What if the doctor refuses to follow my directions?
In most states care providers can refuse to honor advance directives
(directives communicated by the agent or a living will) for moral or religious
reasons. Some of those states require that care providers remove themselves
from the case and transfer care of the patient to someone who will honor the
patient's request. But in practice, a healthcare professional's refusal to
honor an advance directive can cause a new set of issues. For example, it may
be difficult to arrange the patient's transfer to another physician or
A refusal to stop treatment that stems from a misunderstanding of the law or
medical ethics might be resolved by supplying the provider withthe correct
information. In other instances a care provider may feel that the patient's
choice conflicts with his or her professional responsibilities or personal
moral values. Many medical facilities have ethics committees that might help to
resolve disputes over patients' wishes. In extreme cases legal action may be
Sound Body, Sound Mind
When caring for an older adult, it's important not to overlook routine care -- stuff that seems obvious but that may not be on your radar. Here is a rundown of what to keep in mind:
Everyone needs regular checkups. But some older adults (and young ones, too) reason that since they just saw the doctor last month about that sinus problem, they don't need to go again. A visit to the doctor for a specific problem, however, doesn't take the place of a complete checkup.
A possible way to avoid such conflicts is to speak about the patient's
wishes with the physician when you discuss other issues related to the
patient's condition or treatment. This discussion will give you an opportunity
to find out something about the physician's perspective and values related to
end-of-life decision making. If the physician is unresponsive when issues about
patient's treatment wishes are raised, or expresses an unwillingness to honor
the patient's wishes, you may want to transfer the patient to someone else's
care before a conflict arises.
If I withdraw as the agent, can anyone else make decisions for the patient?
If the patient has appointed an alternate agent, you can withdraw and the
alternate agent will become the legal decision maker. If there is no appointed
alternate agent, the outcome varies among the states.
In some states, law sets forth a procedure for making decisions for patients
who do not have designated decision makers. The law usually designates someone
from a ranked order of those who can make decisions, for example, the legal
guardian, spouse, majority of adult children, and so forth.
However, in some states there is no provision for decision making in the
absence of an appointed agent unless the patient's own wishes are clearly
known. If the patient's wishes are not known, treatment may have to
WebMD Medical Reference from the National Hospice and Palliative Care Organization