In Texas family law, enforcement of medical decision-making authority primarily depends on the type of conservatorship or guardianship established by the court, and the specific provisions in the court orders or parenting plans.

Medical Decision-Making Authority in Texas Family Law

• Guardianship Context:
  A guardian of the person in Texas has broad authority to make medical decisions for the ward, including consenting to treatments, selecting healthcare providers, and accessing medical records. However, guardians must follow the substituted judgment standard (making decisions based on what the ward would have chosen) or the best interests standard if the ward’s preferences are unknown. For major medical decisions, such as experimental treatments or end-of-life care, court approval may be required.

• Parental Conservatorship Context:
  In custody cases, Texas courts issue parenting plans that specify medical decision-making rights. These rights can be:

  • Joint: Shared by both parents.
  • Independent: Either parent may act alone.
  • Exclusive: Only one parent has the right to make medical decisions.

  For invasive medical procedures, courts often assign exclusive decision-making authority to one parent or require both parents to agree. The court’s primary consideration is the best interest of the child when allocating these rights.

• Without Medical Power of Attorney:
  If an adult becomes incapacitated without a Medical Power of Attorney, Texas law designates a surrogate decision-maker in a priority order: spouse, adult children, parents, then nearest living relative.

Enforcement of Medical Decision-Making Authority

• If a party fails to comply with a court order regarding medical decision-making (e.g., a parent acting outside their granted authority), the other party can file a motion for enforcement in the family court. This motion must:

  • Cite the specific provisions of the original order violated.
  • Detail the violations with dates and descriptions.
  • Specify the relief sought (e.g., compliance, modification, or sanctions).
  • Include notices of the enforcement action and hearing.

• The non-compliant party must be formally notified and given an opportunity to respond at a hearing.

• Courts have the power to enforce orders through various remedies, including contempt sanctions, to ensure compliance with medical decision-making authority as outlined in the parenting plan or guardianship order.

Summary

• Medical decision-making authority in Texas family law is defined by court orders (guardianship or conservatorship) and governed by standards prioritizing the ward’s or child’s best interests.
• Enforcement involves filing a motion with the family court detailing the violation of medical decision-making provisions, followed by a hearing where the court can compel compliance or impose sanctions.
• For incapacitated adults without a Medical Power of Attorney, Texas law provides a statutory hierarchy for surrogate decision-makers.

This framework ensures that medical decisions are made responsibly and that parties adhere to court-established authority in Texas family law cases.