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Questions & Answers: Advance Directives and End of Life Decisions

Other questions Once a medical treatment is started, can it be stopped?

Yes. There is no legal or ethical difference between withholding and withdrawing a medical treatment. Therefore, people who may want to try a potentially helpful treatment can do so without fear that, once started, it could not be removed. Professional organizations such as the American Medical Association, as well as the courts, have affirmed that it is ethical to discontinue medical treatments that do not benefit the patient. If the patient no longer wants a treatment, for any reason, providers are legally obligated to withdraw it.

In practice, however, caregivers might resist withdrawing a treatment once it has begun. A caregiver might believe he or she would be helping to cause death, even though the patient's condition is irreversible. Also, caregivers might be confused or misinformed about what the law requires and what constitutes ethical practice. They might mistakenly believe they cannot stop treatment, even with clear evidence that the patient would not want it. If a physician refuses to end treatment, the patient or family should find out the reason for the refusal.

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Do healthcare providers run any legal risk by honoring advance directives?

No. Most advance directive statutes state explicitly that providers run no legal risk for honoring valid advance directives. No healthcare provider has ever been successfully prosecuted for honoring a patient's request to stop treatment. In fact, providers might run more legal risk when imposing treatment against a person's or healthcare agent's wishes.

What if my healthcare provider will not honor my advance directives?

In many states, healthcare providers can refuse to honor advance directives for moral or religious reasons. Some of those states require such individuals be removed from the case and transfer care of the patient to someone who will honor the patient's request. But in practice a healthcare provider's refusal to honor an advance directive can cause difficulties. For example, it may be hard to find a physician or facility willing to accept the patient. For this reason, it is important to ask in advance if a healthcare provider has personal views or if an institution has any policy that would prevent them from honoring a person's legal right to refuse treatment.

A refusal by a healthcare provider to stop treatment may stem from a misunderstanding of the law or medical ethics. Supplying the provider with the correct information might solve this type of difficulty. In other cases, a provider might believe that the patient's choice conflicts with his or her professional responsibilities. Many medical facilities have ethics committees that can help to resolve disputes over patients' wishes. In extreme cases, legal action might be required.

These examples show why it is so important to lay the proper groundwork for your advance directives. If you know that your personal doctor is unwilling to carry out your wishes, it would be wise to change to a physician who will respect them. In addition, because conflict is possible, it is important to appoint an agent who is willing to work actively to have your wishes honored, and equally important to discuss your wishes with loved ones and physicians.

WebMD Medical Reference from the National Hospice and Palliative Care Organization

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