Conflicts between Surrogates

by Mark Hughes, MD, MA

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    00:01 Do want to say a word about times when there is family conflict because this does arise.

    00:06 You know, especially when there are multiple surrogates that have equal decision-making or maybe there are multiple family member, maybe one or two people are the primary surrogate decision makers but there's other family weighing in on what should be done.

    00:22 And that's going to create sometimes conflicts and disagreements.

    00:25 The surrogates may be arguing with each other.

    00:28 Other family members may be getting into the conflict, you know, often these arise because there are strong emotions, you know, seeing the patient sick.

    00:38 There may be the physiological stress that I've already mentioned.

    00:41 The surrogate may be fatigued, you know, they're tired by being in the hospital all the time or having to take care of their loved one and that might lead to, you know, more conflict or more disagreement.

    00:56 It may also be the case that there are family dynamics in which the preexisting conflicts may drive the current conflicts.

    01:04 So, right now, you're feeling with the - you're dealing with the conflict of the decision-making for the patient but it's really echoing family conflicts that have been existing for years.

    01:15 You know, maybe it goes all the way back to childhood and, you know, two siblings never agreed with each other and now, that's playing out when they're both having to make decision for the patient.

    01:28 So, what can you do as a clinician when there are these family conflicts? So, first of all, you need to get them to focus and you should focus on what are the goals of care for the patient? Make it all about the patient, not about the conflict.

    01:43 Your aim is really not to resolve the old conflicts.

    01:46 That may be impossible to do.

    01:48 It's really to make sure they understand, they need to make decisions that respect the patient's wishes, values, and goals.

    01:54 That's what they are serving the role as surrogate decision maker for.

    01:58 When they provide a, you know, recommendation about what they think should be done, they should provide a rationale, the reasoning behind their decisions.

    02:07 It's not just this is what I think and, you know, we're going to follow it.

    02:10 And then, another family member says, "This is what I think." And we should follow it.

    02:14 They should provide a rationale for why they think that is appropriate and in the best interest of the patient and the rationale for how that applies for the patient's wishes and values.

    02:25 And it may be that you need to draw on the expertise of other healthcare team members to help with the family conflict.

    02:32 So, know how to negotiate when there are two siblings that are bickering with each other in a meeting.

    02:37 Maybe there's a social worker that can help dissipate the stress and, you know, conflict that's going on in the room.

    02:45 So, making sure all members of the interested team are involved in this process to resolve the conflict.

    02:52 So, the key points about surrogate decision-making are we're trying to serve the best interest of the patient.

    02:57 We have to recognize that the role of surrogate decision maker is hard but we're really trying to support them to make the best decisions they can, so, that we really serve the interest of the patient.

    About the Lecture

    The lecture Conflicts between Surrogates by Mark Hughes, MD, MA is from the course Surrogate Decision Making and Family Meetings.

    Included Quiz Questions

    1. Focus on goals of care.
    2. Ask for the reasoning behind decisions.
    3. Draw on the expertise of team members.
    4. Resolve old conflicts.
    1. Consult a legal expert.
    2. Think about the goals of care.
    3. Make decisions favoring the patient's interests.
    4. Ask for the reasoning behind decisions.

    Author of lecture Conflicts between Surrogates

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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