Bioethics Blogs

Criteria for When to Override an Advance Directive

Courtenay Bruce and her Baylor colleagues have a useful article in a recent Chest:  “Navigating Ethical Conflicts Between Advance Directives and Surrogate  Decision-Makers’ Interpretations  of  Patient Wishes”

“There is little guidance on what clinicians should do when advance directives (or living wills, specifically) are challenged, particularly when surrogate decision-makers’ interpretations of patients’ wishes conflict with the living will. In our commentary, we make a controversial argument suggesting that overriding living wills can be ethically preferable to the alternative of strictly adhering to them.”

“We propose four ethical considerations for determining whether it is ethically supportable to override living wills.”

I like this article.  Just as medical guidelines have both false positives and false negatives, so do legal rules.  If we were solely concerned with mitigating the risk of surrogates wrongly overriding the patient’s express advance direction instructions, then we would categorically bar that.  But the harm from such a rule might exceed the benefits, because it would not allow deviations from the advance directive even when warranted.

It might be an interesting project to take a good subset of cases in which courts override advance directives and see if Bruce et al.’s criteria are satisfied.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.