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 facility.
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 required.
Where to Begin?
It's time to start thinking of yourself as a caregiver when the following types of events occur:
A major health problem, or a collection of smaller ones, is starting to cramp your mother's style.
Financial problems (overdrawn checks, unpaid bills, huge credit balances) start cropping up.
Grandpa doesn't get out as much as he used to and seems less interested in what's going on around him.
Home maintenance is slipping: things that break around your parent's house...
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 continue.
WebMD Medical Reference from the National Hospice and Palliative Care Organization