title: Making decisions with families at the end of life.
abstract: Because advance directives are not yet the norm, end-of-life decisions for patients without medical decision-making capacity are made regularly within discussions between the patient's physician and family. Communication and decision making in these situations require a complex integration of relevant conceptual knowledge of ethical implications, the principle of surrogate decision making, and legal considerations; and communication skills that address the highly charged emotional issues under discussion. The most common pitfalls in establishing plans of care for patients who lack decision-making capacity include failure to reach a shared appreciation of the patient's condition and prognosis; failure to apply the principle of substituted judgment; offering the choice between care and no care, rather than offering the choice between prolonging life and quality of life; too literal an interpretation of an isolated, out-of-context, patient statement made earlier in life; and failure to address the full range of end-of-life decisions from do-not-resuscitate orders to exclusive palliative care.
authors.affiliation: Department of Family Medicine, James H. Quillen College of Medicine, 37614, USA. lang@etsu.edu
authors.forename: Forrest
authors.initials: F
authors.lastname: Lang
authors.forename: Timothy
authors.initials: T
authors.lastname: Quill
mesh_terms: D003657:Decision Making; D004992:Ethics, Medical; D005190:Family / Q000523:psychology*; D006801:Humans; D011368:Professional-Family Relations; D019452:Terminally Ill