Family Decision Making in Foregoing Life-Extending Treatments

Abstract

Families generally serve as surrogate decision makers for hospitalized dying patients who are unable to express their own decisions regarding life-prolonging treatments. The authors interviewed family members whose relatives died in the hospital following the withdrawal of aggressive medical treatments. Interviews were at two time periods: at 1 and 6 months post-patient death. Study data indicated a core set of phases which family members experienced in the process of arriving at the decision to withdraw treatment: recognition of futility, coming to terms, shouldering the surrogate role, and facing the question. At 6 months post decision, families reflected on the need for corroborating evidence that they had made the right decision, which the authors term seeking a triangulation of certainty. Advance directives and forthright communication from clinicians were two factors that most helped family members feel more positive about events.