Julie Adams is a 65-year-old female who lives in Houston, Texas. She was diagnosed with metastatic breast cancer in May of 2019. She has 2 adult children. Her son John is 40 years old. Her daughter Susan is 43 years old. Both are of sound mind and considered competent. Ms. Adams divorced her husband and the father of her children 12 years ago.

In May of 2019 after Ms. Adams was diagnosed with breast cancer, she met with her attorney, James Dean, to prepare and update her will, medical power of attorney (MPOA), and advance directives. Her will was updated to remove her ex-husband as beneficiary, and to add her children as sole and equal beneficiaries of her estate. She had not previously prepared a MPOA or advance directive, so she informed her attorney about the need for these.

Mr. Dean started by preparing her advance directive by using the Directive to Physicians and Family or Surrogates form as outlined in the State of Texas Advance Directives Act. (See her attached Directive to Physicians for her wishes).

Next, Mr. Dean prepared her MPOA. Ms. Adams named her son John as her medical power of attorney, and her daughter Susan as her 1^st alternate agent. She did not list any limitations of decision making authority in her MPOA. She did not list an end date for her MPOA. She signed her MPOA. It was witnessed and signed by Mr. Dean and his legal secretary, Jamie Phillips. She gave her son a signed copy of her MPOA and her Advance Directives.

Ms. Adams immediately started pursuing breast cancer treatment at MD Anderson Cancer Center. Her Oncologist, Dr. Mary Dale, was responsible for her care and treatment. She initially responded very well to her treatments, and was declared to be in remission by January 2020. In June of 2020, she started having reoccurring headaches. She went to see Dr. Dale who ordered a CT scan. Upon review of her CT scan, Dr. Dale informed her that her breast cancer had metastasized to her brain. She informed her that there was a treatment available, and Ms. Adams chose to move forward with it. She informed Dr. Dale of her Advance Directives and her MPOA. She gave copies of the documents to Dr. Dale to put in her medical record.

Her treatment was going well, and she was experiencing overall mild side effects until October 4, 2020 when she had a seizure at home. She was admitted to MD Anderson under the care of Dr. Dale. Upon admission she was awake, alert, and able to converse with the nursing staff. Dr. Dale ordered a CT scan that showed the cancer in her brain had progressed beyond treatment. She discussed the scan results with Ms. Adams, and explained that nothing else could be done, and that her life expectancy was 1 to 6 months. Ms. Adams and Dr. Dale discussed her advance directives, and if those were still her wishes. Ms. Adams informed Dr. Dale that she had not changed her mind as to her advance directives, and told her that she did not want to be intubated or resuscitated either. Dr. Dale wanted to keep her in the hospital for a couple more days to work on pain medication management before discharging her home.

On October 6, 2020 Ms. Adams began to get confused, and the nursing staff notified Dr. Dale. At the time of her assessment, Dr. Dale determined that Ms. Adams was incompetent. She called her son John who was listed as her MPOA. She spoke with John about his mother's condition, her advance directives, and the discussion she had with Ms. Adams previously. She told him that at this time there was nothing else to be done for his mother because of her terminal condition. She recommended that Ms. Adams be discharge to hospice. John was very upset, and said that he wanted everything done for his mom, that he was not ready for her to die. He told Dr. Dale that he was the MPOA and she had to follow his wishes.

Requirements and Structure of Analysis:

1. Your analysis should be a minimum of (3) pages and not more than (7) pages excluding title page and references. An abstract is not required.
2. A minimum of 3 references are required to support your opinion. They may include but is not limited to:
   1. Your text.
   2. State Law (statutory law - Texas)
   3. Federal Law (statutory/legislative law - US)
   4. Case Law (common law; exemplar judgement or ruling)
   5. Medical standard of care from an authoritative source (medical or nursing text, practice guidelines or treatment standards)
3. Be sure to cite all references using both in text citations and a reference page. Use APA for all referencing.
4. Use the following structure to help guide your analysis
   1. Identify the main issue you are analyzing.
      1. Phrase the issue in the form of one or two brief statements.
   2. Is Ms. Adams' Advance Directive valid?
      1. What is required in the State of Texas for an Advanced Directive to be valid?
      2. What facts support it being valid or invalid?
   3. Is Ms. Adams' Medical Power of Attorney valid?
      1. What is required in the State of Texas for a Medical Power of Attorney to be valid?
      2. What facts support it being valid or invalid?
   4. Upon Ms. Adams admission to the hospital who has the authority to consent for her medical treatment?
   5. After Ms. Adams is determined to be incompetent, who has the authority to consent to her medical treatment?
   6. Does John have the right to ignore his mother's advance directives?
   7. What options are available to Dr. Dale and the hospital after John overrides his mother's advance directives?
   8. As the hospital attorney, what advice would you give to Dr. Dale and the Hospital leadership?
   9. What type of conversations would you have with John and Susan?