Clarity is Kindness: Advance Directives Protect Patients, Families

End-of-life care goes beyond the patient; it’s also about the family, the provider and the peace of mind it offers.

Advance directives – an essential piece of end-of-life care – provide necessary guidance and critical clarity during some of life’s most difficult moments. There are four main types of advance directives: directives to physicians and family or surrogates, medical powers of attorney, out-of-hospital do-not-resuscitate orders, and declarations of mental health treatment. Each can be executed depending on a person’s needs and circumstances. Together, these directives provide important support and decision-making authority as individuals and families navigate end-of-life care.

Texas is known for having clear-cut end-of-life care policies, especially when it comes to advance directives. Clear guidelines and standardized advance directive forms remove ambiguity, drastically reduces the risk of misinterpreting a patient’s last wishes, allows bedside clinicians to act in the patient’s best medical interest, and ensures that patients’ voices are heard.

Advance Directives

There are four types of advance directives. You can execute one, or several, depending on your needs and situation.

The most crucial part of addressing advance directives is minimizing the need for interpretation. As Will Holleman, Vice President, Advocacy & Public Policy at THA, puts it, “Clarity is kindness.”

“The clearer the instructions, the easier it is for medical providers to ensure the right level of care is provided,” he said. “When it comes to resuscitation wishes, you don’t want there to be lingering questions. Providers want to be able to serve their patients’ and families’ wishes without uncertainty or confusion.”

THA has spent the better part of the last decade – in collaboration with a diverse and wide-reaching group of stakeholders – working to strengthen protections for patients. In 2023, THA and these groups successfully amended the Texas Advance Directives Act (TADA) with House Bill 3162. This legislation made necessary adjustments and clarifications to the statute, affecting the ability of patients or their decision-makers to direct their care in situations where the TADA applies, including decisions or conflicts around the provision of life-sustaining treatment. Quality of life, particularly near the end of life, is deeply personal and ensuring Texas reached a place where all relevant stakeholders felt the law appropriately addressed the needs of patients, caregivers, medical providers, and families was critical.

Representative Stephanie Klick, a leader on this legislation, shared that the process required extensive collaboration and input from across the state.

“I have worked on this issue for a long time. Finalizing this legislation was a massive success,” Rep. Klick said. “We had more than 50 stakeholders in a room for hours, really diving deep to make sure everyone could agree. Bringing together a diverse group of voices was essential. We’ve already seen that these changes are working and helping Texans.”

Getting this legislation across the finish line was a welcome relief for THA and all its members. Our goal was to ensure clear, concise timelines for when documents and information must be completed and shared, along with resources within hospitals to support patients and families navigating these difficult circumstances.

“I serve as the medical power of attorney for several people. Every year, we review their documents over lunch to make sure they still reflect their wishes,” Rep. Klick said. “It’s incredibly important to keep these documents up to date. Completing advance directives early and revisiting them regularly helps ensure that people’s preferences are honored when it matters most.”

Advance directives are used at all stages of life, particularly in cases involving palliative care, chronic illness and serious, debilitating medical conditions. There is never a bad time to start the conversation – and the earlier, the better.

When handling advance directives, it is best practice to have all necessary paperwork completed and accessible, both in person and virtually, so the appropriate documents are available when needed most.

As we prepare for the 90th legislative session and reflect on our past work, it’s important to put patients and their families first when providing this necessary care. THA will continue to champion efforts to ensure these important voices are heard.