ENFORCING
YOUR ADVANCE DIRECTIVE
The following is one page from the
Introduction
of
Your Last Year: Creating Your Own
Advance Directive for Medical Care
by James Park.
This section of the Introduction is called:
"Getting Doctors to Comply with Your Advance Directive".
If you have experienced resistance from any doctor
or medical institution,
you might consider any of the following 8 methods of getting
better cooperation.
If verbal discussion does not work,
consider sending this whole list of enforcement measures.
This will show the resisting medical personnel that you know your
rights.
And if worse comes to worse, you can start the most effective of these
actions.
Usually your doctor will cooperate with your
wishes,
especially if your wishes have been stated in a legal Advance Directive.
But sometimes stronger measures are required.
At least you should be aware that you have recourse
to the following 8 methods
of enforcement:
1. You should select strong and assertive proxies,
who will make the contents of your Advance Directive known
and make sure that your wishes are fulfilled.
2. You should attempt to get your doctor to agree in writing
to follow your Advance Directive.
3. You should not sign consent forms for any unwanted services.
4. You should assure doctors that there will be no adverse consequences
for them if they follow your Advance Directive
—but that their refusal
might have adverse consequences.
5. You can appeal to an institutional ethics committee
if the doctor does not seem to be following your Advance Directive.
6. You can threaten to withhold payment for unwanted services.
To make this work, you need to make it clear to the hospital and doctors
that specific bills will not be paid because the services were not
authorized.
7. You can threaten to inform the Department of Health and Human
Services
if federal funds are paying for care you do not want.
(Doctors fear even having to answer
such complaints.)
8. You can sue the doctor in civil court to enforce your Advance
Directive.
We would hope that the milder forms of
enforcement would work.
But some doctors might need to be reminded that we have
stronger measures at our disposal if they do not cooperate.
Sometimes it works better to put the case in writing
to the legal department
of the hospital,
which might have more influence over the doctor's behavior
than the request of the clients and/or their proxies.
A few lawsuits about failure to follow Advance
Directives
will put everyone on notice that 'living wills' are legal documents,
not just expressions of opinion that can be easily ignored.
An Advance Directive written in cooperation
with your doctors
should head-off any such unfortunate misunderstandings and conflicts.
And your terminal care should go as you want.
INTRODUCTION YOUR LAST YEAR: CREATING
YOUR ADVANCE DIRECTIVE 31
The selection above is one page from
Your
Last
Year: Creating Your Own Advance Directive for Medical Care.
If you click
this title, you will see
the complete table of contents.
The table of contents lists several other sections of the Introduction.