What if my doctor ignores my health care proxy?

The law in Massachusetts (Massachusetts General Laws Chapter 201D) allows a doctor to refuse to honor a Health Care Agent’s decision (when the Agent attempts to enforce the Principal's Health Care Proxy) if the decision is contrary to the doctor's moral or religious views. However, the physician and the hospital must then help the Agent transfer the Principal/patient into the care of another doctor in the same, or in an equivalent facility, who will honor the Agent’s decision. If the doctor is unable to find another doctor or facility that will carry out the Agent’s decision, then she must either honor the Agent’s decision or seek judicial relief.

If the doctor is willing to honor the Agent’s decision but the facility determines that it is contrary to its adopted policies (based expressly on religious beliefs), then the facility also has the right to refuse to implement the decision. Although Massachusetts law requires that the facility must have informed the patient or her Agent of the policy at the time of admission, the Agent probably cannot force a facility to take an action that violates its religion-based policies, even if the hospital failed to disclose those policies in a timely manner. The facility must assist in transferring the patient, and if no reasonably accessible facility is willing to honor the Agent’s decision, the facility must seek judicial guidance. In some cases, if the Agent agrees, it may be appropriate for the facility to transfer the patient to her home where hospice staff or other medical personnel can make her comfortable while implementing the Agent’s decision.

You may be able to avoid this type of dispute by planning ahead and communicating with your doctor, before you become ill. If your doctor is associated with the hospital where you would most likely be admitted for care, tell her about your Proxy and your wishes regarding medical treatment. In this way, you can determine ahead of time whether your doctor is willing to comply with your wishes. Similarly, if you know which hospital you will go to for treatment or in cases of emergency, find out if they have any adopted policies that might interfere with your wishes.