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    Health Care Agents: Appointing One and Being One

    What do I need to know to make decisions? continued...

    However, in practice, withdrawing a treatment can be psychologically more difficult for the caregivers and the agent. It can feel as if stopping the treatment causes the patient's death. In fact, the treatment may only prolong the dying process, rather than prevent the patient's eventual death or improve the patient's condition. In such a situation it can help to remember that the disease is the real cause of the patient's death, not stopping or withholding treatment. Sometimes withholding or withdrawing treatment does not result in the patient's immediate death, but may make the patient's dying more comfortable.

    Take the time you need to get the information that you feel is necessary to make a thoughtful decision. There may be no "right" decision. You can only make the best decision that you can under the circumstances.

    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.

    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.

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