Disclaimer: Content reviewed and maintained by the clinical team at Hillside Medical Group. This content is provided for educational purposes only and is not a substitute for professional medical advice. Consult a qualified healthcare provider.
What Is an Advance Directive in Texas? An advance directive in Texas is a legal document that lets you state your healthcare wishes in writing. It combines a Directive to Physicians (living will) and a Medical Power of Attorney, allowing you to document treatment preferences and appoint a decision-maker if you cannot speak. Texas law allows completion without a lawyer, with two witnesses or a notary. Completing one prevents family conflict and costly guardianship proceedings.
What Is an Advance Directive in Texas?
An advance directive in Texas is a set of legal documents recognized under Chapter 166 of the Texas Health and Safety Code — the Texas Advance Directives Act. It gives adults the ability to document their healthcare treatment preferences and designate a trusted person to make medical decisions if they become unable to speak for themselves.
Two primary documents form the core of a Texas advance directive:
- Directive to Physicians (commonly called a living will): A written document instructing doctors whether the patient wants life-sustaining treatment if diagnosed with a terminal or irreversible condition and cannot communicate.
- Medical Power of Attorney (MPOA): A document naming a trusted person (agent) to make all healthcare decisions for the patient if a physician determines they lack decision-making capacity.
A third optional document — the Out-of-Hospital Do-Not-Resuscitate (DNR) Order — is available for those who wish to refuse cardiopulmonary resuscitation (CPR) and life-sustaining measures outside a hospital setting, such as at home or in hospice.
Texas law allows any competent adult aged 18 or older to complete these documents at no cost, without hiring an attorney. The documents take effect only when the patient becomes unable to communicate their own decisions — they do not affect a person’s rights or care while they are capable.
Despite their importance, completion rates remain low. Nationally, only 36.7 percent of United States adults have completed any type of advance directive, according to a 2017 study published in Health Affairs. Among adults in the West South Central division — which includes Texas — 64.9 percent of residential care community residents had a documented advance directive in 2016, per the Centers for Disease Control and Prevention (CDC). A 2025 global meta-analysis of 239 studies found a 26 percent worldwide completion rate (Valenti et al., Inquiry).
Key Takeaway: An advance directive is not just for end of life — it is a planning tool for any situation where a person cannot speak for themselves, even temporarily.
Why Do Most Texas Families Wait Too Long to Plan?
Most Texas families discover the value of an advance directive only when a health crisis strikes — and by then, it is often too late to complete one with the patient’s full participation.
Research specific to Texas illustrates the gap. A 2025 study from the University of Texas Medical Branch found that only 2.2 percent or fewer of Texas Medicare beneficiaries with colorectal cancer had a billed advance care planning encounter documented in the last 30 days of life. This means the vast majority of seriously ill patients in Texas had no documented advance directive conversation with their doctor at the time it mattered most.
Without an advance directive, Texas law defaults to a hierarchy of surrogate decision-makers defined in the Texas Health and Safety Code — spouse first, then adult children, then parents, then siblings. This default list may not align with the patient’s wishes and can trigger family disputes when multiple relatives believe they know what the patient would have wanted.
Guardianship proceedings in Texas can cost thousands of dollars in legal fees and typically take months. During that time, medical decisions may be delayed or made by a court-appointed guardian who has never met the patient.
Nationally, the CDC reports that 88 percent of hospice patients had advance directives, compared to only 28 percent of home health patients — showing that planning often happens far too late, when options are already limited.
Completing an advance directive is a gift to loved ones. It removes the burden of guessing what the patient would have wanted and prevents guilt, second-guessing, and fractured relationships at an already stressful time.
What Is the Difference Between a Living Will and a Medical Power of Attorney in Texas?
Many people use “advance directive” as a catch-all term, but Texas law recognizes distinct documents with different functions. Understanding the difference helps patients complete each section thoughtfully.
| Feature | Directive to Physicians (Living Will) | Medical Power of Attorney |
|---|---|---|
| What it does | States treatment wishes for end-of-life care | Names someone to make all healthcare decisions |
| When it takes effect | Patient has terminal or irreversible condition and cannot communicate | Patient lacks decision-making capacity (any condition) |
| Scope | Limited to life-sustaining treatment decisions | Broad — any medical decision the patient could make |
| Who completes it | The patient (principal) | The patient (principal) names an agent |
| Can it be combined? | Yes — Texas form includes both in one document | Yes — same form |
| Legal requirement | Two witnesses or notarization | Two witnesses or notarization |
Directive to Physicians (Living Will): This document specifically addresses life-sustaining treatment when a patient has a terminal condition (incurable and expected to cause death) or an irreversible condition (cannot be cured but may not be immediately terminal). The patient can state whether they want treatment continued, withheld, or withdrawn in these situations. Nationally, 29.3 percent of United States adults have completed a living will specifically (Yadav et al., 2017).
Medical Power of Attorney (MPOA): This document names an agent to make healthcare decisions for the patient if they become incapacitated — not just at end of life, but for any medical situation. The agent’s authority is broader than the living will; they can make decisions about surgeries, medications, pain management, and other treatments. The MPOA takes effect only when a physician determines the patient lacks decision-making capacity. It does not take away the patient’s rights while they are competent.
An advance directive typically contains both documents in one form (Texas uses a combined statutory form), but each section is separate and can be completed independently. A person can name the same individual as healthcare agent under MPOA and as proxy for the living will, or choose different people.
Texas Law Help provides plain-language explanations of both documents — the Texas Law Help Advance Directive guide and the Medical Power of Attorney guide walk through each form’s requirements.
How to Complete an Advance Directive in Texas — Step-by-Step Walkthrough
Completing an advance directive in Texas is a straightforward process. Here is the step-by-step approach recommended for every adult in the state.
Step 1: Download the Free Texas Advance Directive Form
The Texas statutory form is available at no cost. Hillside Medical Group provides both English and Spanish versions:
- Download the free Texas advance directive form (English)
- Descargue el formulario gratuito de directiva anticipada de Texas (español)
Step 2: Complete Part A — Medical Power of Attorney
Choose a trusted person to serve as your healthcare agent. This person should be someone who: – Lives nearby or can travel to your bedside – Is willing to speak up for your wishes, even under family pressure – Is not easily intimidated by medical staff or hospital administrators.
Name an alternate agent as backup in case the primary agent is unavailable.
Step 3: Complete Part B — Directive to Physicians (Living Will)
Mark your choices about life-sustaining treatment. The Texas form offers several options regarding: – Whether to continue, withhold, or withdraw life-sustaining treatment – Pain management preferences – Organ donation wishes – Other specific instructions about personal values.
Step 4: Complete Part C — Out-of-Hospital DNR (Optional)
This section is only for those who want emergency responders to withhold CPR and life-sustaining measures outside a hospital setting. Most patients leave this section blank unless they have a terminal condition and prefer comfort care only.
Step 5: Sign in Front of Two Witnesses or a Notary
Texas law requires either two witnesses or a notary public to validate the form. Important restrictions on who can serve as a witness: – The named agent cannot be a witness – The agent’s spouse cannot be a witness – Anyone related to the patient by blood or marriage who stands to inherit cannot be a witness.
Step 6: Distribute Copies
Give completed copies to: – Your primary care doctor (to scan into the medical record) – Your named agent and alternate agent – Family members who should know your wishes – Keep the original in a readily accessible location at home.
Texas law explicitly permits self-completion — no attorney is required. For answers to common questions, visit the Hillside Medical Group FAQ on advance care planning.
Need Help Completing Your Advance Directive? Patients of Hillside Medical Group can discuss advance care planning during a routine visit. The practice’s providers are familiar with Texas advance directive forms and can answer questions about witnessing, notarization, and how the document is stored in the patient’s medical record. Contact the team at 210-742-6555 to get started.
Do You Need a Lawyer to Create an Advance Directive in Texas?
Texas law does not require a lawyer to complete an advance directive. The statutory form is designed for self-completion by any competent adult.
Two witnesses or a notary are required — both of which are available at no or low cost. Hillside Medical Group can notarize the form for established patients during an office visit.
A lawyer may be helpful in certain complex situations: – The patient owns a business that could be affected by incapacity – The patient has a blended family with potential for conflict among heirs – The patient wants to include unusual specific instructions that could be contested.
For the vast majority of Texas adults, the standard form with careful reading is sufficient. Texas Law Help explicitly states: “You do not need a lawyer to fill out an advance directive.”
The key is not legal expertise — it is having the conversation with family and the chosen agent so everyone understands the patient’s wishes.
What Happens Without an Advance Directive in Texas?
Without an advance directive, Texas law defaults to a list of surrogate decision-makers defined in the Texas Health and Safety Code Chapter 313. The order is:
- Spouse (unless legally separated)
- Adult children (majority decision)
- Parents
- Adult siblings
This default list may not match the patient’s wishes. For example, an unmarried partner, a close friend, or a stepchild who raised the patient may have no legal standing.
If no surrogate is available or family members disagree, a court may appoint a guardian — a process that takes weeks or months and costs thousands of dollars in legal fees. Medical decisions in the meantime fall to an attending physician who must act in the patient’s best interest but without knowing the patient’s specific values or preferences.
Family conflict is the most common and painful consequence. Disagreements among loved ones about “what Mom would have wanted” can cause lasting rifts that no medical document can repair after the fact.
Consider This: Taking one hour today to complete an advance directive prevents weeks or months of legal battles, family conflict, and uncertainty for loved ones. It is one of the most important gifts a person can give their family.
Can You Change or Cancel Your Advance Directive After Signing It?
Yes — an advance directive can be changed or revoked at any time, as long as the patient is mentally competent.
To revoke a Texas advance directive, a patient can: – Destroy the original document – Write “revoked” across all pages – Sign a new advance directive that explicitly cancels the previous one.
Changes to the Medical Power of Attorney require notifying the previously named agent in writing.
After creating a new document, the patient should give updated copies to their doctor, agent, and family members. The most recent dated document is the one that counts.
It is a common myth that advance directives are permanent. They are living documents meant to be updated as life circumstances change — marriage, divorce, new medical conditions, or moving to Texas from another state.
Texas Law Help provides revocation instructions and confirms that patients retain full control to update their documents.
Remember: The most recent signed and witnessed version of your advance directive is the one doctors will follow. Destroy old copies when you create a new one.
Frequently Asked Questions About Advance Directives in Texas
Will a doctor keep a copy of your advance directive?
Yes — patients should give a copy to their primary care provider. Hillside Medical Group scans the document into the patient’s medical record so it is available at every visit. The practice also recommends keeping the original at home and giving copies to the named agent and family members.
How much does it cost to create an advance directive in Texas?
Nothing — the Texas statutory form is free to download and complete. Witnesses are free. If notarization is preferred, some clinics offer it at no charge for established patients. No lawyer is needed, so no legal fees are required for most people. Learn more about Hillside Medical Group’s approach to preventive care by visiting the About Us page.
What if your medical power of attorney lives in another state?
The named agent does not need to live in Texas. However, they should be willing and able to travel to the patient’s bedside or participate by phone or video when decisions are needed. The agent’s authority is recognized across state lines under the Uniform Health-Care Decisions Act, which Texas has adopted.
Does an advance directive expire?
No — a Texas advance directive remains in effect until the patient revokes it or dies. However, it is wise to review the document every few years or after major life events — marriage, divorce, new diagnosis, move — to ensure it still reflects current wishes.
How can you talk to your family about your advance directive?
Start the conversation outside a crisis — during a routine family gathering or after a checkup. Explain that the document is not about giving up but about making sure everyone knows what matters most. Hillside Medical Group providers can help patients start this conversation during a Medicare Annual Wellness Visit. Explore more health resources on the Hillside Medical Group blog.
Your Advance Directive Protects Your Wishes and Your Family
An advance directive in Texas is a free, lawyer-free set of documents that gives a person control over their medical care if they cannot speak for themselves. The two core components — a Directive to Physicians (living will) and a Medical Power of Attorney — work together to cover both treatment preferences and decision-maker designation.
Most Texas families are underprepared. Fewer than 3 percent of Medicare patients in the state had advance care planning documented in their final month of life. Taking one hour today to download, complete, and share the form prevents weeks or months of legal battles, family conflict, and uncertainty for loved ones.
Start Your Advance Directive Today An advance directive is one of the most important documents a person can complete — for themselves and for their family. Hillside Medical Group encourages every adult in San Antonio and Central Texas to download the free Texas form, fill it out, and bring it to their next appointment. Schedule a primary care visit by calling 210-742-6555 or contact the team online at Hillside Medical Group.
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