Advance directives: legal remedies and psychosocial interventions

Although the legal basis to refuse life supports is firmly embedded in the laws of all 50 states, there is evidence that a gap exists between patients' preferences and physicians' actions. Patients and their families have increasingly begun to turn to the courts for redress, requesting damages when a physician has ignored their request to forgo life-sustaining treatment. This article explores the reasons why patients' end-of-life medical choices are often ignored by the medical profession and the results of recent attempts to remedy these situations through the courts. Implications for practice are discussed, including practical suggestions for increasing the likelihood that a patient's wishes will be respected by medical providers.