When Your Healthcare Rep Won’t Honor Your Wishes: Lessons from ‘The Pitt’
In the latest edition of my LinkedIn newsletter, A Matter of Life and Death, I wrote about a storyline from HBO Max’s new medical drama The Pitt that shook me with how accurately portrayed it was.
Without giving away too much, here’s the setup: A father is critically ill, and his adult children are in charge of making medical decisions. He had been clear — very clear — that he did not want to be kept alive on machines. His daughter couldn’t bring herself to “give up on him.” His son was ready to follow his father’s wishes but didn’t want to go against his sister.
The father’s wishes were known. But in the chaos of the hospital, the emotional weight of the moment took over. The staff deferred to the family, and the family wasn’t in agreement.
Why This Happens in Real Life
Most people think that if they put their wishes into an Advance Directive, those wishes will automatically be followed. But in practice, that’s not always true.
In the middle of a medical emergency:
The staff may not have time to read your paperwork in detail.
The staff may follow a hospital protocol that only allows their legal department to interpret Advance Directives, and even then, only if a family member seeks to enforce it.
They may prioritize avoiding conflict with your family.
Your Healthcare Representative — the person you’ve chosen to speak for you — might be swayed by guilt, fear, or pressure from other family members.
And here’s the part people often miss: this isn’t rare. I’ve seen it happen in real life, in cases where everyone thought “the paperwork” was enough.
The Most Important Decision You Haven’t Thought About Enough
Choosing the right Healthcare Representative is one of the most important — and most overlooked — parts of estate planning.
It’s not about who loves you most.
It’s not about who “should” be in charge because of birth order.
It’s about who will actually follow your wishes when the moment comes.
That means choosing someone who:
Understands your wishes clearly.
Respects your autonomy, even if they personally disagree.
Can make hard calls under extreme stress.
Won’t fold under pressure from others.
For many people, that person is not their adult child. Sometimes it’s a spouse. Sometimes a sibling. Sometimes a trusted friend.
How to Protect Yourself
Choose the right person. Think about personality, not just relationship.
Talk to them. Don’t just hand over a form — have an unflinching conversation about what you want and why.
Put it in writing, in detail. An Advance Directive is still important; it can help guide decisions and provide backup.
Name alternates. If your first choice can’t or won’t act, have someone else ready to step in.
Tell the rest of your family. Surprises create conflict. The more they hear from you directly, the less likely they’ll argue later.
The Bottom Line
The Pitt is fictional. But that scenario — wishes ignored, families conflicted, staff caught in the middle — is painfully real.
You can’t control every variable in a medical crisis. But you can make it much more likely your wishes will be honored by choosing the right person to speak for you and making sure they’re ready for the job.
If you missed my The Pitt edition of A Matter of Life and Death newsletter, you can read it here.
And if you’re ready to talk about putting a plan in place that will actually work when you need it, I can help.
If you want to get started on your estate plan, read about our estate planning services and schedule an appointment.
To your family's health + happiness.
~Candice N. Aiston