Texas Advance Directive and Living Will: Forms, Rules, and How to Complete Yours
The free official Texas form, the witness and notary rules, the two condition questions inside the Directive to Physicians, and the statutory traps to know before you sign.
In Texas, the living will is officially called the Directive to Physicians and Family or Surrogates, and the statutory form appears in Texas Health & Safety Code section 166.033. You sign it before two competent adult witnesses, at least one of them independent, or before a notary public instead. Texas HHSC publishes free official versions, and no state registry exists.
That paragraph answers the search query. The rest of this guide covers what Texas law quietly decides for you: who is barred from witnessing, why the form asks two end-of-life questions, what a hospital can do under the dispute-resolution process, and the pregnancy rule. Still deciding which documents you need at all? Start with our overview of advance care planning, then come back for the Texas specifics.
In this guide:
Texas advance directive: the fact box
What the Directive to Physicians is
How to complete it, step by step
Gotcha 1: electronic signing
Gotcha 2: terminal vs irreversible condition
Gotcha 3: the 166.046 dispute process
Gotcha 4: the pregnancy exclusion
Living will vs advance directive vs Medical Power of Attorney
What to do after signing
Where the directive fits in a complete plan
Frequently asked questions
Texas advance directive: the fact box
Item | Texas rule |
|---|---|
Form name | Directive to Physicians and Family or Surrogates (Texas HHS labels it a Living Will for consumers). A separate Medical Power of Attorney form names your agent. |
Statute | Texas Health & Safety Code chapter 166 (Texas Advance Directives Act): execution 166.032, form 166.033, witnesses 166.003; Medical Power of Attorney 166.151 to 166.166. |
Witnesses | Two competent adults. At least one must be qualified under 166.003(2): not your agent, a relative, an heir, your attending physician or their employee, and with no claim against your estate. The second can be anyone, including family. |
Notary | Optional alternative to witnesses: sign and have your signature acknowledged before a notary public (166.032(b-1); 166.154(b) for the Medical Power of Attorney). |
Registry | None. Chapter 166 creates no state registry, and Texas HHS does not operate one. |
Where to keep it | Original with your important papers. Copies to your physician for your medical record, your agent, close family, and the hospital on admission. |
What the Directive to Physicians is (and why the statute never says living will)
Texas Health & Safety Code chapter 166, the Texas Advance Directives Act, never uses the phrase living will. The statutory instrument is the written directive, formally the Directive to Physicians and Family or Surrogates. Texas HHS bridges the vocabulary gap by labelling its free form Directive to Physicians and Family or Surrogates (Living Will), so if you searched for a Texas living will and landed on the HHS page, you are in the right place.
The name is longer than most states' because it describes what the document does. It tells your physicians which life-sustaining treatment you do and do not want if you cannot speak for yourself, and it gives your family or surrogates written proof of what you decided while you could still decide. That second audience matters: in a crisis it is usually the family, not the doctor, who needs convincing.
The form is free. Texas HHSC publishes official versions, section 166.033 sets out the wording, and you need no lawyer, no filing fee, and no government submission. Our living will template guide covers what a good form contains and why the free statutory version usually beats a paid one.
How to complete your Texas directive, step by step
Get the official form. Download the Directive to Physicians and Family or Surrogates from Texas HHS. It is free and matches the statutory language in section 166.033. Print it, or keep it digital: Texas allows electronic signing.
Answer the two condition questions. The form asks what you want in a terminal condition and, separately, in an irreversible condition. Different legal categories, different stakes, explained below. Read both definitions before ticking anything.
Add any personal instructions. If specific treatments, faith commitments, or scenarios matter to you, write them in; doctors and families follow specific instructions far more easily than bare checkboxes.
Choose your execution route: witnesses or notary. Sign before two competent adult witnesses, or sign and have your signature acknowledged before a notary public under 166.032(b-1). Either route alone is enough.
If you use witnesses, qualify at least one of them. This is where Texas directives most often go wrong; the rules are just below.
Pair the directive with a Medical Power of Attorney. The directive states your wishes; the Medical Power of Attorney (statutory form at 166.164) names the person who speaks for you when the document cannot cover the situation. Complete both.
Who can witness, and who cannot
Texas requires two competent adult witnesses, and at least one of them must be a qualified witness under section 166.003(2). That first witness must not be any of the following:
the person you designated to make health care decisions for you (your agent)
anyone related to you by blood or marriage
anyone entitled to any part of your estate
your attending physician, or an employee of your attending physician
an employee of the health care facility caring for you, if that employee provides your direct patient care or serves as an officer, director, partner, or business-office employee of the facility
anyone with a claim against your estate
The second witness can be any competent adult, including family. The clean solution: a neighbour, colleague, or friend who is not in your will as witness one, anyone you like as witness two. If assembling that pair is awkward, use the notary route instead; it is equally valid and removes every eligibility question at once.
Choosing your agent for the Medical Power of Attorney
The agent decision is harder than the paperwork. You are choosing the person who will hold the line on your wishes, possibly against pressure from other relatives. Pick someone who knows what you actually want, can say no in a hospital corridor, and will be reachable when the moment comes. Name an alternate. Then do the thing most people skip: tell your agent, in an ordinary conversation, what the document says and why. A directive your agent understands is protection; one they have never read is just paper.
Gotcha 1: you can sign the whole thing electronically
Texas is unusually modern here. Under section 166.011, digital and electronic signatures are expressly authorized for the declarant, the witnesses, and the notary. A Texas directive can be completed end to end without a printer, which matters for anyone signing from a hospital bed, coordinating witnesses across cities, or simply keeping their affairs digital.
Two cautions. Electronic execution does not relax any other rule: witness qualifications work the same regardless of ink or pixels. And an electronically signed directive still needs to be findable; a perfect PDF in a folder nobody can open fails at the only moment the document exists for, so treat storage and sharing as part of execution.
Gotcha 2: terminal condition vs irreversible condition
The Texas form makes you decide two scenarios separately, and the difference between them is the single most important thing to understand before you sign.
A terminal condition is an incurable condition from which you are expected to die within six months, even with available life-sustaining treatment. This is the scenario most people picture when they think of a living will: the end is coming, and treatment can only stretch the timeline.
An irreversible condition is broader. It covers conditions you will not recover from, where you cannot care for or decide for yourself, and where treatment does not cure you but can sustain you, sometimes for years. No six-month clock applies, which is exactly why the form asks separately: you may feel very differently about declining treatment when death is months away than when the question is years of sustained dependence.
Read both definitions slowly and answer each on its own merits. People who breeze through this page often discover, or rather their families discover, that they answered a question they never considered.
Gotcha 3: the 166.046 dispute process, when a facility can stop treatment
Texas has a rule that surprises almost everyone: under section 166.046, often called the futile care provision, a hospital can decline to continue life-sustaining treatment the attending physician considers inappropriate, even when the family wants it to continue. The disagreement goes to the facility's ethics committee process; if the committee sides with the physician, the family's remaining option is transfer to another facility. House Bill 3162 substantially amended the process in 2023, setting a 25-day transfer window.
What does this mean for your directive? First, honesty: a Texas directive is powerful, but Texas law does not treat any single document as an absolute trump card in every dispute, in either direction. Second, and more usefully: clear written wishes plus an agent authorized to act on them resolve most conflicts before they ever reach an ethics committee. The families who end up in the 166.046 process are overwhelmingly the ones with nothing in writing.
Gotcha 4: the pregnancy exclusion
Section 166.049 provides that life-sustaining treatment generally cannot be withdrawn or withheld from a pregnant patient, regardless of what your directive says: your documented wishes about declining treatment are effectively suspended for the duration of a pregnancy.
If you could become pregnant, complete the directive anyway. It still governs every other circumstance of your life, and your agent still speaks for you on the many decisions the pregnancy rule does not touch. But go in knowing the limit exists, and if it matters deeply to you, discuss the implications with a Texas attorney.
Living will vs advance directive vs Medical Power of Attorney in Texas
Texas vocabulary trips people up because the everyday words and the statutory words do not line up.
Advance directive is the umbrella term, from the Texas Advance Directives Act in chapter 166. When a Texas hospital asks on admission whether you have an advance directive, this umbrella is what they mean.
Living will is the everyday name for the treatment-wishes document. In the statute, that document is the written directive, formally the Directive to Physicians and Family or Surrogates. Texas HHS adds Living Will to the form's title purely so people can find it. If someone tells you Texas has no living will, they are technically right about the words and wrong about the substance.
Medical Power of Attorney is the companion document, with its own statutory form at section 166.164 and execution rules at 166.151 through 166.166. The directive records decisions you have already made; the Medical Power of Attorney appoints a person to make the ones you could not foresee. Complete both; both accept the same notary alternative to witnessing.
One more distinction worth naming while these documents are in front of you. A directive protects your medical wishes. It says nothing about your voice, your stories, or the way you think, and no paperwork in this guide preserves any of that. Protecting your wishes and preserving who you are turn out to be two separate acts; a digital legacy app exists for the second one.
What to do after signing
Texas has no registry for advance directives: chapter 166 does not create one and Texas HHS does not operate one, so distribution is entirely on you. A directive nobody can find has the same effect as no directive at all.
Keep the original with your important papers, and make sure your agent and at least one family member know exactly where.
Give a copy to your physician and ask for it to be placed in your medical record.
Give copies to your agent and alternates, along with the conversation that makes the paper meaningful.
Bring a copy on hospital admission. Texas facilities ask; having the document beats describing it from memory.
Store a digital copy somewhere your family can reach without your passwords. Texas's acceptance of electronic signatures makes a well-organised digital original a valid option, not a mere backup.
Review it after big life changes: a new diagnosis, a marriage, a divorce, or the death of your named agent.
The directive governs medical decisions while you are alive. Your property runs through a different system with its own Texas quirks: see probate in Texas and dying without a will in Texas.
Where the directive fits in a complete plan
Think of a complete Texas plan as four documents and one conversation. The Directive to Physicians records your treatment wishes. The Medical Power of Attorney appoints your medical voice. A will, increasingly a digital will covering online accounts alongside physical assets, handles property. And the conversation with your agent and family turns the paper into something people can act on under pressure.
While you are putting things in order, spend a little of the same energy on what the forms cannot hold. Nothing in the directive captures your voice reading a story, the advice you would give at a wedding you might miss, or the particular way you explain things. With Afterlife AI™ you can build a Persona from your memories, voice, and stories while you are well, alongside the legal work rather than instead of it. Start free: 50 memories, no card.
Frequently asked questions
Does Texas require a notary for a living will?
No, a notary is optional. You can execute the Directive to Physicians before two competent adult witnesses (at least one qualified under Health & Safety Code 166.003(2)) or, under 166.032(b-1), by having your signature acknowledged before a notary public instead. The Medical Power of Attorney offers the same choice under 166.154(b).
Is a living will the same as an advance directive in Texas?
Nearly, but the words differ. Advance directive is the umbrella term from the Texas Advance Directives Act (Health & Safety Code chapter 166). The document people call a living will is, in the statute, the written directive, formally the Directive to Physicians and Family or Surrogates. The statute never uses the phrase living will; Texas HHS adds it to the form title so consumers can find the document.
How many witnesses does a Texas advance directive need?
Two competent adult witnesses, unless you use the notary alternative. At least one witness must qualify under 166.003(2): not your designated agent, not a relative by blood or marriage, not an heir, not your attending physician or that physician's employee, not certain employees of the facility caring for you, and not anyone with a claim against your estate. The second witness can be any competent adult, including family.
Can I sign my Texas advance directive electronically?
Yes. Section 166.011 of the Health & Safety Code expressly authorizes digital and electronic signatures for the declarant, the witnesses, and the notary, so a Texas directive can be validly completed without printing anything. All other rules still apply, including the witness qualifications.
Does Texas have a living will registry?
No. Chapter 166 creates no state registry and Texas HHS does not operate one. Keep the original with your important papers, have a copy placed in your medical record, give copies to your agent and family, and bring one on hospital admission.
What is the difference between a terminal condition and an irreversible condition on the Texas form?
A terminal condition is an incurable condition from which you are expected to die within six months even with treatment. An irreversible condition has no six-month clock: you will not recover, you cannot care for or decide for yourself, and treatment can sustain you, potentially for years, without curing you. The Texas directive asks for your choices separately for each, so read both definitions and answer each on its own.
Can a Texas hospital stop life support against my family's wishes?
In limited circumstances, yes. Under section 166.046, a facility can decline to continue life-sustaining treatment the attending physician considers inappropriate, after an ethics committee process. HB 3162 substantially amended the law in 2023, setting a 25-day window for the family to arrange transfer to another facility. Clear written wishes and an agent are the best tools for staying out of this process.
Does my Texas living will apply if I am pregnant?
Not fully. Under section 166.049, life-sustaining treatment generally cannot be withdrawn or withheld from a pregnant patient, regardless of what the directive says. The document still governs every other situation and your agent still acts for you on decisions the pregnancy rule does not reach, so it remains worth completing. If this limit concerns you, discuss it with a Texas attorney.
Sources
Texas Health & Safety Code chapter 166 (Texas Advance Directives Act), full text
Texas HHS: Directive to Physicians and Family or Surrogates (Living Will), official form page
This guide is general information, not legal advice. Laws change. For advice about your situation, consult a licensed attorney in Texas.