Honoring Advance Directives

Posted by Paula Schneider

I would love to receive feedback from others who are working in the end-of-life field.  I recently gave a presentation to a group of professionals who work with doctors and hospitals (I do not). I was informed that doctors are more and more frequently refusing to honor a patient's advance directive, especially if the family steps in and wants a different course of action, even though they may not be the agents listed in the advance directive.

In my state, Nevada, we have a POLST form, and I heard that doctors are more or less ignoring this form.

Is anyone else hearing this disturbing news?



Response to Suzanne

Thanks for your information and wisdom. I agree that the conversation must come first, and am now beginning to put more emphasis on this first step as I continue to provide community education about advance directives. I am a retired RN CHPN and end-of-life care educator. Helping others approach the last chapter of their life with good information with which to make wise choices is one of my goals. Once again, thank you for your response!

Posted by Paula Schneider

I have been conducting research here on the East Coast and this is what I have been finding…for whatever reason (there are more than one). Let me know if you wish more info or want to discuss this further. Thank you for bringing up this very important and sensitive issue!

Posted by Gail


I am a certified hospice nurse and end of life researcher so I can confidently say that would be surprised to learn that doctors are increasingly disregarding advance directives as they are legally-binding documents. Especially since the Nov. 2014 Institute of Medicine report that calls for significant changes to the way that the healthcare system approaches end of life care and the importance of facilitating the completion of advance care plans. However, with that being said I have also been witness to conflicting goals and high tension among families during times of crisis. Especially when EOL discussions have not taken place far in advance of illness. I believe that the greatest defense is to have a family discussion sooner rather than later, to put those wishes in writing, discuss your desires with your doctor while providing him or her a written copy of your plan to keep in the office medical record, and perhaps most important, to elect a strong advocate to be your healthcare proxy/surrogate--someone you are confident will uphold your wishes, even under pressure. I hope that helps answer your question as I replied in response to my aunt sharing this blog with me.

Posted by Suzanne