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Advance Directives: DNRs and medical power of attorney

Advance Directives are documents used to help a person express their wishes about medical care. There are two other kinds of Advance Directives recognized by Texas law Do-Not-Resuscitate Orders (DNR Orders) and Medical Power of Attorney.

A person who executes a DNR Order directs health care professionals acting in an out-of-hospital setting to withhold any medical intervention used to initiate or continue certain life-sustaining treatment.

According to the Texas Attorney General's office, the Out-of-Hospital DNR is used most commonly when a person has a life-threatening or terminal illness and does not want assistance from a 911 emergency response. A person who has executed a valid Out-of-Hospital DNR Order can wear a DNR identification device around the neck or wrist (most people wear a DNR bracelet). The presence of a DNR identification device is conclusive evidence that the person has executed a valid Out-of-Hospital DNR Order.

People who have serious health problems and do not wish to be resuscitated in the event of an emergency should give consideration to creating the Out-of-Hospital DNR Order.

Texas law also recognizes medical power of attorney, which is a kind of Advance Directive used to help a person express their wishes about medical care. The medical power of attorney allows a person to name someone to make medical decisions in the event that the person is unable to make these decisions for themselves. A medical power of attorney is especially important if a medical or health problem arises that was not anticipated or addressed in a living will.

The person selected to be the medical power of attorney is called the agent. The agent is given the authority to make any and all health care decisions on behalf of the incompetent person that the agent believes the person would have made if competent. A physician is required to follow the agent's instructions. The agent must know what the wishes are of the person entering into the medical power of attorney and must be ready to act on these wishes.

That's a lot of responsibility, so someone who considers acting as an agent should be prepared to make tough decisions. For example, the person creating the medical power of attorney may not want to be placed on life support. Knowing this information, the agent would be charged with making the final decision to withhold life support. In this example, anyone who is not comfortable making the decision to withhold life-sustaining treatment should not be an agent. A person who does act as an agent will not be subject to criminal or civil liability as long as their decisions are made in good faith.

The DNR Order and Medical Power of Attorney can be created for free or for a very nominal fee. If someone changes their mind, the DNR Order and Medical Power of Attorney can be revoked or overridden if the person is still competent to do so. More information about Texas advance directives is available from the Texas Department of Health and the Texas Attorney General.

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