Conceptions of family-centered medical decisionmaking and their difficulties

Cambridge Quarterly of Healthcare Ethics

Volumn 12, Issue 2, 2003, Pages 196-200

  Hyun, Insoo ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

DECISION MAKING; ETHICS; FAMILY; HUMAN; MORALITY; REVIEW; ANALYTICAL APPROACH; ARTICLE; HUMAN RELATION; INFORMED CONSENT; MEDICAL ETHICS; PHILOSOPHICAL APPROACH; PROFESSIONAL PATIENT RELATIONSHIP; PROFESSIONAL PRACTICE; UNITED STATES;

ANALYTICAL APPROACH; PHILOSOPHICAL APPROACH; PROFESSIONAL PATIENT RELATIONSHIP;

DECISION MAKING; ETHICAL ANALYSIS; ETHICS, CLINICAL; FAMILY; HUMANS; PROFESSIONAL PRACTICE; PROFESSIONAL-FAMILY RELATIONS; THIRD-PARTY CONSENT; UNITED STATES;

EID: 0038203119     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0963180103002111     Document Type: Review

References (8)

1. Hardwig J. What about the family? Hastings Center Report 1990;20(2):5-10.
2. Nelson JL. Taking families seriously. Hastings Center Report 1992;22(4):6-12.
3. Nelson JL, Nelson HL. A Patient in the Family: An Ethic of Medicine and Families. New York: Routledge; 1995.
4. See note 1, Hardwig 1990:8. Although Hardwig argues that a patient's medical decisions should be made within the context of a family conference, he does not explore the normative guidelines that are to help determine the course of the final decision. All that Hardwig offers by way of elucidation is that every competent family member who can be significantly affected by the decision should participate. For a criticism of Hardwig's proposal, see: Blustein J. The family in medical decision making. Hastings Center Report 1993; 23(3):6-13. James and Hilde Nelson also do not offer a normative structure for family-centered medical decisionmaking in their otherwise detailed and well-written book A Patient in the Family; see note 3, Nelson, Nelson 1995.
5. Of course, there can be good moral reasons to distribute decisionmaking authority disproportionately in a specific case, as when a particular member is mentally incompetent to participate meaningfully in the decision or when a certain member is obviously maliciously motivated.
6. The monetary dimensions of a family's overlapping interests are discussed briefly in: Fetters M. The family in medical decision making: Japanese perspectives. Journal of Clinical Ethics 1998;9(2):140-1; and Moazam F. Families, patients, and physicians in medical decisionmaking: a Pakistani perspective. Hastings Center Report 2000;30(6):34.
7. The monetary dimensions of a family's overlapping interests are discussed briefly in: Fetters M. The family in medical decision making: Japanese perspectives. Journal of Clinical Ethics 1998;9(2):140-1; and Moazam F. Families, patients, and physicians in medical decisionmaking: a Pakistani perspective. Hastings Center Report 2000;30(6):34.
8. At least one empirical study suggests that some people's concerns about a patient-centered approach to acute care decisionmaking may be unfounded. A recent cross-sectional study of 3158 seriously ill patients revealed that economic hardship on the family does not appear to be a significant issue in patients' and surrogates' disagreements about the goals of acute care. Patients have been found to consider frequently how their particular decisions would affect others. See: Covinsky KE, Landefeld CS, Teno J, Connors AF, Dawson N, Younger S, et al. Is economic hardship of the families of the seriously ill associated with patient and surrogate care preferences? Archives of Internal Medicine 1996;156(15):1737-41.