Life Care Planning: Medical care planning makes for difficult decisions

Sandra W. Reed
Special to the Reporter

Nadine signed a Medical Power of Attorney naming her husband, Dave, to make medical decisions for her if she became incapacitated. She was conflicted about signing a Medical Directive. She had witnessed an aunt being kept alive for years in a vegetative state and she didn’t want that.

Sandra Reed

On the other hand, a cousin had recovered after being in a coma for several months following an accident. If the cousin had been taken off of life support, he wouldn’t be living today.

What is a medical directive?

A Medical Directive instructs physicians and family what health care an individual wants under certain conditions.  An acceptable form is provided in Texas Health and Safety Code §166.033, However, an individual can choose to include provisions other than those in the form.

Patient suffering from a terminal or irreversible condition

Among the choices available in the Texas Medical Directive are for treatment if the patient is suffering from a terminal condition from which the patient is expected to die within six months or from an irreversible condition, is not able to care for or make decisions for himself or herself and is expected to die without life-sustaining treatment.

The directive defines “terminal condition” 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 provided in accordance with the prevailing standard of medical care.”

An “irreversible condition” is “a condition or illness that may be treated, but is never cured or eliminated, that leaves a person unable to care for or make decisions for the person’s own self and that, without life-sustaining treatment provided in accordance with the prevailing standard of medical care, is fatal.”

The signatory can choose to have withheld all treatments, other than those needed to maintain comfort or to be kept alive in this terminal condition using available life-sustaining treatment.

Nadine’s physician pointed out that “life-sustaining treatment” includes life-sustaining medications and artificial life support, such as mechanical breathing machines, kidney dialysis treatment, and artificial hydration and nutrition but does not include administration of pain management medication, performance of a medical procedure or care to provide comfort or to alleviate pain.

Nadine’s doctor mentioned examples of “irreversible conditions” as advanced stages of dementia, diabetes, kidney disease, neurologic conditions, end stage cancer and brain death. He also suggested that Nadine read an article titled “Advanced Care Planning: Medical Issues to Consider” by Cheryl Arenella, MD, MDH, at

Medical care planning decisions are difficult

Clearly, making advance decisions about desired medical treatment is not easy. Advancements in medical treatment or other factors may cause individuals to change their minds about a prior decision. Fortunately, a Medical Directive can be revoked at any time, as long as the maker is mentally competent.

Sandra W. Reed practices Elder Law in Somervell County, which includes handling probating of estates, drafting of wills, trusts, powers of attorney and deeds as well as estate and Medicaid planning.  She lives on beautiful Chalk Mountain and can be reached at 254.797.0211; 817.946.2809 or at