Updated August 3, 2026. Quick answer: Texas gives you a choice at execution — two qualifying witnesses, or a notary. Most people use witnesses, and that is where directives fail, because Texas disqualifies a long list of people from being the witness who matters. The notary route sidesteps the entire problem in one step.
The execution box
- Who may execute: a competent adult.
- Route A: sign in the presence of two qualifying witnesses, who must also sign.
- Route B: sign and have the signature acknowledged before a notary public — no witnesses required.
- After signing: tell the attending physician; it goes in the medical record.
What the statute says
(a) A competent adult may at any time execute a written directive. (b) Except as provided by Subsection (b-1), the declarant must sign the directive 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). The witnesses must sign the directive. (b-1) The declarant, in lieu of signing in the presence of witnesses, may sign the directive and have the signature acknowledged before a notary public.
— Tex. Health & Safety Code §166.032(b), (b-1)
Subsection (b-1) is the escape hatch and it is worth using. If you sign before a notary, the witness qualification rules below stop mattering entirely.
Why the witness rules matter more than the wording
In any circumstance in which this chapter requires the execution of an advance directive or the issuance of a nonwritten advance directive to be witnessed: (1) each witness must be a competent adult; and (2) at least one of the witnesses must be a person who is not: (A) a person designated by the declarant to make a health care or treatment decision; (B) a person related to the declarant by blood or marriage; (C) a person entitled to any part of the declarant’s estate after the declarant’s death under a will or codicil executed by the declarant or by operation of law; (D) the attending physician; (E) an employee of the attending physician; (F) an employee of a health care facility in which the declarant is a patient if the employee is providing direct patient care to the declarant or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or (G) a person who… has a claim against any part of the declarant’s estate after the declarant’s death.
— Tex. Health & Safety Code §166.003
Read the structure carefully, because it is easy to over- or under-read. Both witnesses must be competent adults. Only one of the two must clear the disqualification list. So a spouse may serve as the second witness — but cannot be the one doing the statutory work.
The disqualified categories for that one witness are broad, and three of them catch people out repeatedly:
- Anyone related by blood or marriage. That removes most of the people actually in the room.
- Anyone who would inherit — under a will, a codicil, or by operation of law. Note the last phrase: an heir who would take under intestacy is disqualified even if no will exists.
- Facility staff providing direct care, and officers, directors, partners or business-office employees of the facility or its parent organisation. If the directive is being signed in a hospital, the nearest available people are frequently the wrong ones.
Also excluded: the person you are naming to make decisions, the attending physician and their employees, and anyone with a claim against the estate.
This is the argument for the notary route. Signing in a hospital, in a hurry, with family present, is close to the worst set of circumstances for finding a qualifying witness — and a notary removes the requirement altogether.
Telling the physician is part of it
A declarant shall notify the attending physician of the existence of a written directive. If the declarant is incompetent or otherwise mentally or physically incapable of communication, another person may notify the attending physician of the existence of the written directive. The attending physician shall make the directive a part of the declarant’s medical record.
— Tex. Health & Safety Code §166.032(d)
A directive nobody knows about does not direct anything. The statute puts the duty on the declarant, allows someone else to do it if they cannot, and requires the physician to put it in the medical record.
This is the medical instrument, not the financial one
An advance directive covers health care decisions. It does not let anyone pay a bill, reach a bank account, or manage property — that is a financial power of attorney, a separate document with its own execution rules. Families routinely discover the gap at the worst moment.
Power of attorney execution requirements by state
What could not be verified
We have quoted sections 166.032 and 166.003 and cited 166.033, which sets out a statutory form. We have not reproduced that form, nor covered out-of-hospital DNR orders, the medical power of attorney under a different subchapter, or the rules for a nonwritten directive. Texas treats these as distinct instruments. Hospitals often supply their own combined packet, which is fine as long as the execution requirements above are met.
Related: advance directive requirements by state.
General information drawn from state statutes and official state or court forms, not legal advice. These instruments are governed by the law of the state where the property sits or the document is signed, and formalities differ from state to state — execution, witnessing and recording requirements are the parts that void a document when they are missed. Your own state’s current statute governs.