Navigating Ethical Conflicts Between Advance Directives and Surrogate Decision-Makers' Interpretations of Patient Wishes

Chest. 2016 Feb;149(2):562-567. doi: 10.1378/chest.15-2209. Epub 2016 Jan 12.


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.

Keywords: commentary; critical care; end of life; medical ethics; quality of life.

Publication types

  • Review

MeSH terms

  • Advance Directives / ethics*
  • Decision Making*
  • Humans
  • Living Wills / ethics*
  • Morals
  • Terminal Care / ethics*