Family involvement in medical decisions can be very important, both for the patient and for their loved ones. Collaborative healthcare choices can give everyone involved a feeling of involvement and peace, as much as can be experienced during any difficult medical situation.
An individual can discuss issues with their loved ones so that they know what their wishes are in certain situations. In addition, an individual can draft legal documents that outline their wishes and can help their family make decisions and ensure their wishes are carried out.
Students in the geriatric primary care and cancer settings that family involvement in treatment and decision making can have positive effects, including:
- Lowering the patient’s anxiety;
- Improving communication; and
- Enhancing the patient’s relationship with their physician.
Studies have also revealed that patients, family, and healthcare professionals, in general, do value family involvement in treatment decision making.
What Is the Role of Family in Medical Decision Making?
Family can be a very important part of medical decision making. They can provide support and advice to a patient as well as advocate for their wishes when they cannot do so themselves.
Family support and involvement can help a patient feel supported during what is likely a difficult time. Differences in family opinions, however, can also create conflict among family members and difficulties in medical decision making.
An individual can help their loved ones by putting their wishes in writing as well as drafting any helpful legal documents. An individual should consult with an attorney who can advise them about all of the legal tools, such as advanced medical directives they can use to help themselves and their loved ones when medical decisions must be made.
There are two main types of advanced medical directives, including the living will and the durable power of attorney. An individual can choose a family member they trust to have their healthcare power of attorney.
With this type of legal document, an individual assigns a healthcare agent on their behalf who will be responsible for making medical care decisions for them. The living will is discussed further below.
What Are Some Shared Decision Making Approaches?
Shared decision making in the healthcare context is an approach where medical professionals and patients share the best available evidence when they have to make a decision and patients are supported to consider their options in order to achieve informed preferences.
There are three main elements of the shared decision making process, including:
- Recognizing and acknowledging that a decision has to be made;
- Knowing and understand the best available evidence; and
- Incorporating the patient’s values and preferences into their decision.
There are four main steps to this approach, including:
- A professional informing a patient that they have to make a decision and that their opinion is important;
- The professional explains the options to the patient as well as the pros and cons for each;
- The professional and the patient discuss the preferences of the patient and supports the patient during their deliberation; and
- The professional and patient discuss the patient’s desire to make the decision, the decision is made or they decide to defer the decision and discuss the follow-up process.
Families can actively participate in this process. In many situations, this will require a family member to attend appointments so they can be informed of the options.
In other situations, family members can support a patient by discussing the options they were given as well as share their opinions on those treatment options. A patient can also share their wishes when certain situations arise and ensure that their family members will help carry out those wishes.
What Are Some Challenges with Medical Decision Making Involving Family?
There are challenges that arise with medical decision making that involves family. This may include pressuring the patient through controlling behavior or inundating the patient with too much information.
Communication can be a difficult issue, especially among families. Another issue may be family members putting their preferences ahead of the patient’s wishes.
What Are Legal and Ethical Considerations of Family Participation?
There are many legal and ethical considerations with family participation in medical decision making. The medical professionals involved in the patient’s care have to ensure that they are treating the patient and following the patient’s wishes, not those of their family members.
Typically, the laws and professional codes of ethics will emphasize the right of a competent patient to decide between the treatment options for themselves, even if those choices differ from the recommendations of their doctor or go against the advice of their family members. Family involvement in decision making for competent patients may contrast with laws and professional codes that focus on the rights of the individual to decide.
What Can Be Learned from Difficult Cases?
One of the more famous cases involving family medical decision making was the 1990 Terri Schiavo case. Terri was a 26 year old woman who suffered a cardiac arrest and, as a result, was in a persistent vegetative state.
A dispute arose between her parents, who did not want to remove her life support, and her husband, who said his wife would not have wanted to have her life prolonged artificially without any hope of recovery. The courts ultimately sided with her husband and her feeding tube was removed after 15 years.
The lesson from this case is an individual is never too young to put their wishes into writing. One way an individual can accomplish this is using an advanced directive.
An advanced directive is a legal document that includes specific health care instructions to be provided or to appoint other individuals to make decisions as needed. An advanced directive contains a living will.
This is a written document that describes what type of medical treatment an individual wishes for if they are deemed terminally ill or in a persistent vegetative state. Living wills inform healthcare providers to abstain from or to cease performing certain medical or surgical treatments.
The most common provisions in a living will include:
- Life-sustaining measures: Orders to use or not use life-sustaining measures when an individual is terminally incapacitated;
- Orders regarding mechanical measures: Orders to use or not use mechanical ventilation, dialysis, tube feeding, or other mechanical devices to keep an individual alive; and
- Organ donation and transplantation: Medical directives regarding donating an individual’s organs for transplantation or their body for scientific study.
Healthcare instructions are a type of written advance directive that can be used alone or in addition to the appointment of a health care agent. These instructions allow an individual to choose the treatment they do and do not want in the event they are in a terminal condition, persistent vegetative state, or end-stage condition.
An individual can also include their wishes regarding being an organ donor or other transfusions.
What Are Some Tips for Constructive Family Participation?
Constructive family participation in medical decision making can have a positive impact on the patient. Trusted family members can help ensure that patients are eating well, exercising, and taking their medications as needed.
All of these things can help prevent and manage their illnesses and keep them out of the hospital. Medical practitioners can help encourage constructive family participation by:
- Becoming familiar with the patient’s family dynamics;
- Providing an open and supportive environment for patients and their families to discuss options;
- Providing information they can understand so they can make an informed decision; and
- Providing follow-up care or referrals as needed.
Should I Consult with an Attorney?
If you have any issues, questions, or concerns related to medical decision making that involves family, you should consult with a family law attorney who can help you navigate the legal tools available. It is important to complete this process before an issue arises, so that your family members will know your wishes and will be able to help enforce them.
If you find it helpful, you can include your family members in this process so they are aware of your wishes and their duties. If an issue arises during your care with your legal documents, your attorney can help your family members as well.
