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Texas has enacted the Natural Death Act which allows any competent adult, by signing a directive to physicians, or “living will,” as it often is called, to instruct his or her physician to withhold or withdraw artificial life-sustaining procedures in the event of a terminal condition.  The directive takes effect only after two physicians determine that the patient is terminally ill and the patient’s attending physician determines that death is imminent or will result in a relatively short time without application of artificial life-sustaining procedures.

The form and contents of the directive are prescribed by Texas law.  The directive should be in writing, signed by the patient, and witnessed by two individuals.  The witnesses cannot be related to the patient by blood or marriage, the patient’s heirs, the attending physician or an employee of the physician, a patient in the patient’s health care facility, a person who would have a claim against the patient’s estate upon his or her death, or an employee of the patient’s health care facility who is providing direct care to the patient or who is involved in the financial affairs of the facility.  The directive need not be notarized.

Facilities that receive Medicare and Medicaid funds (so basically, all hospitals) must give patients, at the time of admission, written information on the “advance directive” that are legally available.  This is a federal law based on the Patient Self-Determination Act that went into effect in December 1991. 

Since the Terri Schiavo case in Florida made headlines in 2005, there has been much debate about euthanasia.  The word “euthanasia” comes from the Greek words “eu” and “thanatos,” which mean “easy death.”  Many consider euthanasia to be imposed death, meaning doing something or not doing something in order to induce the death of a person. 

How one chooses to die is a personal decision.  In 2018, Texas revised its directive to physicians, family and surrogates to provide for clearer choices and instructions from the patient on the level of care they desire at death.  The underlying purpose is to give the patient the ability to make those choices and not put a burden on their family.  It is specific to when the moment death is upon the individual.  As long as there is a chance the patient can recover, then everything that can be done medically must be done.  Only when the moment of death is within minutes or hours from occurring does the Texas directive to physicians, family and surrogates apply.  So, for example, if you need a ventilator to assist with breathing due to asthma, then you would receive that up to the moment you medical doctor determines your death is within minutes or hours. 

You can specifically choose to be on a ventilator, tube feeding for nutrients, saline solution for hydration, or antibiotics or pain relief up to that point.  Using antibiotics as an example, many patients develop urinary tract infections once they become sedimentary.  Antibiotics are a common treatment to address these UTIs and provide relief from pain caused by them.  So, you may choose pain relief, but could also give further instruction to provide antibiotics as well. 

Texas also has a power of attorney for health care that grants the agent the power to make health care decisions for the principal if he or she is unable to make them.  This is generally used for day to day care or emergency health care until you recover.  You can leave specific instructions to your agent regarding treatment such as a ventilator, tube feeding, antibiotics and pain relief.  The agent may exercise his or her authority only if the principal’s attending physician certifies that, in the physician’s opinion, the principal lacks the capacity to make health care decisions.  The principal can revoke the power of attorney at any time, orally or in writing, and regardless of the principal’s mental state.  The power of attorney for health care must be signed by two witnesses, neither of whom are:

            1.  the person designated as agent;

2.  the principal’s health or residential care provider or an employee of a health or residential care provider.

            3.  the principal’s spouse;

            4.  the principal’s lawful heirs or beneficiaries named in his or her will or a deed; or

            5.  creditors or persons who have a claim against the principal.

If you want to make the decisions regarding your health care in the event of a prolonged or terminal illness, consult with an attorney to have a directive to physicians, family and surrogates and a power of attorney for health care prepared for you.  It may also be desirable to inform your physician of your wishes and to provide him or her with a copy of the directive and power of attorney for health care.  Failure to sign a directive may result in difficulties for your family in carrying out your wishes with respect to terminating artificial life-sustaining procedures.

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