Must Health Care Providers Honor the Wishes Expressed in My Advance Directive?

Advance directives for healthcare are legally recognized documents that healthcare providers are required to follow in most situations. They are not, however, legally binding as a contract would be. According to the American Bar Association, healthcare providers may refuse to follow an advance directive if they have an objection of conscience or believe that the instructions contained in the directive are medically inappropriate. Further, unless you have a POLST or pre-hospital DNR order, first responders will most likely not follow an advance directive that indicates you do not want life-sustaining measures instituted since they are legally obligated to attempt to save your life unless a signed physicians order indicates otherwise. 

With that being said, advance directives often are not followed for reasons other than a healthcare provider’s refusal to do so. For example, in many cases, the directive is not available when a person presents in the emergency department with a life-threatening event. Even when the directive is in the patient’s medical record, providers may have difficulty locating it while simultaneously attending to the patient’s urgent medical needs. Oftentimes, the patient’s designated healthcare surrogate has a copy of the directive but that person can’t be located at the time a health crisis occurs. In these cases, healthcare providers are legally obligated to institute live-saving measures until the surrogate or a properly executed advance healthcare directive can be found. 

Another scenario in which providers may not honor an advance directive is when the designated healthcare agent disagrees with what the directive says. If the person who executed the directive is incapacitated, the designated surrogate or proxy is empowered to make decisions about their care. In consultation with the patient’s doctor, this person may decide that the wishes expressed in an advance directive are inappropriate given the person’s medical condition and the likelihood of recovery. 

Sources

“What is a legally binding agreement?” Termly. https://termly.io/faq/what-is-a-legally-binding-agreement/ 

“Myths and Facts About Health Care Advance Directives”. American Bar Association. https://www.americanbar.org/groups/law_aging/publications/bifocal/vol_37/issue_1_october2015/myths_and_facts_advance_directives/