Do want to say a word about times when there
is family conflict because this does arise.
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.
And that's going to create sometimes
conflicts and disagreements.
The surrogates may be
arguing with each other.
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.
There may be the physiological stress
that I've already mentioned.
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.
It may also be the case that there are family dynamics in which
the preexisting conflicts may drive the current conflicts.
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.
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.
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.
Your aim is really not to
resolve the old conflicts.
That may be impossible to do.
It's really to make sure they understand, they need to make decisions
that respect the patient's wishes, values, and goals.
That's what they are serving the role
as surrogate decision maker for.
When they provide a, you know, recommendation
about what they think should be done,
they should provide a rationale,
the reasoning behind their decisions.
It's not just this is what I think
and, you know, we're going to follow it.
And then, another family member says,
"This is what I think." And we should follow it.
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.
And it may be that you need to draw on the expertise of other
healthcare team members to help with the family conflict.
So, know how to negotiate when there are
two siblings that are bickering with each other in a meeting.
Maybe there's a social worker that can help dissipate the stress
and, you know, conflict that's going on in the room.
So, making sure all members of the interested team
are involved in this process to resolve the conflict.
So, the key points about surrogate decision-making
are we're trying to serve the best interest of the patient.
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.