Physicians Directives, Advance Directives, or “Living Wills”

A Physician’s Directive, also known as an “Advance Directive” or “Living Will,” is a document that will communicate your wishes about medical treatment or the withholding of medical treatment at some time in the future when you are unable to make your wishes known because of illness or injury.  It is not a “Do Not Resuscitate Order” or “DNR.”

For example, if, in the judgment of your physician, you are suffering with an irreversible condition so that you cannot care for yourself or make decisions for yourself (like a persistent vegetative state) and you are expected to die without life-sustaining treatment provided in accordance with prevailing standards of care, you can request that all treatments other than those needed to keep you comfortable be discontinued or withheld and your physician allow you to die as gently as possible.

Furthermore, if, in the judgment of your physician, you are suffering with a terminal condition from which you are expected to die within six months, even with available life-sustaining treatment provided in accordance with prevailing standards of medical care, you can request that all treatments other than those needed to keep you comfortable be discontinued or withheld and your physician allow you to die as gently as possible.

A Physician’s Directive can be an important part of estate planning.  Here at The Peugh Law Firm we are experienced in drafting Physician’s Directive’s, and other important estate planning documents, for our clients.

Out of Hospital Do Not Resuscitate Orders are for the purpose of instructing Emergency Medical Personnel and other health care professionals to forgo resuscitation attempts and to permit the patient to have a natural death with peace and dignity. This order does NOT affect the provision of other emergency care including comfort care.  Care to be withheld includes; Cardiopulmonary Resuscitation (CPR), Transcutaneous Cardiac Pacing, Defibrillation, Advanced Airway Management, and Artificial Ventilation.  A DNR applies to all health care professionals operating in any out-of-hospital setting to include hospital outpatient or emergency departments and physician’s offices.

A competent adult may execute or issue an Out-of-Hospital DNR Order. The patient’s attending physician will document the existence of the directive in the patient’s permanent medical record.  If an adult patient is capable of providing informed consent for the order, he/she will sign and date the out-of-hospital DNR order on the front of the form in Box A. In the event that an adult patient is unable to provide informed consent, his/her Legal Guardian, agent under Medical Power of Attorney, or Qualified Relative may execute the order by signing and dating the form in Box B. If an adult patient is unable to provide informed consent and none of the persons listed in Box B are available, the treating physician may execute the order using Box D with the consent of a second physician who is not treating the patient and/or is a member of the health care facility ethics committee or other medical committee.

The following persons may execute an out-of-hospital DNR order on behalf of a minor: the minor’s parents, the minor’s legal guardian or the minor’s managing conservator. A person executing a DNR order on behalf of a minor may execute the order by signing and dating the form in Box C. An outof-hospital DNR order may not be executed unless the minor has been diagnosed by a physician as suffering from a terminal or irreversible condition.

The form must be signed and dated by two witnesses except when executed by two physicians only (Box D).

The original standard Texas Out-of-Hospital DNR form must be completed and properly executed. Duplicates may be made by the patient, health care provider organization or attending physician as necessary. Copies of a completed document may be used for any purpose that the original may be used and shall be honored by responding health care professionals.

The presence of a Texas DNR identification device on a person is sufficient evidence that the individual has a valid Out-of-Hospital DNR Order.  Therefore, either the original standard form, a copy of the completed standard form, or the device is sufficient evidence of the existence of the order.

For information on ordering identification devices, contact the Texas Department of State Health Services at (512) 834-6700.  A recent amendment to 25 TAC 157.25 gives consumers greater choice in Texas OOH DNR identification devices by allowing more businesses to offer identification devices. The amendment now requires:

(1) An intact, unaltered, easily identifiable plastic identification OOH DNR bracelet, with the word “Texas” (or a representation of the geographical shape of Texas and the word “STOP” imposed over the shape) and the words “Do Not Resuscitate”, shall be honored by qualified EMS personnel in lieu of an original OOH DNR Order form.

OR

(2) An intact, unaltered, easily identifiable metal bracelet or necklace inscribed with the words, “Texas Do Not Resuscitate – OOH” shall be honored by qualified EMS personnel in lieu of an OOH DNR Order form.