Texas Living Will: Requirements, Pregnancy Limits, and Revocation

A Texas living will, formally called a Directive to Physicians and Family or Surrogates, is a written document that tells doctors whether to continue, withhold, or withdraw life-sustaining treatment if you have a terminal or irreversible condition and can no longer speak for yourself. It is governed by Chapter 166 of the Texas Health and Safety Code and deals only with medical decisions during your lifetime, not property or inheritance.¹

What You Can Decide in the Directive

The statutory form separates two situations. A terminal condition is an incurable illness that will cause death regardless of treatment. An irreversible condition is one that will leave you permanently unable to care for yourself. For each, you choose whether to stop everything except pain management or to continue treatment as your physician recommends.¹

Two specific interventions get their own checkboxes: artificial nutrition and hydration (tube feeding and IV fluids), and artificial respiration (a ventilator). You can accept or refuse each independently of your general treatment preference. Many people are comfortable declining a ventilator while still wanting hydration continued, and the form lets you draw that line.¹

The directive is not only for refusing care. If you want every available life-sustaining measure pursued regardless of prognosis, this is the document where you say so.

How to Make One That Will Be Honored

The basics are straightforward. You must be at least 18 and of sound mind when you sign. The directive must be written and signed. And it must be either notarized or witnessed by two qualified adults who watch you sign.

The witness rules are where directives get invalidated. Texas law disqualifies six categories of people from serving as your witness:¹

Anyone you have designated to make healthcare decisions for you
Anyone related to you by blood or marriage
Anyone entitled to a share of your estate
Your attending physician
An employee of your attending physician
An employee of a healthcare facility where you are a patient, if that employee provides you direct care or works in the facility’s administration

The relative restriction surprises most families. Your spouse, adult children, and siblings are all disqualified. You will need two unrelated friends, neighbors, or coworkers, or you can skip witnesses entirely and sign in front of a notary. Notary fees for acknowledging a signature are set by Texas statute.²

Texas provides a statutory form in Section 166.033 of the Health and Safety Code. You are not required to use it word for word, but following it closely eliminates arguments about validity later.¹

When the Directive Takes Effect

Signing does not activate the directive. Two things must be true at the same time before it controls your care: your attending physician certifies in writing that you have a terminal or irreversible condition, and you are either incompetent or physically unable to communicate.¹ Until both triggers are met, your doctors follow your real-time instructions the same as they would for any other patient.

Once activated, the directive goes into your medical record and your physician must follow it. That only works if the document is findable. Keep the original where it can be reached quickly, and give copies to your primary care doctor, any specialists you see regularly, and close family. A directive sitting in a safe deposit box during an emergency helps no one.

Two Limits People Miss

The Pregnancy Override

Texas law prohibits withdrawing or withholding life-sustaining treatment from a pregnant patient, regardless of what her directive says.³ The override applies automatically, and no language you add to your directive can defeat it. Women of childbearing age drafting a Texas living will should know this going in.

When a Physician Refuses to Comply

Texas is one of the few states where a physician can refuse to follow your directive, and there is a formal process for the disagreement. The dispute goes to the hospital’s ethics or medical committee. You or your representative must get at least 48 hours’ written notice of the meeting and are entitled to attend. Life-sustaining treatment continues throughout the review.¹

If the committee sides with the physician, the hospital must make a reasonable effort to transfer you to a provider willing to honor the directive. You have 25 calendar days from the written notice to find one. If no transfer happens in that window, the physician and facility are no longer legally required to continue life-sustaining treatment. A court can extend the 25 days, but only if a judge finds a reasonable expectation that a willing provider will be found with more time.¹

Even after the 25 days expire, the hospital must continue artificial nutrition and hydration unless doing so would hasten death, cause irremediable pain, or be medically ineffective. A physician who follows this procedure in good faith is shielded from civil and criminal liability.⁴

Changing or Revoking Your Directive

You can revoke a Texas living will at any time in any of three ways:

Sign a written revocation, or have someone sign one at your direction.
Physically destroy the document by burning, tearing, or similar means.
Say out loud that you want to revoke it.

One detail matters more than any other here. Texas does not require you to be competent to revoke your directive. The statute allows revocation “without regard to the declarant’s mental state or competency.”¹ A patient in cognitive decline who says “I don’t want that anymore” has legally revoked the directive. The law errs on the side of a change of heart.

Signing a new directive automatically revokes the old one. After any revocation, tell your physician, your family, and anyone else holding a copy.

The Documents That Fill the Gaps

A living will alone leaves holes. Two other Texas documents pair with it and cover the situations it does not.

Medical Power of Attorney

A Medical Power of Attorney (MPOA) names an agent to make healthcare decisions for you when you cannot. A living will hands out specific instructions about life-sustaining treatment; an MPOA hands a real person the flexibility to handle everything your directive did not anticipate. The agent can consent to or refuse surgery, choose among treatment options, and make judgment calls that a checkbox form cannot cover.¹

The MPOA has its own statutory form, its own witness rules, and its own rules about who can serve as agent. A living will without an MPOA leaves no one authorized to make the countless medical decisions that fall outside its narrow scope. An MPOA without a living will leaves your agent guessing about your end-of-life wishes. Having both is the standard advice.

Out-of-Hospital DNR

An out-of-hospital do-not-resuscitate order (OOH-DNR) handles one specific scenario: cardiac or respiratory arrest outside a hospital, with EMS on the way. Without a DNR, paramedics are legally required to attempt resuscitation. A living will will not stop them, because emergency responders do not have time to read multi-page legal documents during a code.⁵

The OOH-DNR is a standardized form signed by the patient (or an authorized representative), the attending physician, and either two adult witnesses or a notary. Texas also recognizes OOH-DNR identification bracelets and necklaces. If you have a terminal illness and want a peaceful passing at home, this is the document that reaches the paramedics.

Directives Signed in Another State

Texas recognizes an advance directive legally prepared in another state as having the same effect as one prepared under Texas law, with one limit: an out-of-state directive cannot authorize any treatment decision Texas law prohibits. If you split time between Texas and another state, have both versions reviewed by an attorney familiar with each state’s rules. Most providers will honor an out-of-state directive in practice, but meeting Texas formalities avoids delay during a crisis.

Penalties for Tampering

Intentionally concealing, defacing, or destroying someone else’s directive without consent is a Class A misdemeanor in Texas, punishable by up to one year in jail and a fine of up to $4,000. Forging a directive or hiding a revocation with intent to cause life-sustaining treatment to be withheld, where the patient dies as a result, exposes the person to prosecution for criminal homicide under the Texas Penal Code.⁶

1
State of Texas. Texas Health and Safety Code Chapter 166 – Advance Directives
2
Texas Secretary of State. Texas Notary Public Fee Schedule
3
State of Texas. Texas Health and Safety Code 166.049 – Pregnant Patients
4
State of Texas. Texas Health and Safety Code 166.045 – Procedure if Physician Refuses to Comply
5
Texas Department of State Health Services. Texas Out-of-Hospital DNR Order Form
6
State of Texas. Texas Health and Safety Code 166.048 – Criminal Penalties