How to Fill Out a Texas Living Will Form (Directive to Physicians)

A Texas living will form, officially called the Directive to Physicians and Family or Surrogates, lets you record in advance whether you want life-sustaining treatment if you’re ever diagnosed with a terminal or irreversible condition and can’t speak for yourself. You can download it free from the Texas Health and Human Services Commission, fill it out without a lawyer, and make it legally valid by signing in front of two qualified witnesses or a notary public.

Where to Download the Form

Texas writes the suggested form directly into the statute. Section 166.033 of the Health and Safety Code sets out the text, and the form “may be” in that format, meaning you can use the statutory language as-is or adapt it as long as the substance stays the same.¹ The simplest route is the ready-made PDF from the Texas Health and Human Services Commission, which mirrors the statutory language and has the signature lines already formatted.² There is no filing fee and no requirement to involve an attorney.

When the Directive Actually Takes Effect

The form applies to two medical situations defined in Chapter 166. A terminal condition is an incurable illness, injury, or disease that, even with life-sustaining treatment, will cause death within six months according to reasonable medical judgment. An irreversible condition is one that can be treated but never cured, leaves you unable to care for yourself or make your own decisions, and would be fatal without life-sustaining treatment.³ Until one of those is diagnosed, the directive sits dormant and has no effect on your routine medical care.

“Life-sustaining treatment” means any medical procedure that uses mechanical or artificial means to keep a bodily function going. Ventilators, dialysis machines, and feeding tubes all fit. Pain medication and comfort care are not life-sustaining treatment and continue regardless of what you choose.

The Choices You Make on the Form

The core question on the form is what happens if you develop a terminal or irreversible condition and can no longer communicate. You pick one of two paths.

Withhold or withdraw life-sustaining treatment. This tells your doctor to stop or never start mechanical interventions that only delay the dying process. You still receive comfort care: pain management, hygiene, and anything aimed at keeping you comfortable rather than keeping you alive artificially.
Continue all available treatment. This directs your physician to use every medical tool available to prolong your life, including ventilators, tube feeding, and other mechanical support, even if the condition is terminal or irreversible.

Below that choice, a separate section covers artificial nutrition and hydration. You can accept, reject, or set conditions for tube feeding and IV fluids independently of your general treatment decision. Some people are comfortable declining a ventilator but still want to receive nutrition, or the other way around. Be specific; vague language creates exactly the kind of confusion the form is meant to prevent.¹

Section 166.032 also lets you add directions beyond what the standard form covers, and lets you designate a person to make healthcare decisions for you if you become incapacitated.⁴ Use the blank space to record personal, religious, or cultural preferences. If you want a chaplain consulted, or CPR attempted once but not repeated, write it down. Doctors work with whatever level of specificity you give them.

The Pregnancy Clause

The statutory form includes a pregnancy provision that you cannot opt out of. If you have been diagnosed as pregnant and your physician knows about it, the directive has no force or effect for the duration of the pregnancy.³ Even if you chose to withhold life-sustaining treatment, that choice is suspended while you are pregnant, and life-sustaining treatment will continue until the pregnancy ends. The language is embedded in the form itself.

Signing the Form

You have two ways to make the directive legally valid. Either works on its own.

Two qualified witnesses. Sign the directive in front of two witnesses who also sign the document. Texas disqualifies a long list of people: your spouse, anyone related to you by blood or marriage, anyone who stands to inherit from your estate or has a financial claim against it, your attending physician, employees of your attending physician, and employees of the healthcare facility who provide you direct patient care or hold officer, director, partner, or business office positions at the facility. Neighbors, coworkers, friends, or members of your faith community are usually the best fit.⁴
Notary public. Instead of using witnesses, you can sign the directive and have your signature acknowledged before a notary. Banks, shipping stores, and many public libraries offer notary services at modest fees.⁴

If you are already in a hospital, the witness restrictions get awkward fast. Most staff members are disqualified, and family at the bedside is disqualified too. A notary is often the simpler path in that setting. A directive signed without meeting these requirements can be challenged and potentially thrown out.

Getting It to Your Doctor and Keeping It Findable

Once the form is signed, you are responsible for telling your attending physician that it exists. The physician must then place it in your medical record.⁴ If you are already incapacitated, someone else can notify the doctor on your behalf, but the system works far better when you handle it while you are healthy.

When you are admitted to a hospital, skilled nursing facility, or hospice program, bring a copy. Facilities that participate in Medicare or Medicaid are required under the federal Patient Self-Determination Act to ask whether you have an advance directive and document your answer, and they cannot refuse to treat you based on what it says.⁵

Keep the signed original somewhere secure but easy to find, like a fireproof home safe or a clearly labeled folder. Give copies to your spouse or partner, your adult children, and anyone you have designated to make healthcare decisions. A few extra steps help prevent the document from being unavailable in a crisis:

Digital backup. Scan the signed form and store it in a cloud service your family can access, or email it to yourself and your designated contacts.
National registry. The U.S. Advance Care Plan Registry stores scanned advance directives in an online database accessible to healthcare providers around the clock. Hospitals can search by name and date of birth, and registrants get a wallet card.⁶
Wallet notice. Carry a card or note saying you have a directive, with the name and phone number of someone who can produce it.

Changing or Canceling It Later

You can cancel your directive at any time, and Texas law says competency is not required at the moment you revoke it.⁷ Three methods work:

Destroy the document. You or someone acting at your direction can tear, burn, deface, or otherwise destroy the directive.
Write a revocation. Sign and date a written statement revoking the directive. It takes effect only after your attending physician is notified or receives the revocation by mail.
Say it out loud. Verbally tell someone you want to revoke the directive. Like the written method, an oral revocation becomes effective only once your attending physician is notified.

Whichever method you use, your doctor must mark “VOID” on every page of the directive copy in your medical record and note the date and time of the revocation.⁷ Tell everyone who holds a copy, and update any online registry you used. An outdated copy circulating after a revocation can cause real confusion in an emergency.

If Your Doctor Won’t Follow It

A physician who is unwilling to follow your directive cannot simply ignore it. Under Section 166.046, the refusal gets reviewed by an ethics or medical committee at the facility, and the physician who refused cannot sit on that committee during the review. You continue to receive life-sustaining treatment while the review is underway.⁸

If the committee sides with the physician, the facility must make a reasonable effort to transfer you to another doctor or facility that will honor the directive. Neither is required to continue life-sustaining treatment beyond 25 calendar days after formal written notice to the person responsible for your healthcare decisions.⁸

How This Differs From a Medical Power of Attorney

The Directive to Physicians and a medical power of attorney are separate documents that do different jobs. The directive records your specific treatment preferences for terminal or irreversible conditions: ventilator yes or no, tube feeding yes or no. A medical power of attorney designates another person as your agent to make healthcare decisions when you cannot, across any medical situation, not just end-of-life scenarios.² Most estate-planning attorneys recommend completing both. The directive tells your agent and your doctors what you want. The medical power of attorney gives your agent the legal authority to advocate for those wishes and to handle situations the directive did not anticipate.

1
State of Texas. Texas Code Health and Safety Code 166.033 – Form of Written Directive
2
Texas Health and Human Services. Directive to Physicians and Family or Surrogates – Living Will
3
State of Texas. Texas Health and Safety Code Chapter 166 – Advance Directives
4
State of Texas. Texas Health and Safety Code Section 166.032 – Written Directive by Competent Adult; Notice to Physician
5
National Center for Biotechnology Information (NCBI). Patient Self-Determination Act
6
U.S. Advance Care Plan Registry (USACPR). How The Registry Works
7
Texas Public Law. Texas Health and Safety Code Section 166.042 – Revocation of Directive
8
State of Texas. Texas Health and Safety Code Section 166.046 – Procedure if Not Effectuating a Directive or Treatment Decision