§ 137.007.Use and Effect of Declaration for Mental Health Treatment

What a provider does with the document, and what happens where the provider will not follow it.

On being presented with a declaration, a physician or other health care provider shall make the declaration a part of the principal’s medical record.

Filing it is what makes it operate. A declaration in a drawer at home reaches nobody, and the liability section protects a provider who never learned of one — so getting it into the record is the principal’s practical priority.

When acting in accordance with a declaration, a provider shall comply with it to the fullest extent possible.

"To the fullest extent possible" acknowledges that a declaration may not fit the situation. A refused medication may have no available alternative; a stated preference may be impracticable. The provider follows what can be followed rather than setting the document aside.

Subsection (b) governs the unwilling provider, and it permits withdrawal rather than disregard. A physician or provider unwilling at any time to comply may withdraw from providing treatment consistent with the exercise of independent medical judgment.

Three obligations follow, and each must be done promptly.

Make a reasonable effort to transfer care to a provider who is willing to comply. The duty is to try, not to succeed, though it is what prevents withdrawal from becoming abandonment.

Notify the principal, or the principal’s guardian if appropriate, of the decision to withdraw.

Record in the medical record the notification and, if applicable, the name of the provider to whom the principal is transferred.

The recording requirement leaves a trail. A later reader can see that a provider withdrew, when, and where the patient went.