An elderly client’s daughter called me from a hospital in Manhattan. Her mother had suffered a catastrophic stroke and was on life support. Years ago, we had prepared a clear Living Will and Health Care Proxy for her mother, appointing the daughter as her agent. The documents were explicit: no heroic measures. Yet the attending physician, citing his own convictions, was refusing to honor that directive. The daughter was distraught, asking a question we hear too often: “He’s ignoring my mother’s wishes. What can I do?”
This is among the most difficult situations a family can face. You have done the prudent thing—put your wishes in writing and appointed a steward to carry them out. But a Health Care Proxy is not a self-enforcing document. Its power depends on the agent’s ability to advocate and the willingness of medical professionals to comply with their legal duties.
The Authority of Your Appointed Agent
In New York, a Health Care Proxy is a powerful legal instrument. It allows you to appoint someone—your agent—to make medical decisions for you when you are no longer able to make them for yourself. The principle is simple: your agent steps into your shoes. Their authority is as broad as your own. They are not merely suggesting a course of action; they are speaking with your voice, guided by your expressed wishes in a Living Will or by their personal knowledge of your values.
This authority is not just a custom; it is codified in law. New York Public Health Law Article 29-C establishes the entire framework for these directives. The statute is clear: an agent can make any health care decision the principal could have made. This includes the right to refuse life-sustaining treatment.
When we draft these documents, we work to eliminate ambiguity. We work with clients to be intentional and deliberate about their instructions, so their agent is armed with the clearest possible mandate. This clarity becomes critical when a medical provider raises an objection.
When a Physician Can—and Cannot—Object
A physician cannot simply ignore a valid Health Care Proxy because they disagree with a medical decision. The law does provide a narrow window for a physician to object based on conscience. If a doctor has a sincerely held moral or religious belief that is contrary to the agent’s directive, they are not legally compelled to carry it out.
This objection, however, is not the end of the matter. The doctor’s objection does not invalidate your wishes. A physician who objects on grounds of conscience cannot simply abandon the patient. They have a continuing fiduciary duty to the patient. They must cooperate fully and promptly to transfer the patient to another physician or facility that will honor the agent’s instructions. They cannot obstruct or delay the process.
Refusing to facilitate a transfer is a form of patient abandonment and a breach of professional duty. Your agent’s role in this contingency is to be a firm, persistent advocate, demanding that the hospital administration intervene and arrange for a transfer of care without delay.
The Agent’s Burden as a Fiduciary
Serving as a health care agent is a profound responsibility. It is a fiduciary duty of the highest order. The person you appoint must be prepared not just to make a difficult decision, but to defend it. They must withstand pressure from medical staff with different opinions and from family members struggling with the situation.
The agent is the custodian of your final wishes regarding your own body. Their job is to ensure your legacy of self-determination is honored. This requires fortitude and a clear understanding of their legal authority. The emotional weight is immense, and it is made heavier when met with resistance. That is why choosing the right agent—and equipping them with impeccably drafted documents—is one of the most critical acts of stewardship you will undertake in your estate plan.
The strength of these documents lies not on the paper they’re printed on, but in the clarity of the instructions and the resolve of the person you appoint. Have a frank conversation with your chosen agent about your wishes—and the challenges they might face—before a crisis hits.
If your advance directives are more than a few years old or were drafted without a focused discussion on these contingencies, they may not provide the firm support your family will need. We can schedule a review of your existing Health Care Proxy and Living Will to ensure the language is unambiguous, giving your chosen agent the strongest possible position to act as your steward.
