(Susan Hatch is a retired certified nursing assistant and medical office manager from Dover, New Hampshire. After her husband, Clifton “Teddy” Hatch, was intubated and resuscitated despite explicitly stating in his advance directive (AD) that he did not want these interventions, she began advocating for stronger patient-directed care in hospital settings and for broader education on end-of-life planning. Used with permission, this article appeared at https://kevinmd.com/2025/11/advance-directives-not-honored-a-wifes-story.html.)
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For nearly a decade, almost every time my husband, Teddy, went into the hospital, they asked if he had an AD. He did. It was notarized and given to any doctor he saw and any hospital he visited, including the one he died in.
But on the last day of Teddy’s life, the interventions he received were explicitly against his wishes as documented in his advance directive: no resuscitation, no intubation.
My husband was clinically dead when they started the CPR and intubation. There was no coming back to himself. So why were his wishes not honored?
I’ve since learned that what Teddy experienced is not that unusual in a healthcare system that prioritizes aggressive treatment above all else, including patient directives. I see this model reflected in news outlets focused on health and healthcare. The voices featured there are much more likely to be doctors than patients. But patient voices matter, too, especially when it comes to end-of-life care.
For the last seven to eight years of Teddy’s life, he was in ill health, dealing with COPD, two heart attacks, atrial fibrillation, and kidney problems. We had long discussions about what kind of end-of-life care he wanted. He didn’t want to be hooked up to machines. He didn’t want artificial nutrition. He didn’t want to be intubated. He wanted comfort care, and when it was time for him to go, he wanted to hold my hand. He felt secure knowing that he had his advance directive in place and that he and I had talked about it.
On February 13, 2024, Teddy fell and broke his hip. We went straight to the hospital. Although surgery was successful, a day later things started to change. His breathing was labored; he was struggling. At that point, a bunch of respiratory staff came in, and, feeling like I was in the way, I left.
In the middle of the night, I got a call from the hospital that they had intubated Teddy. They said it was only temporary. I said, “OK.”
When I went back to the hospital in the morning, they had removed his breathing tube as expected, but Teddy was angry he had been intubated. It broke my heart that he felt let down by me, his healthcare proxy. At my sister-in-law’s suggestion, I confirmed with his case manager at the hospital that they were in possession of his advance directive, and I provided new copies as well. I thought that would matter.
The last time I saw my husband was February 24. That afternoon, shortly after coming home from the hospital, I received a call that Teddy had been coded and they were intubating him again. I said, “Tell them to stop it!” I rushed back to the hospital so I could see Teddy and say my goodbyes. When I arrived, he still had the tube in his throat and mitts on his hands to prevent him from yanking out a nasogastric tube.
Today, I tell people that I’m grieving two losses: I grieve the loss of my husband of 58 years, my best friend, and the father of my children. But I also grieve the loss of the ending Teddy wanted. He just wanted to hold my hand and go. He wasn’t allowed to do that.
I understand now that on their own, ADs are not enough to ensure someone has the end-of-life experience they want. That requires having ongoing conversations with healthcare providers. But the burden should not be on patients and their proxies to be heard by the medical professionals caring for them. Hospitals and healthcare workers need a dramatic reorientation, one that prioritizes patient-directed care and preemptively familiarizing themselves with their patients’ wishes.
Teddy and I had no idea how naive we were to think that his healthcare providers would not immediately jump to unnecessary or unwanted interventions and invasive procedures, given his explicitly stated wishes. I imagine many other baby boomers are like us, unaware of all that’s required to get the care they want at the end of their lives.
I’ve learned a lot since Teddy’s death, but nothing I’ve learned will give me and Teddy the final goodbye we should have had. It should not be too much to ask that medical professionals listen to what their patients want and respect – not blatantly disregard – their wishes. We all deserve that.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
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I am so sorry to learn your husband’s directive was not honored. This is a problem that the medical community refuses to resolve. But there is a way to get their attention: sue for ‘wrongful prolongation of life.”. This is a relatively new tool and often a very effective one. When the hospital has to pay significant damages, their legal staff will ensure that future directives are honored.
Malpractice Lawsuits Allege Wrongful Prolongation… : ED Management https://share.google/tt2pJHORZ452WvIKa
So sorry this happened to you and your husband. It is not clear to me why you think having ongoing conversations with healthcare providers would ensure patients would get the end-of-life experience they want. You told them to stop, but it did not seem to have any effect.
Sometimes it seems smarter at end of life to avoid the hospital altogether.
There have been legal cases where healthcare providers have had to pay for ignoring advance directives.
I concur. Avoiding the hospital sounds good in theory, but if one has fallen and broken a hip, or if one can hardly breathe, or if one is suddenly in great pain–and if one is not on hospice–what else can we do? Unfortunately, the writer does not give us salient information: namely, what happened when she came back and found her husband intubated again–did she insist it be taken out? Did the care team abide by her wishes?
In any case, without knowing the hospital personnel’s side of the story, it does seem like, once the hip issue was treated, they should not have intubated him.
This is terrible and what worries me as a person alone, but with a living well with explicit directions and a healthcare proxy person who knows how I feel, that they will not abide by this anyway. All it takes is the lure of money for more medical treatment by the hospital or someone in their care team who is religious and doesn’t believe in these directives.
This is really a concern. I would think you could sue them. Mary
This happened to my 87 yr. old Mom who was in the hospital because she was experiencing severe shortness of breath. She had her DNR paperwork in her hands but when her heart stopped they did CPR and intubation. She was unconscious and uncomfortable for 3 days afterward until she died. We were so angry they didn’t follow her wishes!
I hope the law suits have a long term effect but I think the best suggestion above was to avoid hospitals or take your loved one out of the hospital if at all possible after the acute problem is addressed. I pray nothing like this happens to anyone else who has so carefully done their due diligence with end of life planning and legal directives.
A related issue: an article in KevinMD – https://kevinmd.com/2026/07/why-medicare-hospice-coverage-fails-the-dying.html
signed “Patricia M. Fogelman is a nurse practitioner,” but the link to her bio says “Page not found.” She complains (and gives some suggestions for improvement) that because Medicare won’t pay for board and care, what happens with hospice patients who don’t have competent people at home to care for them (or don’t have the proper setup … “bathrooms that won’t fit a hospital bed” ???? must be misspoken…)
end up being sent to SNF-level facilities when being discharged from the hospital. The paperwork reflects a rehabilitative trajectory. It looks like the author is back east somewhere. I think the operative principle here is that the hospice patient was in the hospital and the hospital needs to find an “appropriate” place to discharge her. It brings up all sorts of questions in my mind about being discharged Against Medical Advice.
My comment is: I once had a client who was dying from cancer (at least 10 years ago). She lived alone and had not been admitted to a hospital prior being on hospice. She was able to get on hospice despite having no one to care for her (Southern CA). She remained at home for several weeks on hospice (mostly alone) until she collapsed and could not get up. The ambulance took her to the hospital where she remained in a hospice bed before dying a few days later.
I’m so sorry this happened to you. As heartbreaking as Teddy’s story is, sadly it doesn’t surprise me. As an end-of-life doula and patient advocate, I’ve seen far too many situations where a person’s clearly documented wishes weren’t honored, and it’s one of the reasons I’m so passionate about this work. You did exactly what Teddy asked of you. The heartbreaking part is that even with an advance directive in place and a healthcare proxy advocating for him, his wishes still weren’t respected. No one should spend their final hours receiving treatments they explicitly refused. Thank you for having the courage to share Teddy’s story. I hope it opens more people’s eyes to the fact that an advance directive is only one piece of the puzzle—and that we still have a long way to go in truly honoring patient choice at the end of life.
There are so many stories like this one. Maybe it’s time to open up the discussion and bring hospital personnel into it. Ask them, Why are they (sometimes? always?) not abiding by advanced directives? In Teddy’s case, could he have been given comfort treatment instead of being intubated? Or is being intubated part of comfort treatment? A lot of questions that could use some answers.