Tex. Health & Safety Code ch. 166 · Texas
Texas: how to sign your advance directive
Texas does not have an advance directive. It has four instruments, in one chapter, and they do different jobs.
Why WearableDocs
In Texas, a signed directive in a drawer is not enough
The statute makes delivery — or getting the document into the medical record — part of what switches the directive on. A relative who might know which drawer is not a plan. WearableDocs stores the document you signed and puts it on a page that opens when someone scans your card, so the person who needs it can build the record while there is still time.
You answer a few questions — your name, your state, and what you refuse — and WearableDocs builds the directive. Print it, sign it, upload it. Changing your answers later is part of the plan, so nothing is locked in.
What Texas asks
What you need to sign in Texas
- Instruments
- Four — directive (may name a proxy) · medical power of attorney · out-of-hospital DNR · facility DNR
- Form
- Directive illustrative; medical power of attorney mandatory
- Execution
- Two witnesses OR a notary, for all instruments. The DNR order also requires a physician's signature
- May not witness
- Only one of the two witnesses must be free of disqualification — not related to you, not an heir, not your agent, not a provider's employee. The other may be any of those
- May not be your agent
- A health care provider; a provider's employee unless related to you; a residential care provider or its employee unless related
- Copy rule
- DNR order only — a "photocopy or other complete facsimile" is covered. No copy-equivalence provision for the directive
- Delivery
- No precondition for the directive — but a delivery condition for the medical power of attorney. §166.152(g): the MPOA "is effective indefinitely on execution as provided by this subchapter and delivery of the document to the agent". The recipient is the agent, not a clinician, so this is the one Texas condition a card worn by the principal does not answer
- Who decides
- One determination
- Standard determined
- Condition, not capacity — terminal or irreversible
- Registry
- None
- Age
- 18
- Pregnancy
- **Yes — the directive *"has no effect if I have been diagnosed as pregnant."***
- Revocation
- Divorce revokes the agent designation
- Oral instructions
- Nonwritten directives are recognized for certified patients only
- Provider may not require
- §166.036 — a provider may not require notarisation, may not require the provider's own form, and may not make a directive a condition of care
- Carried device
- Yes — for the DNR order. "Conclusive evidence" (§166.090(b)). Nothing for the directive
- Citation
- Tex. Health & Safety Code ch. 166
Read from the enacted statute, 2026-09-18.
The instrument
What Texas actually recognizes
A directive — what most people mean — carries your instructions and may name a proxy. A medical power of attorney appoints your agent, and unlike the directive its form is mandatory: Texas prescribes it and you use it. An out-of-hospital DNR order keeps EMS from resuscitating you outside a hospital, and it needs a physician's signature. A facility DNR does the same inside one.
The chapter also does something almost no other state does. Texas gives a carried device legal force — not for the directive, for the DNR order:
A DNR identification device is "conclusive evidence" of the order, and responders "shall honor the DNR identification device as if a valid out-of-hospital DNR order form … were found in the possession of the person." (§166.090(b))
That is the strongest carried-device language in the fifty-one. It reaches the DNR order, not the directive. No Texas statute gives a carried advance directive any force at all.
What the popular guides get wrong
Corrections for Texas
"Witnesses can't be related to you." Texas is more permissive than the guides say. Only one of the two witnesses must be free of the disqualifications — the other may be a relative, an heir, your agent, or a provider's employee. A Texan who was told to find two unrelated witnesses was given a harder job than the statute requires.
"The 10-day rule." Widely repeated, including in hospital literature. The period is 25 days (§166.046(e)).
"Your agent can't consent to sterilisation." Sterilisation does not appear in §166.152(f), the list of an agent's limits. The claim is repeated often enough to look authoritative; it is not in the text.
Carried on you
What a WearableDocs card does in Texas
Texas is the best carried-device state in the country, and it is important to be exact about why.
A DNR identification device is conclusive evidence of a DNR order. That is not a suggestion or a safe-harbour — "conclusive" is the statute's word, and responders must honour the device as though the order itself were in the patient's possession. If a Texan is carrying a valid DNR device, EMS does not get to weigh it.
That force belongs to the DNR order. Your advance directive — the document that names your agent and states your instructions — has no carried-device provision in ch. 166. Wearing it does nothing a statute recognizes.
So Texas splits cleanly, and the page says so: the directive still has to reach the decision-maker to do its work, and the card is how it gets there. The DNR order is the one instrument in Texas where carrying it is the mechanism.
If you have a Texas out-of-hospital DNR, the device is not a convenience. It is the thing that makes the order operate in the field.