By Ginsburg Law Group, P.C. | Estate Planning & Elder Law
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Imagine this situation: Your mother has been diagnosed with a terminal illness and has entered hospice care. Several years earlier, she signed estate planning documents, including a Medical Power of Attorney and a Directive to Physicians.

You are named as her healthcare agent.

While reviewing her paperwork, you discover a sentence written in capital letters:

“THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.”

Naturally, you have questions.

Does that mean you no longer have authority to make medical decisions for your mother? Does hospice override her Medical Power of Attorney? Can you request hospitalization if her condition changes? What happens if family members disagree about her treatment?

These questions arise because Texas law distinguishes between a patient’s wishes concerning life-sustaining treatment and the legal authority of someone appointed to make healthcare decisions.

Understanding that distinction is essential for families navigating hospice, serious illness, and end-of-life planning.

1. What Does “This Selection Does Not Apply to Hospice Care” Actually Mean?

The language appears in the statutory Texas Directive to Physicians and Family or Surrogates, commonly referred to as a living will or advance directive.

Under Texas Health and Safety Code § 166.033, a person may indicate whether they want life-sustaining treatment continued or withheld under certain terminal or irreversible medical conditions.

When someone selects the option requesting continued life-sustaining treatment, the form includes a specific warning:

“THIS SELECTION DOES NOT APPLY TO HOSPICE CARE.”

This language appears in connection with both terminal conditions and irreversible conditions.

The provision can be confusing because many people assume it refers to their Medical Power of Attorney.

It does not.

The statement limits the application of the patient’s election to receive life-sustaining treatment in the context of hospice care. It does not automatically terminate the authority of a healthcare agent appointed under a separate Medical Power of Attorney.

In fact, the statutory directive specifically recognizes that a person may have already appointed a healthcare agent through a Medical Power of Attorney.

That distinction is important because these documents serve different legal purposes.

2. A Medical Power of Attorney and a Living Will Are Not the Same Thing

Although both documents are part of a comprehensive estate plan, they perform different functions.

Medical Power of Attorney

A Texas Medical Power of Attorney allows you to appoint a trusted individual to make healthcare decisions when you are unable to make those decisions yourself.

Under Texas Health and Safety Code § 166.152, the appointed agent generally has authority to make healthcare decisions that the patient could make, subject to statutory restrictions and any limitations expressly included in the document.

The agent’s decision-making authority becomes exercisable when the attending physician certifies in writing, and places in the medical record, that the patient lacks competence to make healthcare decisions.

The agent must follow the patient’s known wishes, including religious and moral beliefs. When those wishes are unknown, the agent must act according to the patient’s best interests.

Directive to Physicians (Living Will)

A Directive to Physicians communicates the patient’s preferences concerning life-sustaining medical treatment in specified circumstances.

For example, it may address whether a person wishes to continue treatment that prolongs life or instead receive treatment focused on comfort when facing a terminal or irreversible condition.

The directive provides instructions about treatment preferences.

The Medical Power of Attorney identifies the person authorized to make healthcare decisions when the patient cannot.

One document expresses treatment wishes. The other appoints a decision-maker.

A properly coordinated estate plan often includes both.

3. Does Entering Hospice Cancel a Texas Medical Power of Attorney?

No. Entering hospice does not, by itself, revoke or invalidate a Texas Medical Power of Attorney.

Hospice enrollment is not identified as an automatic revocation event under Texas Health and Safety Code § 166.155.

A valid Medical Power of Attorney may continue to provide decision-making authority while the patient receives hospice services.

For example, depending on the document’s terms and applicable law, an authorized healthcare agent may participate in decisions concerning:

• Pain management and comfort measures.
• Medications and treatment recommendations.
• Changes in care settings.
• Hospital evaluation or transfer.
• Communication with healthcare providers.
• Changes in the patient’s plan of care.
• Continuation or discontinuation of hospice services.

However, the agent does not have unlimited authority.

The agent must act within the scope of the Medical Power of Attorney, follow the patient’s known wishes, and comply with applicable Texas law.

The agent’s authority also does not permit the agent to disregard the patient’s objections to treatment.

If a Medical Power of Attorney contains its own express restriction concerning hospice decisions, that restriction requires separate analysis.

4. What Happens When Someone Who Requested Life-Sustaining Treatment Enters Hospice?

Consider a person who signs a Texas Directive to Physicians and chooses the option requesting continued life-sustaining treatment.

Years later, the person develops a terminal illness and elects hospice care.

Does the earlier directive automatically require the hospice provider to continue every available life-sustaining intervention?

No.

The Texas statutory directive expressly distinguishes the election for continued life-sustaining treatment from a subsequent hospice election.

The form explains that when the patient or authorized representative elects hospice, the patient accepts a treatment approach focused on comfort rather than available life-sustaining treatments.

That does not mean the patient is abandoned or denied medical attention.

Hospice generally emphasizes symptom relief, pain control, emotional support, and quality of life.

It also does not mean every medication or medical intervention must automatically stop. Whether a particular intervention is appropriate depends on the patient’s goals, medical circumstances, hospice plan of care, and applicable rules.

For example, medications used to relieve pain, breathing difficulties, anxiety, or other distressing symptoms may remain appropriate even when treatments intended primarily to prolong life are discontinued.

Families should discuss individual treatments with the hospice medical team rather than assuming that every form of medical care is prohibited.

5. Can a Healthcare Agent Remove Someone From Hospice?

This is one of the most important practical questions families ask.

A properly authorized healthcare agent may have authority to make decisions concerning hospice enrollment or discontinuation when the patient lacks decision-making capacity.

However, several factors matter:

• First, the patient retains decision-making rights. A patient who can make healthcare decisions generally makes those decisions personally.
• Second, the agent must have authority. The Medical Power of Attorney must be valid, the required physician certification must be in place, and the contemplated decision must fall within the agent’s authorized powers.
• Third, the patient’s wishes matter. An agent cannot simply substitute personal preferences for the patient’s known treatment wishes.
• Fourth, hospice and insurance rules may affect the process. For Medicare hospice beneficiaries, separate rules govern hospice elections and revocations. The person legally authorized to act for the beneficiary must satisfy those requirements.

Consider an example.

A father enters hospice following a serious illness. His daughter is his designated healthcare agent. He later becomes unable to make medical decisions.

The daughter believes he needs evaluation at a hospital because of a new medical problem.

Her status as healthcare agent does not automatically disappear because her father is receiving hospice care. She may be authorized to discuss and make decisions concerning his care.

But the appropriate course depends on his wishes, the nature of the medical problem, his hospice arrangements, and whether the requested treatment is consistent with applicable medical and legal requirements.

Families should contact the hospice team promptly before making nonemergency changes to care arrangements.

6. What If the Healthcare Agent and Other Family Members Disagree?

Disagreements about end-of-life care can become especially difficult when several family members believe they know what the patient would have wanted.

For example, one adult child may believe that a parent wanted every possible treatment continued.

Another may believe that the parent wanted comfort-focused care and no further hospitalization.

A third may insist that hospice means the healthcare agent no longer has legal authority.

Texas law does not simply give every family member an equal vote.

When a valid Medical Power of Attorney is operative, the designated agent generally has the authority granted by that document, subject to applicable law.

Other family members do not automatically acquire equal decision-making authority merely because they disagree with the agent.

However, the agent remains obligated to honor the patient’s known wishes and applicable legal requirements.

If a serious disagreement develops, the family may need to review the actual advance directives, consult the attending physician, request an ethics consultation, or obtain legal guidance.

7. Does Hospice Automatically Mean There Is a Do-Not-Resuscitate Order?

No.

Hospice enrollment, a Medical Power of Attorney, a Directive to Physicians, and a Do-Not-Resuscitate order are related but distinct.

A Do-Not-Resuscitate order addresses whether cardiopulmonary resuscitation should be attempted under the circumstances governed by that order.

Texas has separate statutory requirements concerning out-of-hospital DNR orders and in-hospital DNR orders.

Families should not assume that entering hospice automatically creates a legally valid DNR order or that a general advance directive substitutes for every required medical order.

Instead, patients and healthcare agents should review resuscitation preferences with the treating physician and hospice team and ensure the appropriate documentation is completed.

8. What If the Patient Changes Their Mind?

End-of-life preferences can change.

A person may initially request aggressive medical treatment and later decide that comfort-focused care better reflects their wishes.

Someone receiving hospice services may also reconsider their care goals.

Texas law recognizes mechanisms for revoking advance directives and medical powers of attorney, although the requirements differ by document.

For example, Texas Health and Safety Code § 166.155 addresses revocation of a Medical Power of Attorney, while Texas Health and Safety Code § 166.042 addresses revocation of a Directive to Physicians.

The key point is that these are separate documents with separate legal functions.

Changing or revoking one does not necessarily have the same legal effect as changing or revoking the other.

Patients and families should ensure that healthcare providers receive updated documentation and understand the patient’s current wishes.

9. Five Mistakes Texas Families Should Avoid

Mistake 1: Assuming the hospice exception cancels the Medical Power of Attorney

The hospice exception in the statutory Directive to Physicians concerns the election requesting continued life-sustaining treatment. It is not a blanket cancellation of healthcare-agent authority.

Mistake 2: Assuming a healthcare agent can make decisions whenever the patient is seriously ill

Under Texas law, the agent’s authority to act requires the attending physician’s written certification of the patient’s incompetence.

Serious illness alone does not necessarily satisfy that requirement.

Mistake 3: Failing to discuss hospice preferences before a medical crisis

Advance directives are most effective when the patient, healthcare agent, and family understand the patient’s values and goals before difficult decisions arise.

Mistake 4: Assuming hospice prohibits all medical treatment

Hospice focuses on comfort and symptom management. The appropriateness of particular treatments should be evaluated in light of the patient’s goals and clinical circumstances.

Mistake 5: Signing documents without understanding how they work together

A Medical Power of Attorney, Directive to Physicians, and DNR order address different questions.

Documents that are poorly coordinated, outdated, or unclear may create avoidable confusion during a medical emergency.

10. How Texas Residents Can Better Prepare for Hospice and End-of-Life Decisions

Thoughtful estate planning involves more than deciding who receives property after death.

It also involves protecting your ability to make meaningful decisions about your healthcare and ensuring that trusted individuals can act when necessary.

Texas residents should consider taking the following steps:

• Review existing advance directives. Determine whether your documents accurately reflect your current preferences.
• Choose a healthcare agent carefully. Select someone who understands your values, communicates effectively, and is willing to make difficult decisions.
• Discuss specific treatment preferences. Consider hospitalization, resuscitation, artificial nutrition and hydration, pain management, and hospice.
• Understand the hospice language. Recognize that the statutory hospice exception does not automatically revoke a Medical Power of Attorney.
• Coordinate documents with medical providers. Ensure that your physician and relevant healthcare facilities have appropriate copies.
• Review documents after major life changes. A serious diagnosis, marriage, divorce, death of an appointed agent, or change in personal preferences may warrant a review.
• Seek legal guidance when documents appear inconsistent. The exact wording of a document may significantly affect how it operates.

Frequently Asked Questions

Does my Texas healthcare agent lose authority when I enter hospice?

Not automatically. Hospice enrollment does not itself revoke a valid Medical Power of Attorney. The agent’s authority depends on the document, the required physician certification, and applicable law.

What does “This selection does not apply to hospice care” mean?

It means the election requesting continued life-sustaining treatment in the statutory Directive to Physicians does not apply to hospice care. It does not, by itself, remove the authority of a healthcare agent.

Can my healthcare agent override my living will?

An agent must act consistently with the patient’s known wishes and applicable law. The relationship between an agent’s decisions and an advance directive depends on the particular circumstances and documents.

Can a person leave hospice after enrolling?

Yes. Hospice is not necessarily a permanent election. A patient or legally authorized representative may be able to revoke hospice enrollment, subject to applicable requirements.

Does hospice automatically mean no CPR?

No. Hospice enrollment and DNR orders are distinct. Resuscitation preferences should be addressed through appropriate discussions and documentation.

Can my family override the person I appointed in my Medical Power of Attorney?

Family disagreement alone does not ordinarily displace a properly authorized agent. However, the agent’s authority is subject to the terms of the document and Texas law.

The Bottom Line: Hospice Does Not Automatically End Your Healthcare Agent’s Authority

The phrase “THIS SELECTION DOES NOT APPLY TO HOSPICE CARE” can be alarming when encountered during a family medical crisis.

But its meaning is narrower than many people assume.

The provision concerns the patient’s election to receive continued life-sustaining treatment under the Texas statutory Directive to Physicians.

It does not automatically invalidate a separate Medical Power of Attorney.

A properly designated healthcare agent may continue to have important responsibilities while a patient receives hospice care, including participating in decisions about treatment, comfort, and care arrangements.

The most effective way to prevent confusion is to understand these documents before they are needed and ensure that they accurately communicate the patient’s wishes.

Texas Estate Planning and Advance Directive Assistance

At Ginsburg Law Group, P.C., we believe estate planning should protect more than financial assets. It should also help individuals preserve their dignity, communicate their wishes, and provide guidance to loved ones during difficult circumstances.

Whether you are preparing advance directives for the first time, reviewing an existing Medical Power of Attorney, or trying to understand how your documents interact with hospice care, careful legal planning can help reduce uncertainty.

Your healthcare wishes deserve to be understood, documented, and respected.

Visit www.ginsburglawgroup.com to learn more about our estate planning services.

Texas Legal References

• Texas Health and Safety Code § 166.033 — Directive to Physicians and statutory hospice language.
• Texas Health and Safety Code § 166.152 — Scope and duration of healthcare-agent authority.
• Texas Health and Safety Code § 166.155 — Revocation of a Medical Power of Attorney.
• Texas Health and Safety Code § 166.164 — Statutory Medical Power of Attorney form.

Disclaimer: This article provides general information about Texas law and is not legal or medical advice. Individual circumstances, document language, and applicable healthcare regulations may affect the outcome. Reading this article does not establish an attorney-client relationship. Consult qualified legal and medical professionals regarding specific situations.