Legally false, but as in many endeavors, reality muddies the waters. As a matter of law, it is clear that medical providers cannot treat an individual against his or her wishes. Consequently, if a physician acts contrary to a patient's clear instruction directive or contrary to the decision of the patient's authorized proxy, the physician risks the same liability he or she would face if the physician were to ignore a refusal of treatment by a fully competent patient. Treatment would constitute a battery. However, a few factors complicate the situation.
First, the doctor or health facility sometimes do not know about the existence of an advance directive. While federal law requires hospitals, nursing homes, and home health agencies to ask about and to document your Advance Directive, the document often does not make it into the appropriate record. It is up to the patient and those close to the patient you to ensure that everyone who might need a copy of the directive in fact has a copy.
Second, as noted earlier, people often do not express their wishes very clearly or precisely in advance directives. Simply using general language that rejects "heroic measures" or "treatment that only prolongs the dying process" does not give much guidance. Therefore, interpretation problems may arise. Giving a proxy broad authority to interpret one's wishes will help avoid this problem, except that sometimes proxies themselves are not quite sure what the patient would want done. This fact underscores the importance of discussing one's wishes and values with the intended proxy.
Third, in most states, if a physician or facility objects to an Advance Directive based on reasons of conscience, state law permits the physician or facility to refuse to honor it. However, facilities must notify the patient of their policies regarding advance directives at the time of admission. If a refusal occurs, the physician and facility should provide assistance in transferring the patient to a provider that will comply with the directive.
Fourth, persons who are dying, but living in the community, may face problems in having an advance directive followed if a crisis occurs and emergency medical services (EMS) are called (for example, by calling "911"). EMS personnel are generally required to resuscitate and stabilize patients until they are brought safely to a hospital. States are beginning to address this situation by creating procedures that allow EMS personnel to refrain from resuscitating terminally ill patients who are certified as having a "do not resuscitate order" and who have an approved identifier (such as a special bracelet).