Perhaps the most difficult questions our clients grapple with are those related to end of life decisions.  Does your family know your wishes?  Clients sometimes joke that if you don’t talk about it, it won’t happen!  It may be sad, but the old saying seems true – nothing is certain except death and taxes.

Your Living Will, Advanced Directive, Pull the Plug Document, Directive to Physicians and Family — the document by many names!

In Texas, the law allows us to prepare what’s most commonly referred to as a “Living Will” to designate your end-of-life preferences.  This document may also be called your “Advanced Directive” or your “Pull the Plug Document.”  Legally, this document is called a “Directive to Physicians and Family,” and it allows you to make choices regarding “pulling the plug” in two different situations:

First, this document comes into effect if you are diagnosed with a “terminal” condition. A “terminal” condition is defined as “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…”  The example we usually give our clients of a “terminal” condition is the end stages of cancer or even a traumatic accident such as a car crash.

Second, this document comes into effect if you are diagnosed with an “irreversible” condition.  An “irreversible” condition is defined as “a condition, injury or illness that (1) may be treated but is never cured or eliminated; (2) leaves a person unable to care for or make decisions for the person’s own self; and (3) without life-sustaining treatment provided in accordance with the prevailing standard of medical care, is fatal.”  The examples we give for this range from a diagnosis of a Alzheimer’s, ALS or even organ failure.  It may be significant to you to know that what is “irreversible” may become “terminal” depending on the stage or severity of the illness or condition.

As you can probably imagine, medicine is not always black-and-white – the gray area surrounding treatment options, medical opinions and (sometimes) the diagnosis given by different doctors can lead to a great deal of confusion and anxiety for patients and their families.  The Directive to Physicians and Family is created to alleviate some of that anxiety because you are able to tell your family and doctors what you prefer, and guide them in their course of action.

Directive to Physicians and Family vs. DNR

It’s important to remember that the Directive to Physicians and Family is not the same thing as a “Do Not Resuscitate” or “DNR.”

The Directive to Physicians and Family is for in-hospital situations to tell your doctors to stop treatment if they have determined there is nothing more they can do for you.  The out-of-hospital DNR is used by clients whose illness or condition is so severe, they do not want to be resuscitated if they pass away for any reason.  A DNR is a document that should only be signed with the consent and supervision of a physician.  In the appropriate circumstances, a DNR can help prevent a painful and prolonged existence by giving your family, physicians or emergency medical providers authority to allow you to pass away peacefully.

Both the Directive to Physicians and Family and the DNR provide guidance for your family when you can no longer communicate these thoughts or decisions yourself.  However, we strongly encourage our clients to discuss their wishes with their family members before an emergency happens to avoid confusion, anxiety and arguments.