Making Decisions With Families at the End of Life
Document Type
Review
Publication Date
8-15-2004
Description
Because advance directives are not yet the norm, end-of-life decisions for patients without medical decision-making capacity are made regularly within discussions between the patient's physician and family. Communication and decision making in these situations require a complex integration of relevant conceptual knowledge of ethical implications, the principle of surrogate decision making, and legal considerations; and communication skills that address the highly charged emotional issues under discussion. The most common pitfalls in establishing plans of care for patients who lack decision-making capacity include failure, to reach a shared appreciation of the patient's condition and prognosis; failure to apply the principle of substituted judgment; offering the choice between care and no care, rather than offering the choice between prolonging life and quality of life; too literal an interpretation of an isolated, out-of-context, patient statement made earlier in life; and failure to address the full range of end-of-life decisions from do-not-resuscitate orders to exclusive palliative care.
Citation Information
Lang, Forrest; and Quill, Timothy. 2004. Making Decisions With Families at the End of Life. American Family Physician. Vol.70(4). 719-723+725. https://www.aafp.org/afp/2004/0815/p719.html PMID: 15338785 ISSN: 0002-838X