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How To Enforce An Advance Directive

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Doing everything by-the-book when creating an Advance Healthcare Directive does not guarantee that a patient's wishes will be carried out. In fact, studies show that the percentage of advance directives which are not complied with is high. 

If a patient's wishes are not carried out, there can be prolonged and expensive treatment that wasn't wanted. Adding more injury to injury, the patient or his or her estate will have to pay for the extended care.

If the doctor and/or facility refuses to go along with a patient's Advance Healthcare Directives, it is advisable to take the following steps as soon as possible.  While the following are noted as steps, they should basically be pursued at the same time):Above all, it is important to be persistent until the patient's desires are satisfied.

Step 1: Try to get the doctor and/or facility to change their decision. It cannot hurt to make one last attempt.  Work quickly up the chain of command, starting with the hospital's patient advocate or ombundsman. Leap to the hospital's chief administrator next. (Often speaking with the administrator's assistant will get things done if you can't get through to the administrator). The head of the hospital's ethics committee may also be able to help and/or one of the facility's lawyers.

Step 2: Get a lawyer involved

  • If you have a lawyer, contact him or her. If your lawyer is not the right person to handle the situation, he or she will refer you to a specialist. 
  • If you do not have a lawyer:
    • Start looking for a lawyer who specializes in elder law who has experience with enforcing Advance Directives.while continuing with the following steps. If you start the search now, you'll have a laywer to turn to if needed. If necessary, low cost or free lawyers are available. To learn more, click here. To find an elder law attorney, you can contact the National Academy of Elder Law Attornies.  offsite link
    • An alternative is to contact a federally-mandated Protection & Advocacy (P&A) agency. Each state has a P&A. P&As provide legal representation and other assistance. There are eligibility requirements. To find out more, contact the P&A in your state. You can locate your local P&A through offsite link. In the section headed "Consumers", click on "Get Help In Your State."

Step 3: E-mail or hand deliver to the doctor and health care facility a letter stating that neither the patient nor the patient's estate will be liable for any future medical or other expenses other than those which you authorize in writing. If you have a lawyer (no matter what kind): clear the content first with him or her. Note that a copy is being sent to (the lawyer's name: including either "Esq." or "Attorney at Law" after the person's name.) For a sample letter, click here. Be sure to keep a copy of the e-mail or letter for your file. 

Step 4: If you do not meet with success with the doctor or health care facility: 

  • Contact the state agency in charge of licensing medical facilities to find out if it will help. (To find the agency, search on words such as "(name of state) hospital regulatory agency" or "(name of state) health care regulatory agency). 
  • Look for other sources of influence over the doctor or facility. For example:
    • A major donor who is willing to make a phone call
    • A large organization that tends to send it's employees/members to the facility 
    • Public pressure. Such as:, 
      • Social media such as Facebook and/or Twitter.
      • Traditional media. (To learn how to get medica coverage, see: How To Get Press Coverage)
  • Consider having the patient moved to another facility that is willing to comply with your requests.
    • If the patient has health insurance and the company balks at paying for the transfer, point out that the transfer will save the insurer money, if that is indeed the case.

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