Decision making

Patient's wishes aren’t documented or known

The family expects me to save him, but his body is shutting down and nothing I can do will stop that. 

If you determine that there is no legal documentation about the patient’s goals of care, then you will need to give careful thought to who should be involved in this process.


  • What direction do your provincial laws, policies, and guidelines provide regarding default substitute decision-maker? (Most often it will be a family member who assumes this role.)
  • What guidance do your community guidelines provide as to who you may consult about decision-making?
Once you’ve clarified who is legally able to make decisions on the patient’s behalf, you can focus on the decision-making process. Begin by:

  • Taking time to sit down with the family or substitute decision-maker and focus on what they believe the patient would want.
  • Explaining what treatment can be provided and how those measures might impact the patient and family.
  • Providing options to manage symptoms and keep the patient comfortable and at home.

Conversation Prompts

Your husband is deteriorating rapidly. Here’s what we can do to make him comfortable and give you and the family time with him. 

If your mother could make this decision, what do you think she would want? Would she want us to keep her as comfortable as possible at home?

We can give your son medication that will ease his symptoms and keep him comfortable. This way you can spend some quiet and calm time together before he dies.