Decision making

If the intervention proceeds

When a patient, family, or substitute decision-maker has made up their mind, you may not be able to change it. Trying to convince them otherwise will only create a power struggle and undermine your relationship.

You may want to begin by requesting a consult with another health care professional. Look to your community guidelines for direction as to who this should be (e.g., a palliative care team member or on-call local resource, such as an EMS or ED physician). This consultation may continue while you are engaged in the intervention.

If the family insists on an intervention you don’t support, pause during the intervention if the patient responds poorly or their suffering becomes more evident. Continue to check in with the family that you are acting according to their wishes; and, if possible, continue to consult with another health care resource.

Conversation Prompts

From what I’m observing (e.g. his breathing is more laboured, his colour has changed, he’s becoming more agitated), this intervention is making him feel worse. 

Do you want me to stop? I would like to contact the physician on call now to see about getting new medical orders.

After the call

When patients or families challenge your best medical advice, you may feel that they don’t respect or trust you. Remember that they’re facing death in a very personal way. They’re grappling with strong feelings and overwhelming thoughts under very difficult circumstances, and their reactions most likely come from a place of fear and even desperation.

Try not to see any push back as a sign that you have failed. It may help to remember you’re both doing the best you can with what you know. In the end, patients and families hold the decision-making power and are ultimately responsible for the decision.

Even if your mind knows this to be true, you may find yourself struggling with uncomfortable feelings about the way the intervention went. Reach out to a trusted colleague or seek support from someone who can support you.