Fighting With Families Over Patient Care

Batya Swift Yasgur, MA


April 16, 2015

In This Article

Families May Have Ulterior Motives

Family dynamics can be difficult in the best circumstances. A hospital room is one of the worst circumstances. Physicians can be drawn into complicated family situations, pitting what the physician thinks is best for the patient against what the family wants.

Medscape's Ethics Report 2014, Part I, surveyed more than 21,000 physicians about two of these painful dilemmas:

"Would you go against a family's wishes and continue treating a patient whom you felt had a chance to recover?"

"Would you withhold information from a patient at a family's request?"

Many survey respondents unequivocally affirmed the primacy of the physician's responsibility toward the patient. However, others noted that they might be put in a difficult situation. Whereas 22% said they would fight the family's wishes, 28% said they would not, and 50% said "it depends."

"My duty is to the patient, not the family," said one respondent. "Prioritizing the family would dilute the sacred relationship between the patient and physician," said another.

Some physicians described situations in which they felt the family's chief concern was money, not the patient's welfare. "I would fight the family if I felt the family's intentions were to end her life sooner for money or fortune, or other unethical reasons," said one physician. "More than family's wishes are my beliefs about the chances of recovery for this patient." "My duty is to the patient, not an inheritor who may want to kill him off to get his estate."

"I'm glad so many participants said, 'It depends,' comments Paul N. Lanken, MD, professor of medicine in the Division of Pulmonary and Critical Care at the Hospital of the University of Pennsylvania, and associate dean for professionalism and humanism at the Perelman School of Medicine. "These are some of the most complex questions physicians can face. There are general rules, but there will always be exceptions."

"In all circumstances, we owe our allegiance to the patient," agrees Geri-Ann Galanti, PhD, of the Doctoring Program at the David Geffen School of Medicine, UCLA. "The best interest of the patient comes first."

Do Families Always Have the Patient's Best Interests at Heart?

Most of the time, families want what's best for the patient. Their requests to discontinue treatment or withhold information comes from a sincere desire to protect their loved one from unnecessary suffering.

But regrettably, that's not always the case. Survey respondents described families with ulterior motives for treatment discontinuation, such as greed (to receive an inheritance or cash in on a life insurance policy), fear of financial burden, or even malicious intent. And some families wish to have information withheld as a means of controlling the relative. So it's important to keep unsavory motives on your radar.


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