician, family and friends how you want to be treated and cared for in the event you have a terminal condition or are suffering from an irreversible condition that will eventually lead to your death.  This is essentially an end of life document.  As long as you have the capacity to communicate with your physician, you will control what treatments you receive or do not receive.  However, if there comes a time when you are no longer able to communicate with your physician, this document makes your physician and family aware of what extraordinary measures you want, or do not want, to prolong your life. 

There are two key terms in the Directive to Physician: “terminal” and “irreversible.”  A terminal condition is defined as an incurable condition caused by injury, disease or illness that according to reasonable medical judgment will produce death within six months, even with available life-sustaining treatment.  An irreversible condition is defined as a condition, injury, or illness that may be treated, but is never cured or eliminated, leaves the person unable to care or make decisions for himself/herself and that without life sustaining treatment is fatal.  The Directive to Physician you execute will provide you with the opportunity to spell out what you do or do not want in these situations. 

These are very personal decisions you must make.  To illustrate the significance of this document I will share with you the experience of a young woman I met.  She was 19 years old and in college and her parents had been divorced for many years.  One day her father fell at his home, suffered a brain bleed and was rushed into surgery at the hospital.  The surgery did not achieve what the physician had hoped, and he informed the family that the decision as to whether or not to take him off of life support must be made by his closest legal next of kin. As a result, it was up to the 19-year-old to make the decision.  For months and months after she made the decision to remove her father from life support, the young woman suffered from the responsibility of making that decision.  She second guessed herself continually as to whether or not she made the right decision.  She dropped out of college for a while and eventually sought out the services of a counselor. 

I have also heard individuals make the statement, “My family knows what I want.”  Maybe.  Maybe not.  One child may remember the parent saying one thing and another child may remember it completely differently.  At a time like that, it is important for a family to see in black and white what their loved one wanted under such terrible circumstances.  Even with this Directive, it is a very difficult decision that must be made.  But, without a Directive, it can be life altering.

The Directive to Physician must be executed in the presence of two witnesses who then sign their names to it, or you must execute it in the presence of a notary.  Keep in mind, the desire of the patient “supersedes the effect of a Directive,” In addition, even if a you are incompetent, you can revoke a Directive.  Revocation is done either by you, or someone on your behalf and at your direction, destroying the Directive, signing and dating a written revocation, or orally revoking the Directive.  If the revocation is done orally, it is not effective until the attending physician is notified.

Some physicians treat a Directive as a guideline and even when presented with the document, will routinely speak to the family. If a patient has previously executed a Directive and is now incompetent or unable to communicate, the physician may make a treatment decision in conjunction with a person the patient has designated to make a treatment decision on his behalf. If there is no such person, the physician must comply with the Directive unless he believes that the Directive “does not reflect the patient’s present desires.” Additionally, prior to a physician withholding life-sustaining treatment, the physician must determine that doing so conforms with the patient’s existing desires.