Who Is Responsible for Making Sure an Advance Directive Is Followed?

The responsibility for making sure an advanced directive is followed is shared by healthcare providers, institutions, and designated healthcare agents. Since healthcare providers are largely responsible for the delivery of care, they have an obligation to honor the requests indicated in an individual’s advance directive. As an example, if the patient’s advance directive indicates that they do not want to receive life-sustaining treatments, the healthcare provider should respect the patient’s autonomy and honor the request as it is outlined in the documents. 

Healthcare institutions have a different level of responsibility in ensuring advance directives are followed. Institutions have the ability to implement specific processes to maintain accurate documentation regarding advance directives and empower healthcare providers or other staff to ensure that directives are upheld. This can involve providing additional training regarding the content and purpose of advance directives, ensuring directives are easily accessible in patient records, and coordinating additional support or communication to ensure directives are acted upon appropriately. 

Healthcare agents handle the necessary communication and decision-making on behalf of the patient. It is important for healthcare agents to understand the requests and instructions that have been provided in the advance directive so that they can explain these decisions and the reasons behind them if asked. The healthcare agent has the authority to make decisions, but also holds the responsibility of ensuring that those decisions honor the patient’s preferences. 

In an ideal situation, all three of these entities work collaboratively to adhere to the indications provided in advance directives. If one entity ignores the advance directive or does not follow it appropriately, another entity should acknowledge this and establish accountability to ensure that the patient’s requests are maintained and honored. Ensuring that everyone is aware of the advance directive and the actions that need to be taken can ultimately reduce the risk of unnecessary delays, violations, or interpersonal conflict regarding final decisions. 

Sources

“Advance Care Planning: Advance Directives for Health Care”. National Institute on Aging. https://www.nia.nih.gov/health/advance-care-planning/advance-care-planning-advance-directives-health-care 

“Health care agents”. MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000469.htm