Texas: Health Care Power of Attorney Requirements

In Texas the health care power of attorney is a distinct, named document: the
medical power of attorney, governed by Subchapter D of the Texas Advance
Directives Act (Health & Safety Code ch. 166). It is separate from the
"directive to physicians" — the living will where you record end-of-life
treatment wishes. This page is about the medical power of attorney: the document
that names an agent to make your medical decisions when you cannot.

Requirements one by one

Governing law and document

The medical power of attorney lives in §§ 166.151–166.166. Unlike California,
Texas keeps it separate from the living will rather than folding both into one
combined directive. Texas also standardizes the document: under § 166.164 the
"medical power of attorney must be in substantially the following form," and the
statute prints that form. So while you can adjust wording, a Texas medical power
of attorney is expected to track the statutory form, and it is normally
accompanied by the statutory disclosure statement that explains the agent's
authority.

Who can sign

The principal must be an "[a]dult," defined in § 166.151(1) as "a person 18
years of age or older or a person under 18 years of age who has had the
disabilities of minority removed," and must be competent. If you are physically
unable to sign, § 166.154(c) lets another person "sign the medical power of
attorney with the principal's name in the principal's presence and at the
principal's express direction."

Witnesses or notary

Section 166.154 gives you the same either/or choice California does, in Texas
wording. The default is two witnesses: the document "must be signed by the
principal in the presence of two witnesses who qualify under Section 166.003, at
least one of whom must be a witness who qualifies under Section 166.003(2)."
Alternatively, under § 166.154(b), "in lieu of signing in the presence of the
witnesses," you may "sign the medical power of attorney and have the signature
acknowledged before a notary public." You do not need both.

Who can't witness or serve

Texas requires only one of your two witnesses to be fully disinterested, but the
disqualification list for that witness is long. Under § 166.003(2), at least one
witness must not be your designated agent, someone related to you by blood or
marriage, an heir or estate claimant, your attending physician or that
physician's employee, or a facility employee who gives you direct care or is an
officer or business-office employee of the facility. Separately, § 166.153 bars
certain people from ever exercising the agent's authority: your health care
provider or residential care provider, and their employees, unless the person is
a relative of yours.

When the agent can act

The medical power of attorney is springing. Section 166.152(b) provides that
"[a]n agent may exercise authority only if the principal's attending physician
certifies in writing and files the certification in the principal's medical
record that, based on the attending physician's reasonable medical judgment, the
principal is incompetent." The statutory form says the same thing in plain words:
it "takes effect if I become unable to make my own health care decisions and this
fact is certified in writing by my physician" (§ 166.164). The document itself,
though, is "effective indefinitely on execution ... and delivery of the document
to the agent" (§ 166.152(g)).

Agent's powers and limits

Once the power is active, § 166.152(a) lets your agent "make any health care
decision on the principal's behalf that the principal could make if the principal
were competent," subject to any limits you write in. Five decisions are off the
table for every agent under § 166.152(f): "voluntary inpatient mental health
services," "convulsive treatment," "psychosurgery," "abortion," and "neglect of
the principal through the omission of care primarily intended to provide for the
comfort of the principal." And no matter what, treatment "may not be given to or
withheld from the principal if the principal objects" (§ 166.152(c)).

How to revoke

Texas makes revocation deliberately easy. Under § 166.155(a) the document is
revoked by "oral or written notification at any time by the principal to the
agent or a licensed or certified health or residential care provider or by any
other act evidencing a specific intent to revoke the power" — and this works
"without regard to whether the principal is competent." Executing a later medical
power of attorney also revokes an earlier one. And § 166.155(a-1) automatically
revokes a spouse-agent's authority if your marriage "is dissolved, annulled, or
declared void unless the medical power of attorney provides otherwise."

Out-of-state directives

If you executed a medical power of attorney or similar directive in another
state, § 166.005 gives it "the same effect as an advance directive validly
executed under the law of this state" — with the caveat that it cannot authorize
care Texas law otherwise prohibits.

What trips people up

• The medical power of attorney is not the living will. Texas splits them
  into two documents. If you only signed a "directive to physicians," you have
  stated your treatment wishes but have not named an agent — and vice versa. Many
  people need both.
• Only one witness has to be disinterested — but that one has a long
  disqualification list. Your other witness can be a relative or an heir, but at
  least one witness must clear every bar in § 166.003(2), including not being your
  doctor, your doctor's employee, or a caregiver at your facility.
• The notary is an alternative, not an add-on. You can sign before a notary
  instead of two witnesses (§ 166.154(b)). Neither path is "better"; either one
  makes the document valid.
• Your named agent can't act until a physician certifies you're incompetent.
  Signing the form does not hand your agent authority today. That authority
  switches on only when your attending physician certifies in writing, in your
  medical record, that you cannot make decisions (§ 166.152(b)).
• Divorce cancels a spouse-agent automatically. If you named your spouse and
  later divorce, that appointment ends by law (§ 166.155(a-1)); sign a new
  document if you still want that person to decide for you.

Common questions

Do I need the medical power of attorney notarized in Texas?
No. You can either have two qualified witnesses sign it or have your signature
acknowledged before a notary — your choice (§ 166.154).

Is the medical power of attorney the same as a living will?
No. In Texas they are separate documents. The medical power of attorney names an
agent; the "directive to physicians" records your own treatment instructions.

Can my agent make decisions for me right away?
No. Your agent can act only after your attending physician certifies in writing
that you are incompetent (§ 166.152(b)). Texas does not offer an
effective-immediately option the way some states do.

What can my agent never do?
Your agent can never commit you for inpatient mental-health treatment, or consent
to convulsive treatment, psychosurgery, abortion, or the withholding of comfort
care (§ 166.152(f)).

Statutes and sources

All sections were read from the Texas Legislative Council's official chapter
text at https://tcss.legis.texas.gov/resources/HS/htm/HS.166.htm (accessed
2026-07-16).

• Tex. Health & Safety Code § 166.151 — definitions of "adult" and
  "principal."
• Tex. Health & Safety Code § 166.152 — scope of authority, the
  physician-certification trigger, agent limits, and duration.
• Tex. Health & Safety Code § 166.153 — who may not exercise the agent's
  authority.
• Tex. Health & Safety Code § 166.154 — execution: two witnesses or a notary.
• Tex. Health & Safety Code § 166.003 — witness qualifications and the
  disinterested-witness disqualification list.
• Tex. Health & Safety Code § 166.155 — revocation and the effect of a
  terminated marriage.
• Tex. Health & Safety Code § 166.005 — enforceability of directives executed
  in another jurisdiction.
• Tex. Health & Safety Code § 166.164 — the mandatory statutory form.