Advance care planning

Begin with your priorities

Think about what makes a day meaningful, which people you want involved, and what you would want your team to understand if you became too ill to explain. Preferences can change. Planning is an ongoing conversation rather than a decision you must get perfect today.

• Consider everyday life: Being at home, staying comfortable, recognizing loved ones, practicing your faith, or remaining alert may have different importance to different people.
• Ask about your illness: A clinician can explain likely changes and the benefits and burdens of treatment options, so your choices reflect your actual situation.

Know what each Texas document does

• Medical Power of Attorney: This names an agent to make medical decisions if your physician determines and documents that you cannot make them yourself. Choose someone willing to follow your wishes and discuss those wishes together. This document is different from authority over finances.
• Directive to Physicians and Family or Surrogates: Sometimes called a living will, it records treatment preferences for the circumstances described in the Texas form. Ask your clinician to explain how its choices relate to a terminal or irreversible condition.
• Use the current instructions: Texas documents have requirements for execution, including witness or notarization options. Read the instructions for the particular form and ask for help if the situation is complicated. A conversation or an unsigned worksheet does not automatically meet those requirements.

A DNR order is a separate decision

A Texas out-of-hospital Do Not Resuscitate order addresses specified resuscitation procedures when breathing or the heartbeat stops in the settings covered by Texas law. These include homes, care facilities, transport, and hospital outpatient or emergency departments. It is not the same as a living will or a medical power of attorney, and it does not mean withholding comfort care. Discuss the order, its signature requirements, and where to keep it with your medical team. Do not assume that simply enrolling in hospice communicates a resuscitation decision to emergency personnel.

Make your plan available

• Share copies: Give completed documents to your chosen agent, physicians, hospice team, and any facility involved in your care. Tell a trusted person where the originals are kept.
• Revisit the plan: Review it after a new diagnosis, a change in health, or a change in the person you want to speak for you. Let the care team know when you update or revoke documents.
• Start with one step: If everything feels like too much, begin by naming the person you would want beside you in a medical conversation. Ask the hospice social worker to help you find the correct forms and appropriate local guidance.