Now Serving- Collin, Cooke, Denton, Fannin, Grayson, Hunt, Rockwall, Tarrant  and Wise Counties

Advance Directives

Purpose:

To ensure the Agency’s implementation of the provisions of the Advance Directives Act, Health and Safety Code, Chapter 166.

Policy:

  1. The Agency will honor the client’s wishes related to his/her advance directive, if made known to the Agency, unless the Agency is incapable of providing the requested procedures at the level of intensity required by the client’s condition.
  2. If at any time the Agency is unable to honor an advance directive elected by the client, s/he will be notified and if the client’s representative requests, s/he will be transferred to another appropriate agency/organization s/he chooses. The advance directive will remain in effect unless revoked by the client or his/her representative.
  3. The Agency will not discriminate against the client or withhold care based on whether or not s/he has an advance directive.
  4. The Agency complies with applicable Federal conscience and anti-discrimination laws prohibiting exclusion, adverse treatment, coercion, or other discrimination against individuals or entities on the basis of their religious beliefs or moral convictions as found in the Department of Health and Human Services, Office for Civil Rights, Rule 45 CFR, Part 88, Protecting Statutory Conscience Rights in Health Care, effective May 2019.
  5. Life sustaining procedures the Agency is unable and/or unwilling to withhold in accordance with a client’s advance directive and/or as discussed with the client or his/her representative, family, physician, and/or the Agency’s governing body are:
    1. Artificial nutrition;
    2. Artificial hydration;
    3. Mechanical breathing machines such as for oxygen, a ventilator,;
    4. Total parenteral nutrition;
    5. Blood transfusions;
    6. Life sustaining medications regardless of the route(s);
    7. Dialysis;
      1. The Agency will not withdraw follow-up support services such as assessments and coordination of care because the client is at the end of his/her life.
    8. Any other methods recognized as artificial life support; and
    9. Surgical procedures as discussed on an individual basis with the client or his/her representative, family, physician, and/or the Agency’s governing body.
  6. The Agency provides personal assistance services; accordingly, its employees do not administer cardiopulmonary resuscitation (CPR).
  7. The Agency does not participate in the withdrawal of life sustaining

Definitions per the Health and Safety Code Chapter 166:

  1. Advance directive: an instruction made to administer, withhold, or withdraw life-sustaining treatment in the event of a terminal or irreversible condition, an out-of-hospital do not resuscitate (OOHDNR) order, or a medical power of attorney.
  2. Artificially administered nutrition and hydration: provision of nutrients or fluids by a tube inserted in a vein, under the skin in the subcutaneous tissues, or in the gastrointestinal
  3. Attending physician: a physician selected by, or assigned to, a client who has the primary responsibility for his/her treatment and care.
  4. Cardiopulmonary resuscitation (CPR): any medical intervention used to restore circulatory or respiratory function that has ceased.
  5. Competent: possessing the ability, based on reasonable medical judgment, to understand and appreciate the nature and consequences of a treatment decision, including the significant benefits and harms of, and reasonable alternatives to, a proposed treatment decision.
  6. Declarant: a person who has executed or issued a
  7. Digital signature: an electronic identifier intended by the person using it to have the same force and effect as the use of a manual signature. For an advance directive in which a signature by a declarant, witness, or notary public is required or used, the declarant, witness, or notary public may sign the directive or a written revocation of the directive using a digital signature that:
    1. Uses an algorithm approved by the department;
    2. Is unique to the person using it;
    3. Is capable of verification;
    4. Is under the sole control of the person using it;
    5. Is linked to data in a manner that invalidates the digital signature if the data is changed;
    6. Persists with the document and not by association in separate files; and
    7. Is bound to a digital
  8. Electronic signature: a facsimile, scan, uploaded image, computer-generated image, or other electronic representation of a manual signature that is intended by the person using it to have the same force and effect of law as a manual signature. For an advance directive in which a signature by a declarant, witness, or notary public is required or used, the declarant, witness, or notary public may sign the directive or a written revocation of the directive using an electronic signature that:
    1. Is capable of verification;
    2. Is under the sole control of the person using it;
    3. Is linked to data in a manner that invalidates the electronic signature if the data is changed; and
    4. Persists with the document and not by association in separate
  1. Ethics committee: a committee appointed ad hoc to conduct a specific investigation or established under state or federal law or rule or under the bylaws or rules of the organization or institution.
  2. Health care or treatment decision: consent, refusal to consent, or withdrawal of consent to health care, treatment, service, or a procedure to maintain, diagnose, or treat an individual’s physical or mental condition, including such a decision on behalf of a minor.
  3. Incompetent: lacking the ability, based on reasonable medical judgment, to understand and appreciate the nature and consequences of a treatment decision, including the significant benefits and harms of, and reasonable alternatives to, a proposed treatment decision.
  4. Irreversible condition: condition, injury or illness that may be treated but is never cured or eliminated that leaves a person unable to care for or make decisions for his/her own self and that, without life sustaining treatment, is fatal.
  5. Life sustaining treatment: treatment that, based on reasonable medical judgment, sustains life of a client and without which the client will die. The term includes both life-sustaining medication and artificial life support such as mechanical breathing machines, kidney dialysis treatment, and artificially administered nutrition and hydration. It does not include the administration of pain management medication or the performance of a medical procedure considered to be necessary to provide comfort care, or any other medical care provided to alleviate a patient’s pain.
  6. Medical Power of Attorney: a document delegating to an agent the authority to make health care decisions executed by the client.
  7. Physician: a physician licensed by the Texas Medical Board or a properly credentialed physician who holds a commission in the uniformed services of the United States and who is serving on active duty in this state.
  8. Terminal Condition: 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 provided in accordance with the prevailing standard of medical care.
  9. Witness: a person who may serve as a witness to the execution of an advance directive or the issuance of a non-written advance directive as follows per Section 166.003:
    1. Each witness must be a competent
      1. The Agency’s staff may be a witness to the client’s execution of an advance
    2. At least one of the witnesses must be a person who is not:
      1. A person designated by the declarant to make a health care or treatment decision;
      2. A person related to the declarant by blood or marriage;
      3. A person entitled to any part of the declarant’s estate after the declarant’s death under a will or codicil executed by the declarant or by operation of law;
      4. The attending physician;
      5. An employee of the attending physician;