What to Do If a Nevada Hospital Refuses to Follow Your Advance Directive

You did everything right — executed the advance directive, had it properly witnessed, registered it with the Lockbox. Then the attending physician tells your agent they will not follow your treatment instructions. Is this legal?

In some circumstances, yes. But the physician has obligations that many families do not know about.

When a Provider Can Legally Refuse

Under NRS 449A.112, a healthcare provider in Nevada can refuse to comply with a patient's advance directive based on moral, ethical, or religious objections. This provision protects physicians from being forced to participate in treatment decisions that conflict with their professional conscience.

Common scenarios where refusal occurs:

• A physician personally objects to withdrawing life-sustaining treatment
• A religiously affiliated hospital has institutional policies against certain end-of-life interventions
• The physician believes the directive's instructions do not apply to the patient's current clinical situation (for example, the directive addresses terminal illness, but the physician does not consider the patient terminal)

The Transfer Obligation

Here is the part most families miss: a provider who refuses to follow your directive is not allowed to simply ignore it. Under Nevada law, they have an immediate statutory duty to:

1. Inform the patient or their agent that they will not comply with the directive
2. Coordinate the transfer of care to another provider or facility willing to honor the directive

The physician cannot continue treating you according to their own preferences while disregarding your documented wishes. They must either follow the directive or hand your care to someone who will.

If the physician refuses to inform you or arrange a transfer, this is a violation of patient rights, not a matter of medical discretion.

The POLST Gap

The most common "refusal" is not actually a refusal of the advance directive — it is a misunderstanding about what the directive requires of emergency responders.

An advance directive is a legal planning document. Paramedics and EMTs are legally required to attempt full resuscitation unless they see a signed medical order: either a POLST (Provider Order for Life-Sustaining Treatment) or an Out-of-Hospital DNR. Presenting your advance directive to a paramedic team and expecting them to withhold CPR is not a failure of the system — it is a gap between legal documents and clinical orders.

If your goal is to ensure that emergency responders honor a no-CPR preference, you need a POLST (signed by your physician, printed on 65-pound pink cardstock) or an Out-of-Hospital DNR (issued by the state after physician certification of terminal illness, with a $5 fee).

What to Do in the Moment

If a physician or facility refuses to follow your advance directive:

Ask for the refusal in writing. Request that the provider document their refusal and the specific reason in the medical record. This creates a record if you need to file a complaint or pursue legal remedies later.

Request an immediate transfer. Invoke the provider's statutory duty to coordinate your transfer to a willing facility. In large metropolitan areas like Las Vegas and Reno, alternative providers are typically available. In rural Nevada, options may be more limited, and the transfer process may take longer.

Contact the hospital's patient advocate or ethics committee. Most hospitals have an internal dispute resolution process. The ethics committee can review the situation and may resolve the conflict without requiring a transfer.

File a complaint with the Nevada Division of Public and Behavioral Health. If the provider refuses to follow the directive and also refuses to transfer care, this is a reportable violation.

Preventing Refusal in Advance

Several steps reduce the likelihood of a directive being refused:

• Discuss your directive with your physician before a crisis. A physician who has reviewed and discussed your wishes in advance is far less likely to refuse in the moment.
• Choose providers whose values align with yours. If withdrawing life-sustaining treatment is part of your plan, confirm that your physicians and preferred hospital do not have institutional policies against it.
• Register with the Lockbox. A registered directive that the hospital can retrieve electronically carries more institutional weight than a photocopy presented by a family member.
• Coordinate POLST and DNR orders when clinically appropriate. These convert your wishes into binding clinical orders that leave less room for provider discretion.

The Nevada Advance Directive & Living Will Kit includes a treatment preferences worksheet that helps you and your physician align on expectations before a crisis, plus a POLST coordination reference for translating your directive into medical orders.

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