Advance Care Planning refers to a process of mapping out the types of medical and non-medical care you would like to receive at some future point should a life-threatening or terminal disease make it impossible for you to express your wishes at that time. This type of planning is an ongoing process. It is a process of thoughtful discussion between you and your care providers, spouse, family, and significant others. While this conversation often results in a document (see Advance Directives below), it is more than just a piece of paper. It is an effort to better educate yourself about alternatives regarding the end of life and an opportunity to educate your physician, spouse, family, and others about your values, goals, and wishes related to end-of-life care.
This communication between you and your health care provider can be done at any time, preferably when you are younger and still healthy. Once completed, it should be revisited on a regular basis - every five years or after any potentially life-changing event, such as marriage, divorce, death of a spouse, or the onset of a life-threatening disease.
Advance care planning usually produces an Advance Directive, which is a written document that helps to summarize the plans you have made for future care. These documents take several forms, such as a Living Will and a Medical Power of Attorney. While they can be completed without the involvement of your health care provider, it is much preferred to do this together. The future usefulness of these documents is better assured if your health care professional has been part of the planning process.
Download Advance Care Planning
Documents
Use these documents if you are choosing not to complete them online. If
you would like to complete them online, click here
to begin the process. You will need Acrobat
Reader to download and view these documents.
Please click here if you need instructions
for filling out your Advance Care Planning Documents.
A Living Will, referred to as a "Directive to Physician
& Family" on Texas' form, briefly states your wishes regarding
treatment that "only prolongs the process of dying." A living
will ONLY takes effect when you are declared "terminal" ("means
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 provided in accordance with the
prevailing standard of medical care") or have an irreversible condition
("may be treated but never cured," "leaves a person unable
to care for or make decisions for the person's own self," and "that,
without life-sustaining treatment provided in accordance with the prevailing
standard of medical care, is fatal." In addition, you must meet a
second standard of lacking competence ("possessing the ability, based
on reasonable medical judgment, to understand and appreciate the nature
and consequences of a treatment decision, including the significant benefits
and harms of and reasonable alternatives to a proposed treatment decision").
A Medical Power of Attorney is a document in which you
designate someone to officially represent your views. Unlike other power-of-attorney
designations, this type ONLY comes into effect if you can no longer express
your own wishes regarding health care. Importantly, medical powers of
attorney differ from living wills in that it is NOT necessary for you
to be declared terminal for the person you appoint (your proxy) to speak
on your behalf. This type of document also allows you to express your
wishes about care at the end-of-life in greater detail than is possible
in a living will.
The Texas Health & Safety Code, Title 2, Subtitle H, Chapter
166 prioritizes the order of authority regarding life sustaining
treatment in the event a written directive does not exist as follows:
- The patient's spouse
- The patient's reasonably available adult children
- The patient's parents
- The patient's nearest living relative
- If there is no legal guardian and none of the above are available, then the decision may be made by the treating physician and a second physician who is not involved in the treatment of the patient or who is a representative of an ethics or medical committee of the health care facility in which the person is a patient.
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