When patients and families disagree

Advance care planning is meant to safeguard the patient's autonomy when that individual is unable to make his or her own healthcare decisions. Yet, families do not always agree with the specific wishes of their family member when there is a need to make critical decisions, such as continuing treatment because of some new research protocol or providing comfort through palliative care. When there are patient-family disagreements, the decision-making process is even more complicated if the patient is fully able to participate because competent patients have the right to make their own healthcare decisions. In addition, family members may not agree with each other. Thus, even though healthcare providers want to respect their patients' wishes, they are uncertain about the most appropriate course of action. This article discusses why families and patients may disagree, describes relevant ethical perspectives for understanding the issues, and identifies possible strategies to help nurses address these ethical dilemmas. Valuing the patient as a person, the vulnerability of the patient, whose interests should prevail, and quality of life are pertinent and overlapping ethical issues in this case. Possible strategies that nurses can implement to address the "thorny" issues raised by patient-family disagreements include helping the patient to remain in control, facilitating responsible decision making, requesting an ethics consultation, and requesting a palliative care consultation.