hes. Who Decides In one study, nurses indicated that family opposition to the terms of the advance directive was the primary factor that inhibited health care providers from following the patient's advanced directives (Weiler, Eland, Buckwater, 1996). When families contradict the clients wishes, physicians take their views under consideration giving them immense weight. After all, who does the physician have to answer to? The living, of course. This is why when the family disagrees with the advance directive, the family's decisions usually win out. Another factor for the failure to follow an advance directive was the treating physician's refusal (Weiler et al). One reason for the physician's refusal may be reluctance to acknowledge increasing client autonomy. According to Hoefler, "dramatic changes in the medical profession itself have led to a breakdown in patient trust". Another reason for their refusal may be that it is unmistakably apparent that medical paternalism still exists. "A lingering paternalistic attitude on the part of many physicians is fostering distrust. If the treatment preferences of patients are to be honored, doctors may face the difficult prospect of relinquishing, at least in part, this central element of their professional role" (King, 1996, p. 51-52). Still another reason physicians may refuse is a for-your-own-good reasoning. If physicians are reluctant to honor clients' choices, they may explain their reluctance as a disagreement about whose judgment is better - theirs or their client's (King, p. 52). Also, physicians may give their own ethical principals priority when they conflict with clients wishes. This is reflected in the following statement by J.M. Hoefler: When a patient's advance directive was too restrictive to allow a simple or basic procedure that would yield the patient substantial benefits from...
