title: Translating psychosocial insight into ethical discussions supportive of families in end-of-life decision-making.
abstract: A large number of Americans would rather rely on family and friends more than their physicians about end-of-life care and decisions. Moving beyond traditional clinical ethics and its dyadic focus on the physician-patient relationship, this article presents an approach to ethical decision-making at the end of life that is more inclusive of the patient's family and has the potential to advance social work practice in end-of-life care. Initial attention is given to how psychosocial and bioethical perspectives and practices interact to shape understanding of moral issues in end-of-life decisions. Morally relevant principles are then adapted from contextual therapy as being useful for including more of a family focus and viewing ethical decision-making at the end of life as a family process. Specifically, focus is on exploring the ethical dynamics of family systems that impact the decision-making process and translating psychosocial insight into ethical discussions that are supportive of families. The case of a patient with sudden and unexpected brain death and without advance directives demonstrates one family's unresolved grief and illustrates how its members were helped to reason morally about end-of-life choices. Contributions of a social worker and bioethicist are illustrated.
authors.affiliation: Department of Social Work, Cleveland State University, OH 44115, USA. l.w.foster@csuohio.edu
authors.forename: Larry W
authors.initials: LW
authors.lastname: Foster
authors.forename: Linda J
authors.initials: LJ
authors.lastname: McLellan
mesh_terms: D000328:Adult; D001926:Brain Death; D003657:Decision Making / Q000941:ethics; D033061:Ethics Consultation; D005066:Euthanasia, Passive / Q000941:ethics / Q000523:psychology; D005190:Family / Q000523:psychology*; D006801:Humans; D008020:Life Support Care / Q000941:ethics* / Q000523:psychology; D008297:Male; D028681:Moral Obligations; D033262:Narration; D018458:Persistent Vegetative State; D011368:Professional-Family Relations; D012944:Social Support; D012949:Social Work, Psychiatric / Q000941:ethics*; D013727:Terminal Care / Q000941:ethics* / Q000523:psychology; D014481:United States