Ms. B was told that she had a brain aneurysm.  She made an advance statement of wishes saying that she did not want surgery if the aneurysm burst.  However, shortly after she made this statement of wishes, the aneurysm burst and a team of surgeons took her to surgery believing that if not treated with surgery she would surely die.  The hospital (Hospital #1) backed the decision of the surgeons thinking if there was no intervention the hospital would be liable for her death. This all happened as the family were alerted to the emergency and were making travel arrangements as they were all from out-of-town. Unfortunately, the outcome of the surgery was that she became ventilator-dependent paralyzed from the neck down and needing 24-hour care.  Once the family was in the hospital, they held a family conference agreeing that Ms. B would not want to continue on in this state, and they petitioned the hospital to remove her from the ventilator. The hospital refused still believing the potential for legal ramifications.  The family was distraught; but eventually, with the guidance of a lawyer they retained, they were able to have her transferred to another facility (Hospital #2) that was willing to take her off the ventilator knowing that the chances of her making it were slim.  The felt that they were honoring her wishes along with her families’ wishes. A day later Ms. B was taken off the ventilator and she expired within the hour.  The family felt like they had done the right thing and they retained the lawyer to sue the initial hospital stating that they had not honored the wishes of their loved ones.  In the trial, the hospital claimed that there was not enough evidence that Ms. B wished to not be placed on machines as the family claimed, even though it was witnessed by a nurse that the anesthesiologist for the care engaged her in a conversation about this very topic before her aneurysm burst.  The hospital maintained that without documentation to that claim, they could not honor her wishes. In a surprising turn of events, the family filed suit in the Court of Appeals and won.  The appellate court agreed with the family stating that any conversation, whether it be personal or professional could be used to reach a conclusion about one’s desire about the nature of their own death.

Title: Legal Implications of Advanced Healthcare Directives: A Case Study Analysis


The case study presented involves Ms. B, who had previously expressed her wish not to undergo surgery if her brain aneurysm were to burst. Despite her advance statement of wishes, the aneurysm ruptured, leading to a decision by a team of surgeons to perform surgery. The outcome resulted in Ms. B becoming ventilator-dependent and paralyzed from the neck down. Upon the arrival of her family, they held a conference and unanimously agreed that Ms. B would not want to continue in such a state. However, Hospital #1 refused to remove Ms. B from the ventilator due to potential legal ramifications. Ultimately, the family sought legal assistance and transferred Ms. B to another facility (Hospital #2) willing to honor their wishes. Subsequently, the family sued Hospital #1 for not honoring Ms. B’s wishes, and the Court of Appeals ruled in their favor.

Legal Analysis:

In analyzing this case, it is essential to consider the legal framework governing advance healthcare directives. Advance directives are legal documents that allow individuals to express their healthcare preferences in the event they become unable to communicate or make decisions. These directives typically encompass living wills or durable powers of attorney for healthcare.

The principle of autonomy is fundamental in the context of healthcare decision-making. It grants individuals the right to make informed choices about their medical treatment, including end-of-life decisions. Thus, respecting an individual’s wishes is paramount when interpreting advance directives.

The case highlights the tension between the principle of autonomy and the duty of care owed by medical professionals. Hospitals have a legal obligation to act in the best interests of their patients and provide appropriate medical care. However, when faced with conflicting interests, such as honoring an advance directive versus administering potentially life-saving treatment, hospitals may find themselves in a legal dilemma.

Hospital #1’s decision to proceed with surgery despite Ms. B’s advance statement of wishes was likely influenced by the perceived legal liability for her potential death. This concern reflects the concept of medical futility, where healthcare providers may be hesitant to withhold treatment if it could be argued that it would likely result in a patient’s death.

The claim made by Hospital #1 that there was insufficient evidence to support the family’s assertion regarding Ms. B’s wishes raises the issue of documentation. In the absence of clear and explicit written documentation, hospitals may face difficulties in determining an individual’s true desires. However, this case introduces the role of personal or professional conversations as potential evidence for deciphering an individual’s desires regarding end-of-life care.

The Court of Appeals’ ruling in favor of the family signals a broad interpretation of what can be considered valid evidence in determining an individual’s wishes. By recognizing that conversations, whether professional or personal, can hold evidentiary weight, the court allows for a more nuanced understanding of a patient’s intentions beyond traditional written documentation.

The court’s decision aligns with the prevailing legal principles surrounding healthcare decision-making, emphasizing the importance of consent, patient autonomy, and communication with healthcare professionals. This ruling serves as a vital precedent that acknowledges the value of verbal exchanges and underscores the significance of patient-centered care.


The case of Ms. B illustrates the complex legal landscape surrounding advance healthcare directives and end-of-life decision-making. It highlights the delicate balance between honoring an individual’s autonomy and preserving the duty of care held by healthcare providers. The Court of Appeals’ ruling reflects a progressive interpretation of evidence, allowing for a wider range of factors, including personal and professional conversations, to inform healthcare decisions. As such, this case serves as a reminder of the critical role that effective communication and clear documentation play in ensuring an individual’s wishes are respected within the healthcare system.