What is a recommended approach when there is conflict between patient autonomy and family wishes?

• A. Prioritize family wishes.
• B. Ignore patient wishes if family disagrees.
• C. Make unilateral decisions without documentation.
• D. Prioritize patient expressed wishes when capacity is intact, facilitate communication, document decisions, and involve ethics as needed.

Answer: (D)

When a patient’s wishes conflict with what family wants, the key is to uphold the patient’s autonomy if the patient has decision-making capacity, while actively facilitating conversation and clarity among all parties and documenting the outcome, with ethics consultation available as needed. If capacity is intact, the patient’s expressed choices guide care because they have the right to decide about their own treatment. This involves providing clear information, exploring the patient’s goals and values, and ensuring they understand the consequences of options. Involving the family is still important to support understanding and to align on goals, but they do not override the patient’s decisions. Clear documentation of the patient’s decisions, the information provided, and the rationale helps protect everyone and guides future care. When uncertainties or disagreements persist, consulting an ethics committee or ethics liaison can help mediate and reach a plan that respects the patient’s wishes while considering family concerns.