Documenting your end-of-life wishes in an advanced directive is one of the best ways to ensure those choices will be respected. That’s why the number advanced directives for seniors has increased by more than 60% in recent years. Unfortunately, documentation alone usually isn’t enough to get the job done. Advanced directives are frequently ignored and, without the right preparation, you may find your loved one’s wishes being neglected.
When Advanced Directives Fail
Under the care of a single physician, advanced directives might be rarely confused. But when treatment requires multiple specialists or several care environments, it’s much more difficult to know if each attending physician is up to speed. As paperwork gets shuffled around and administrative errors accumulate, it’s all-too-easy for an advanced directive to be lost or forgotten. In the heat of the moment, many physicians choose to err on the side of caution, which can mean taking action prohibited by an advanced directive.
It’s important to understand that advanced directives aren’t legally binding, as noted by the American Bar Association. This means that doctors may refuse to comply with your wishes if they believe they’re medically or ethically inappropriate. In fact, legal recourse is usually only possible in instances where physicians knowingly ignored these orders. If you want to ensure your directives aren’t ignored, the best strategy is to discuss those wishes with care providers ahead of time. This will help ensure that they’re informed about what you want, and that you’re informed about their willingness to support those decisions.
In some rare circumstances, physicians have even argued that ignoring advanced directives can be ethically appropriate. For example, someone with dementia who suffers a minor fracture could have a directive which prohibits surgery and hospitalization, but they may face a total loss of mobility without that prohibited treatment. It is cases like this which underscore the importance of having a healthcare proxy, because there’s no way an advanced directive can foresee every possible circumstance.
If you want an advanced directive to be followed, it helps to have a strong health care proxy. This is someone who can advocate on your behalf when you can’t, and who can ensure all the appropriate forms make it into the right hands, for every new care provider and facility. It also helps to share copies of your advanced directive to every family member involved with care, because nothing is better at ensuring an advanced directive will be followed than vigilance. Those who make-and-forget their advanced directive may be unpleasantly surprised at the results.
With the right formalities in order, many states recognize an oral conversation with your doctor as an advanced directive, but it may be better to have a written document prepared in case legal recourse becomes necessary. Having a written advanced directive also means you may be able to take advantage of the electronic registry program that many states have, enabling physicians’ 24-hour access to their patient’s directives. Few of these programs are extensive enough to include every hospital, county, and care provider, but they’re still worth enrolling in where available.
Physicians more easily face punishment for failing to treat someone than they do for violating an advanced directive they may not even know about. While there are a small number of examples of patients seeking damages, and care providers being charged for failing to follow an advanced directive, these cases are few and far between. In truth, the only guarantee you have that your wishes will be respected is to have conversations with care providers, and to be vigilant about making your loved one’s end-of-life wishes known.