Decision making

Patient is unconscious, unwilling, or unable to make decisions

The palliative care expert says
Dr. Mike Harlos discusses working with families to make difficult decisions. (3:22)Video transcript
The paramedic says
Honouring patients' wishes(3:22)
The importance of clear and accurate information(3:22)Video transcript

When a patient’s wishes are unknown or unclear and they are unable or unwilling to participate in decision-making, first you will need to determine whether or not the patient created any documentation about their goals of care.

Considerations

  • Is there a legal decision-making document that makes the patient’s wishes known?
  • Do plans made in the past still apply to the present situation?
  • Is there a valid order to withhold resuscitation?
  • Is there a formal substitute decision-maker who is willing and able to serve?

If there is a legal decision-making document, then you can use it to work with the family. If there is a formal substitute decision-maker, you'll need to work with that person closely.


Conversation Prompts

I know this is a very hard time for you, but thankfully, we don’t need to make a decision right now. You and your partner already made that difficult decision and now it’s time to honour it. 

Are we still all in agreement with the treatment plan?  

His condition is deteriorating quickly and he’s seems closer to death than we first thought. As the substitute decision-maker, do you and I need to revisit the plan? 

 We seem to be going back and forth here. Can we discuss what that’s about?