Legal Briefing: New Penalties for Ignoring Advance Directives and Do-Not-Resuscitate Orders

Thaddeus Mason Pope


The Journal of Clinical Ethics 28, no. 1 (Spring 2017): 74-81.


Patients in the United States have been subject to an ever-growing “avalanche” of unwanted medical treatment. This is economically, ethically, and legally wrong. As one advocacy campaign puts it: “Patients should receive the medical treatments they want. Nothing less. Nothing more.” First, unwanted medical treatment constitutes waste (and often fraud or abuse) of scarce healthcare resources. Second, it is a serious violation of patients’ autonomy and self-determination. Third, but for a few rare exceptions, administering unwanted medical treatment contravenes settled legal rules and principles. This “Legal Briefing” describes a central and growing role for the law. Specifically, courts and agencies have increasingly imposed penalties on healthcare providers who deliberately or negligently disregard advance directives and DNR (do-not-resuscitate) orders. I group these legal developments into the following five categories:

1.   Five Types of Unwanted Medical Treatment

2.   State and Federal Duties to Follow Advance Directives

3.   Doctors Hospital of Augusta v. Alicea

4.   Other Lawsuits for Ignoring Advance Directives

5.   Administrative Penalties for Ignoring Advance Directives


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