• Ruth-Ann E. Toups

Understanding Your Advance Directive

In my experience, one of the least understood estate planning documents is an advance directive to physicians. This might be because the advance directive can also be known by another name, a living will. I find that it is often confused with yet another document, a do not resuscitate (DNR). The two documents are very different.


An advance directive (also known as an advance directive to physicians) (also known as a living will) is a document that allows you to indicate your treatment preferences if you are ever in a very specific medical state. For an advance directive to come into play in Texas two physicians must conclude that you have an irreversible or terminal condition. The advance directive allows you to indicate what kind of care you would want at that point.

Think of your advance directive like a stop light. You pull up to the stop light when two doctors conclude your condition is irreversible or terminal. Your advance directive tells your loved ones if you want to stop on red, move forward with caution on yellow, or go without hesitation on green. Red means you want all care ceased, including ventilators, respirators, IV antibiotics, feeds tubes, etc. Yellow means you want some care, perhaps feeding tubes or IV antibiotics, but you would not want to be on a ventilator or respirator. Green means you want it all, anything and everything to keep you alive no matter the diagnosis.


A do not resuscitate or DNR is a different document entirely. A DNR indicates that you would not want to be revived using CPR or other means and you would like to pass naturally if you go into cardiac arrest. This is an end of life document and should only be signed by individuals after serious thought and consideration. It is also important to note that there are two DNRs: an in hospital and an out of hospital. If you sign a DNR in the hospital and return home or to another facility you will need to sign a new DNR, and vice versa. A DNR is not included in your advance directive.


Advance directives can be put in place by anyone over the age of 18 who knows that in that specific scenario the kind of treatment or care they would want to receive. Putting your advance directive in place removes, from your loved ones, the heavy burden of deciding what treatment honors you best.

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