Questions & Answers: Advance Directives and End of Life Decisions
What if my healthcare provider will not honor my advance directives? continued...
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.
Who would make decisions about my medical care if I did not complete advance directives?
There is no simple answer to this question. In general, physicians consult with families when the patient cannot make decisions. But if the decision involves ending a treatment and will result in the person's death, the family may or may not be permitted to make the decision, depending on state law.
In some states treatment cannot be withheld or withdrawn without clear and convincing evidence that the person would refuse it. In other states, if the physician and the family agree, the treatment could be stopped without recourse to any outside authority (such as the courts). If any conflict about treatment exists among family members or between the family and the physician, treatment is likely to continue until the patient dies or the issue is resolved through legal action.
A number of states have passed surrogate decision-making statutes. These laws create a decision-making process by identifying the individuals who may make decisions for patients who have no advance directives. However, the person whom the law appoints to make decisions might not be the person you would want as your decision maker or might make decisions you would not want. Thus, it is important to name the person you do want by completing advance directives, including the appointment of an agent.