For decades, the pressing end-of-life treatment issue was whether patients had the right to decline life- sustaining medical treatment. They do, and that right is now firmly established. A significant patient autonomy issue, however, remains unresolved: do patients have the right to demand and receive life- sustaining treatment when such treatment is contrary to the standard of care? Current precedent in the area provides uncertain guidance for health care professionals struggling to ascertain their obligations, as well as for patients wanting to know their rights. Yet, patient physician disagreement on end-of-life care will continue, especially as medical technology improves. A process-based statute provides the best Framework for addressing patient demands for care that are opposed by physicians and hospitals. This Note contends that the Texas Advance Directives Act is an effective model.