Medical power of attorney or Living Will: which document speaks when?

A Texas medical power of attorney names the person who may make health-care decisions when the principal cannot. A Directive to Physicians, commonly called a Living Will, states the principal’s treatment instructions for a terminal or irreversible condition. One answers who decides. The other answers what treatment the patient wants in a defined medical setting.

Many people sign one and assume they signed both. That leaves a gap at the worst time: a physician needs a decision, but the family cannot tell whether it has authority, instructions, or only access to information.

The medical power of attorney names the decision-maker

Under Texas Health and Safety Code Section 166.152, the agent may make health-care decisions after the attending physician certifies in writing and files in the medical record that the principal lacks competence. Signing the document does not ordinarily remove the principal from decisions while the principal can decide.

The agent’s authority is broad within health care, but it is not unlimited. The agent must act according to the principal’s wishes, including known religious and moral beliefs. The document may restrict the agent’s authority. Chapter 166 also limits particular decisions and preserves the principal’s ability to revoke the appointment or object to treatment.

The agent does not receive financial authority from the medical document. Paying bills, handling insurance proceeds, managing an account, or signing a property document may require the separate authority discussed in the Texas durable power of attorney article.

The Living Will states treatment instructions

The Texas Directive to Physicians and Family or Surrogates addresses treatment when the patient has a terminal or irreversible condition and cannot make or communicate a decision. The statutory form allows a person to state whether life-sustaining treatment should be used or withheld in those circumstances and to add other directions.

The directive does not appoint a general health-care agent. It gives the medical team and the people involved evidence of the patient’s decision. It also does not operate as a universal refusal of treatment. Its defined conditions and the language selected in the document matter.

A person can want aggressive treatment for a reversible illness and still decline burdensome treatment in a terminal condition. That distinction is one reason the document is more useful when the signer understands the medical events it addresses instead of treating it as an all-purpose “do not treat” form.

The two documents should tell one consistent story

Consider the sequence. A patient cannot communicate. The physician determines the medical condition and documents the capacity finding required for an agent to act. The agent then applies the patient’s instructions and known wishes to the decision that remains.

If the directive is clear and applies, it supplies the patient’s instruction. If the situation falls outside it, the medical agent may have to exercise judgment. The agent should know what outcomes, burdens, faith commitments, comfort measures, and family considerations matter to the principal. A name on a form is authority. A conversation supplies direction.

Successors matter as well. The first agent may be unavailable, estranged, ill, or unwilling to act. A current plan identifies the next person and gives each named person access to the document when it is needed. The public explanation of estate-plan maintenance identifies the life events that should trigger a review.

Information access is a separate question

HIPAA does not create a health-care decision-maker. Federal regulations generally require a covered entity to treat a personal representative as the individual to the extent applicable law gives that person authority over health-care decisions. The representative’s access therefore tracks the scope and current status of the legal authority.

A HIPAA authorization can permit disclosure to another person without giving that person authority to consent to treatment. This can be useful before incapacity, when a parent, adult child, or trusted friend needs information but the patient remains the decision-maker. The authorization must contain the elements federal law requires and may be limited by record type, recipient, purpose, and expiration.

Special confidentiality rules and the federal abuse or endangerment exception can also affect access. No planning document should be described as a promise that every provider will release every record in every circumstance.

Primary sources and legal boundary

Reviewed August 19, 2026. Primary state and federal sources:

This article is general information. It cannot determine competence, whether a directive applies to a patient’s current condition, an agent’s authority, or a provider’s duties concerning a particular record or treatment. Reading it does not create an attorney-client relationship.

Make the authority and the instructions meet

Confirm that the plan names a willing medical agent and successors, states treatment wishes in the correct document, addresses information access, and gives the right people usable copies. Then have the conversation that explains what the words mean to the person signing them.

If family conflict, unusual treatment wishes, religious directions, or a complex capacity issue makes the documents difficult to coordinate, those facts call for document-specific review rather than another blank form.

Request an Appointment