Statesboro, GA, USA
I appreciate your questions. I'll give it a shot (forget the pun), though I'm still learning things myself about these issues.
I'm getting a little confused here, given the above definition. Per your experience in dealing with these issues, your post suggests that the Durable Power or Advanced Directive is subordinate to the wishes of an individual's family, and that it is not a legally binding document or set of documents.
If this is so, it makes the whole thing pretty pointless if a relative simply doesn't choose to honor a relative's choices.
You're right. In some cases it can be 'pointless', though not entirely. I've seen next-of-kin go against living wills in many cases, and in those cases the wishes of the living family always take precedence over the piece of paper. There are practical/ legal reasons for that, I suspect. The family can always claim that they know better the patient's most recent and intimate wishes than a document (that was often signed years before) can provide. In a considerable number of cases, however, the family does go ahead and honor the written wishes. Like I said before, the living will (I used the word 'advance directive' which you're right to point out is not exactly the same - more on that in a bit) is in reality more of a guideline. And questions can always arise in the minds of those presently conversant with the Medical Staff, about whether the layperson in the hospital bed really understood (before they were unable to respond) what they were signing way back when. The bottom line is, if the next-of-kin second-guesses any of this, they may act contrary to the ink.
What about the Power of Attorney? In that case, the POA does override next-of-kin (though often they are one and the same). But just like the previous scenario, the POA is not bound to a piece of paper, but is the source of the final decision.
So for good or for ill, written statements work sometimes and to limited degrees. We still value living decisions more than documents I suppose.
I am for Living Wills, but more than that ... I'm for clear communication to whoever (spouse or otherwise) is likely to be making those kinds of decisions. For when the time comes you'll likely be cognitively absent from the decision.
That's where the rub comes in this discussion. The mentally demented are already legally "absent" from the decision. And if they may be euthanized (something quite different from withholding treatment in an actively dying situation- which is what is currently supported under our laws) based upon a previously signed document perhaps years old, there will be a strong argument that next of kin, POAs, and medical professionals (where there are no family members or POA involved) should be able to make the same kind of decision. And Voila ... you have state sanctioned homocide of those who cannot legally make their own decisions.
I'm actually glad this discussion has taken place, because I feel that there are a lot of misconceptions ... and often not the clearest view of what would ensue if such a course were followed. Talking it through helps, I think.
Is a religiously founded/funded hospital entitled to ignore a patient's DNR request if such a request is contrary to the institution's philosophy?
Legally the patient (along with Physician approval, though this MD requisite is legally questionable when it comes to DNRs) has the say. But, having said that, I am also aware of no religious perspective that would condemn the refusal of life support by the actively dying. What is religiously condemned (in most if not all major religious views) is the subtle step forward into interventional causation of death via pharmocology.
Is a primary attending physician in any hospital, on the basis of his/her moral belief, entitled to ignore a patient's DNR request.
I'm pretty sure that the patient's wishes to refuse any medical treatment is legally binding. The physician in this case would only have to option to "quit" or "fire" the patient, while turning over care to another physician. But again, I've never known of a doctor (religiously minded or otherwise) who would oppose a DNR request. The tension runs mostly in the other direction ... where the physician doesn't want to "code" imminently dying patients whose decision-makers keep insisting on the full expression of ACLS (advanced Cardiac Life Support) over and over again.
If a patient has stipulated in an Advanced Directive that they wish to be creamated after after death, or donate body or organs upon death, and a relative objects for whatever reason, does the relative's view take precedence?
The same answer as I gave above. Ultimately a living decision-maker takes precedence over a document. The best option is to have harmony of wishes among your close kin, or if not, then the willingness to honor your wishes even if they don't quite agree. And in many cases, this is (thankfully) exactly the way it is.