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
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.
In Nora Ephron's best-selling book, I Feel Bad About My Neck, she
laments the sorry state of her 60-something neck: "Our faces are lies and our
necks are the truth. You have to cut open a redwood tree to see how old it is,
but you wouldn't have to if it had a neck," she writes.
"Every so often I read a book about age, and whoever's writing it says it's
great to be old. It's great to be wise and sage and mellow; it's great to be at
the point where you understand just what matters in life. I...
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