Advocate for patients by adhering to advance directives

By | 2020-05-12T08:17:55-04:00 September 14th, 2016|Tags: |3 Comments

I have received several comments about advance directives, including that sometimes they are not followed by hospital staff. The importance of doing so as a healthcare provider was underscored in a recent case (Doctor’s Hospital of Augusta et al. v. Alicea, Administratrix, Si5G1571, Supreme Court of Georgia, July 5, 2016).

Ms. S, an 89-year-old grandmother executed an advance directive for healthcare. She named her granddaughter, Alicea, with whom she lived, as her agent. The advance directive clearly authorized Alicea to make all of Ms. S’s healthcare decisions, including “decisions to provide, withhold or withdraw artificial nutrition and hydration, and all other forms of healthcare to keep me alive,” based on the personal values she had shared.

Ms. S suffered a severe stroke, was admitted to the hospital and was unable to make decisions for herself, triggering Alicea’s power to make treatment decisions.

Alicea, gave the advance directive to the staff. However, it was placed in the back of the chart rather than in front of the admission tab, which is required by hospital policy.

During the Ms. S’s hospital stay certain diagnostic and treatment procedures were initiated with Alicea’s consent. Alicea consistently told the staff and physicians caring for her grandmother that under no circumstances were “heroic measures” to be used, including CPR and intubation.

A thoracentesis was recommended and Alicea agreed not knowing that this procedure would require intubation and the use of a ventilator. She was not told that these two procedures were done during surgery.

The grandmother’s condition worsened after surgery, requiring intubation and a ventilator due to the potential for respiratory failure. Alicea was not contacted. When she visited her grandmother in the hospital later that morning she discovered the ventilator.

Without a reasonable alternative at the time, ventilation was continued until several days later when the grandmother’s kidneys began to fail.  Alicea and her family decided to take her grandmother off of the ventilator and provide comfort measures only. Ms. S died three days later.

Alicea filed a case against the hospital, the physician and the nursing staff, alleging breach of agreement, professional and ordinary negligence, medical battery, intentional infliction of emotional distress and breach of fiduciary duty.

The appellate court upheld one of the lower court decisions that no summary judgment could occur for the defendants because there was a question about whether the physicians and the hospital nurses “made a good faith effort to rely on” Alicea’s decisions.

After carefully analyzing applicable law, all Justices of the Supreme Court of Georgia affirmed the two lower court decisions. Hence, the case proceeds in the trial court.

Implications of this case are unequivocal. All RNs must, at a minimum, make a good faith effort to rely on the treatment decisions of their patients or agents whom patients have appointed.

Critical, too, is the need to advocate for your patients when those documented decisions are not relied on in good faith. You are the last line of defense in ensuring those decisions are acknowledged.

NOTE:  Nancy Brent’s posts are designed for educational purposes and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.


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About the Author:

Nancy J. Brent, MS, JD, RN
Our legal information columnist Nancy J. Brent, MS, JD, RN, received her Juris Doctor from Loyola University Chicago School of Law and concentrates her solo law practice in health law and legal representation, consultation and education for healthcare professionals, school of nursing faculty and healthcare delivery facilities. Brent has conducted many seminars on legal issues in nursing and healthcare delivery across the country and has published extensively in the area of law and nursing practice. She brings more than 30 years of experience to her role of legal information columnist. Her posts are designed for educational purposes only and are not to be taken as specific legal or other advice. Individuals who need advice on a specific incident or work situation should contact a nurse attorney or attorney in their state. Visit The American Association of Nurse Attorneys website to search its attorney referral database by state.


  1. Avatar
    Third-party Custody Spokane September 17, 2016 at 6:21 am - Reply

    I really appreciate the kind of topics you post here. Thanks for sharing information that is actually helpful. Good day!

  2. Avatar
    Shannon Little September 20, 2016 at 11:31 pm - Reply


    Thank you for sharing this. I hope more nurses read and learn from the message that your write up holds.
    I feel as though ALL healthcare providers-especially nurses, need thorough education about all aspects of Advanced Directives. It is of paramount importance, because we ARE all too often the closest and/or the only eyes and ears that our patients have! I have always found that the majority of staff, patients, and the patient’s family members are simply not properly versed on Advanced Directives. No one seems to realize how vital their role in upholding a patient’s Advanced Directives is! Last, I would just like to say that personally, in addition to any legalities involved, I feel as nurses, we have an oath to uphold, and part of that oath is ALWAYS, ALWAYS to advocate for,and to educate our patients. Both should be from admission to discharge; from the beginning of life to the end of life. We must never forget why we became nurses in the first place, for if we do, may we retire from the nursing practice pronto! 🙂
    Again – I enjoyed your article!


    Shannon Little, RN;BSN

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    Wausau WI Estate Planning Attorney September 21, 2016 at 10:59 am - Reply

    Good writing. Keep up the good work. I just added your RSS feed my Google News Reader

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