Texas Advance Directives Act - Rarely Used to Resolve NBT/PIT Medical Futility Conflicts

For the past few years, Texas began formally collecting and reporting hospital use of the dispute resolution provisions in the Texas Advance Directives Act. But these reports, like the most recent one from April 2026, show that almost no hospitals are using this process. 

These disputes are surely just as common as ever. What are the possible explanations? Here are four.

1. Informal Resolution. Hospitals are informally resolving these conflicts with better communication, negotiation, and mediation. Substantial evidence shows 95% of conflicts can be resolved this way - with tools like ethics consults, time limited trials. 
2. Surrogate Surrender. Surrogates cave-in to the hospital, because they know the hospital ultimately has TADA and withholding or withdrawal is a fait accompli.
3. Clinician Surrender. Clinicians cave-in to surrogates. Even though the law supports unilateral withholding or withdrawal, the process is cumbersome and still creates bad PR for the hospital.
4. Reporting Noncompliance. Hospitals are not submitting the required reporting or not submitting it accurately.