Living Will vs Health Care Proxy: Key Differences You Should Know

When you’re thinking about future medical care, it’s important to consider who will speak for you if you can’t speak for yourself. That’s where legal documents like a living will and a health care proxy come into play. While both serve to protect your wishes in case of serious illness or incapacity, they do so in different ways. Knowing the distinctions between the two can help ensure that your healthcare preferences are clearly understood and followed.

If you’re planning for long-term care, dealing with a terminal illness, or just preparing for the unexpected, understanding the role of a living will vs health care proxy is a critical step. Both are part of what’s often referred to as an advance directive. But they don’t work the same way, and they don’t cover the same decisions. Here’s what you need to know.

• Living Will vs Health Care Proxy: The Basics
• Do You Need Both a Living Will and Health Care Proxy?
• How Living Will and Health Care Proxy Works in Texas
• Who Should Be Your Health Care Proxy?
• Can You Override a Living Will or Health Care Proxy?
• Common Misunderstandings About Living Will vs Health Care Proxy
• Where to Store Your Living Will and Health Care Proxy
• What Happens Without These Documents?

Living Will vs Health Care Proxy: The Basics

A living will and a health care proxy are both essential tools in an advance care planning strategy, but they serve distinct roles and operate in different ways depending on your medical condition and legal status at the time of a health crisis.

Living Will

A living will is strictly instructional. It outlines your preferences regarding specific medical treatments, particularly in scenarios where you are diagnosed with a terminal condition or are in a persistent vegetative state and unable to communicate. It typically addresses whether you want to receive or refuse:

• Artificial respiration
• Cardiopulmonary resuscitation (CPR)
• Intravenous fluids or nutrition
• Palliative or comfort care
• Surgical procedures meant solely to prolong life

Activated only under certain medical conditions, it generally takes effect when two physicians agree that you’re permanently unconscious or terminally ill with no chance of recovery. At that point, your healthcare providers must refer to your living will to determine which interventions are consistent with your preferences.

Health Care Proxy

On the other hand, a health care proxy is a person, not a document. Also referred to as a medical power of attorney in Texas, it is a legal appointment of someone you trust to make medical decisions on your behalf when you’re temporarily or permanently unable to do so. This could apply during a wide range of situations—not just end-of-life care—including surgery under general anaesthesia, serious injury, stroke, or mental incapacity due to illness.

Your proxy’s authority is broad unless you place specific limitations on it. For example, your proxy may:

• Authorise or refuse medical tests or procedures
• Choose between treatment options
• Move you to another facility
• Decide when to continue or withdraw treatment

Unlike a living will, a health care proxy is flexible and adaptable. Your proxy can weigh new information, consult with medical professionals, and make real-time decisions, especially in situations your living will doesn’t explicitly address.

While a living will is focused on documenting your treatment preferences in advance, the health care proxy is designed to provide real-time decision-making power. The two are not interchangeable but instead act as complementary safeguards. Your living will can guide your proxy, ensuring decisions align with your values even when not explicitly stated.

Do You Need Both a Living Will and Health Care Proxy?

Yes, it’s often beneficial to have both. Each one covers different scenarios. A living will is limited to situations where the instructions apply—typically terminal conditions or irreversible states of unconsciousness. A health care proxy can make decisions even if your condition isn’t explicitly covered in a living will.

Without a proxy, medical providers must rely solely on the living will or look to next of kin, which can lead to confusion or disagreements. Having both documents gives your agent guidance while ensuring there’s a fallback plan if your situation falls outside the scope of your written instructions.

How Living Will and Health Care Proxy Works in Texas

In Texas, both documents are legally recognised under the Texas Health and Safety Code. The Directive to Physicians and Family or Surrogates functions as the Texas version of a living will. It lets you state your preferences for medical treatment, especially at the end of life.

Meanwhile, the Medical Power of Attorney serves as the state’s format for appointing a health care proxy. It allows you to designate someone to make decisions about any kind of medical treatment, and not just end-of-life care, if you’re incapacitated.

Here are a few Texas-specific rules:

• Both documents must be signed in front of either two witnesses or a notary public.
• The person you appoint as your proxy must be at least 18 years old.
• You cannot appoint your attending physician or an employee of a facility providing your care (unless they’re a relative).

Who Should Be Your Health Care Proxy?

When choosing your proxy, consider someone who:

• Understands your medical values and preferences
• Is capable of staying calm in stressful situations
• Can communicate clearly and assertively with healthcare providers
• Is willing to follow your wishes even if others disagree

It’s a good idea to have a backup proxy as well. If your primary agent is unavailable or unwilling to act, your alternate can step in.

Always have a conversation with your chosen proxy before signing any documents. They need to understand what you’re asking of them and agree to the responsibility.

Can You Override a Living Will or Health Care Proxy?

You always retain the right to revoke or update these documents while you’re still mentally competent. You can:

• Revoke them in writing
• Verbally tell your doctor or provider
• Create a new document, which automatically replaces the old one

If you change your mind about specific treatments or wish to appoint a new proxy, update your documents immediately and distribute the new versions to your healthcare providers and family.

It’s also important to understand that a health care proxy can’t override your living will unless the document specifically allows for it. If there’s a conflict between the two, medical teams usually defer to your written instructions, unless state law or a court says otherwise.

Common Misunderstandings About Living Will vs Health Care Proxy

Many people assume these two documents are interchangeable. That’s not the case.

Here are some common myths to clear up:

• Myth: A health care proxy only makes decisions at the end of life.Truth: Your proxy can make any medical decisions once you’re declared incapacitated, not just end-of-life ones.
• Myth: A living will covers every possible medical scenario.
  Truth: It usually applies to very specific conditions. Anything outside of that may still require a proxy.
• Myth: Once you name a proxy, you lose the ability to make your own decisions.
  Truth: As long as you’re mentally capable, you remain in charge. Your proxy only acts when you can’t.

Where to Store Your Living Will and Health Care Proxy

Keep the original documents in a safe but accessible location. Give copies to:

• Your primary care doctor
• Your appointed health care proxy
• Any alternate proxy
• Family members who may be involved

You may also want to carry a wallet card stating that you have an advance directive, where it’s stored, and who your proxy is. Some people also choose to upload their documents to state or national health care directive registries if available.

What Happens Without These Documents?

If you become incapacitated and don’t have either document, medical decisions may fall to your next of kin. In Texas, the order of priority is typically:

• Legal Guardian
• Spouse
• Adult children
• Parents
• Nearest living relative

This can cause tension, especially if family members disagree about your care. Without a living will, there’s also no written record of your treatment preferences, which could lead to unwanted interventions.

By taking time to complete both documents, you’re giving your loved ones guidance and peace of mind during difficult times.

Making Your Voice Heard

Understanding the difference between a living will vs health care proxy empowers you to make thoughtful decisions now, so others won’t have to guess later. These documents work best when used together: the living will communicates your values, and the health care proxy ensures someone you trust can carry them out.

It doesn’t matter how healthy or young you are—it’s smart to put your preferences in writing and select someone who will speak on your behalf when you can’t. Your future care should reflect your choices, and these tools help make sure that happens.

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