What you'd want: advance directives in Texas

Texas advance directives let you name who can speak for you and record what care you would want. The form matters, but the conversation with your family matters just as much.

The fuller answer

Families put this conversation off because it feels like inviting something terrible into the room. What would you want if you couldn't speak for yourself? Who should decide? What matters enough that the treatment should serve it?

The heart of it is simple, and hard. Someday somebody you love may have to stand at a bedside and answer for you. A signed form helps them. A conversation helps differently, because it tells them not only what to choose but who you are. Maybe independence matters most to you. Maybe it's one more Christmas, or being able to recognize your family. Maybe your faith shapes the answer. Maybe there are treatments you'd accept for a short while but not forever. Maybe you don't know yet, and that's worth saying out loud too.

This isn't only about the end of life. It's a mercy toward the people who would otherwise have to guess. The form is the record, and the conversation is the gift.

The Texas forms

Texas Health and Human Services publishes the official forms free, in English and Spanish, at Texas HHS Forms & Handbooks: - Medical Power of Attorney. You name a health care agent to make medical decisions when you can't. This is usually the most important one. It is not the same as a financial power of attorney, which covers money and property. Medical libraries such as MedlinePlus and the National Institute on Aging call the national version a durable power of attorney for health care, and the person it names a health care proxy. - Directive to Physicians and Family or Surrogates. Often called a living will, it states your wishes about life-sustaining treatment if you have a terminal or irreversible condition. MedlinePlus lists the kinds of things a living will can address: dialysis and breathing machines, resuscitation, tube feeding, and organ or tissue donation. - Out-of-Hospital Do-Not-Resuscitate Order. This tells EMS and others outside a hospital not to attempt resuscitation. It's signed with your physician. - Declaration for Mental Health Treatment. It records your preferences for mental health treatment during a future crisis. More on crisis help at Help for your mind.

Signing them

Texas law sets out who may witness. The Medical Power of Attorney form itself states that it isn't valid unless you sign it before a notary, or in front of two competent adult witnesses, and that certain people can't serve as one of the witnesses, including the agent you're naming, a relative, anyone who'd inherit from you, and your doctor or their staff. Read the instructions printed on each form before signing.

The Out-of-Hospital DNR has its own rules. The state's instructions say that two witnesses or a notary must sign, that one of the witnesses must be a person who is not a health care provider or facility employee involved in the patient's care, and that the second can be any competent adult. To have it honored, EMS needs to see the original form, a copy of the completed form, or an approved Texas DNR bracelet or necklace. Keep one where a stranger in your home could find it.

Baytown's Official Notary Public Service, 1300 Rollingbrook Dr, Suite 406, is listed as a notary. Ask any notary whether there is a fee and what identification to bring. If you want a lawyer's help with the paperwork around the forms, Pinney Law Firm, 503 Ward Rd, is a Baytown firm listed for wills, trusts and probate, open weekdays 8 a.m. to 5 p.m.

After signing

• Give copies to your agent, your doctor, and anyone likely to be called in an emergency.
• Keep the original somewhere findable, not in a safe-deposit box nobody can open on a Sunday. The National Institute on Aging's advice is to put important papers in one place, and to make sure someone you trust knows where to find them in an emergency.
• Look at it again after any big change: a diagnosis, a death, a divorce, a move.
• If you're on Medicare, the yearly wellness visit includes an offer to talk about advance directives. It's a good time to bring the form. See Finding a doctor.

Choosing your agent

Choose someone you trust to carry out your wishes even when others disagree, who can handle hard conversations with family and doctors, and who would be reachable when needed. Ask them first. It's a lot to carry. If you are the one being asked, see When you're taking care of someone.

The NIA suggests questions to ask yourself: Do I trust this person with my life? Am I comfortable talking with them about my wishes? Will they honor my wishes when the time comes? Can they handle conflicting opinions from family, friends and providers? Do they live near me, or would they travel to be with me? It also suggests talking with more than one person about your wishes before you decide, and then talking with your agent at least once a year.

Palliative care and hospice aren't the same thing

Families often meet these words at the worst moment. Here is the difference, as the National Institute on Aging and Medicare describe it. - Palliative care focuses on quality of life for people with a serious illness, and for the people caring for them. It can start at diagnosis and go on alongside treatment meant to cure. - Hospice is comfort-focused care for someone approaching the end of life, when treatment aimed at a cure has stopped. Medicare covers hospice when two doctors certify a life expectancy of six months or less if the illness runs its normal course, and the patient chooses comfort care. People can stay in hospice longer if a doctor recertifies them.

Asking about palliative care doesn't mean giving up. Many families wish they'd asked sooner.

Baytown has several hospice providers listed. Harbor Hospice is at 1600 James Bowie Dr, Ascend Hospice Care is at 606 Rollingbrook Dr, Suite 2G, with weekday hours of 8:30 a.m. to 4:30 p.m., and Faith Community Hospice Llc is at 4721 Garth Rd, open weekdays 8 a.m. to 5 p.m. Serenity Care Solutions, Llc., in Highlands at 607 E Wallisville Rd, lists hospice and palliative care along with home health, in English, Spanish and Arabic. We don't rate them. Ask each which insurance it works with, and whether it is Medicare-certified, before you choose.

Before you go

• Talk with the person you would name as your agent before you put their name on a form, and ask whether they are willing.
• Print the state forms and read the witness rules on each one, since the medical power of attorney and the out-of-hospital DNR do not have the same requirements.
• Decide whether you will sign before a notary or two eligible witnesses, and line them up before the day you sit down to sign.
• Give copies to your agent and your doctor, and tell the family where the original is.
• Set a date each year to read it over and confirm it still says what you mean.

Sources

Texas HHS, advance directive forms; Texas Department of State Health Services, Out-of-Hospital DNR instructions; Texas Health and Safety Code chapter 166; NIA, advance care planning, choosing a health care proxy and getting your affairs in order; MedlinePlus, advance directives; NIA, "What are palliative care and hospice care?"; Medicare.gov, hospice care and yearly wellness visits.