What do I do when a health care directive is challenged by hospital doctors?

Laws in most states obligate doctors to honor a valid advance directive—or else transfer the patient to the care of a doctor who will honor it.

But as you might already have discovered, it can be difficult indeed to break through the unwritten Physicians' Code of Silence and find one who will act against the express lobbied wishes of another.

If the advance directive is being challenged, there is likely an internal procedure for it; contact the patient representative at the hospital to find out. Most hospitals will also provide a dispute resolution service to resolve the matter is family members or close friends butt heads with medical doctors unwilling to act.

If you believe the advance directive accurately reflects the patient's wishes, be aggressive in insisting that it's enforced as written. This may involve testifying before a hospital committee, enlisting others to testify presenting relevant correspondence or other evidence underscoring the patient's wishes—or insisting that the dispute be resolved by an objective body such as a dispute resolution service.

Pay attention to the particular reason that the doctor refuses to honor the directive. If he or she claims the patient lacked capacity to make one, for example, concentrate your efforts on finding and presenting evidence of the patient's cogent actions around the same time the directive was made.