Courts generally uphold the validity of a properly executed advance directive. In Rettinger v. Little John, (No. 9CVD455, Forsythe, North Carolina General Court of Justice, September 2, 1991), the court held that the patient had validly executed a court declaration of desire for a "natural death" under a North Carolina statute, and the court ordered a nursing home to honor any requests by patient's wife to withdraw a nasogastric tube. The court added that the nursing home, its' officials, and Mr. Rettinger's physician would be absolved from criminal or civil liability for complying with the spouses request.

Similarly, in Re: Ray, (No. 9-2202ca A, Circuit Court of Oskaloosa, Florida, July 29, 1991), the court concluded that a living will was valid and thus ordered the cessation of all life supports, including the removal of feeding tubes within twenty-four hours.