I Need Help Making a Medical Decision for Someone Else
A serious medical decision may involve surgery, life-support treatment, another round of treatment, a feeding tube, dialysis, hospitalization, or whether to begin, continue, limit, or stop an intervention.
It may also involve changing the goal of care when treatment is no longer helping in the way the person hoped.
The question isn’t only, “Can this be done?” It’s also: “What’s it likely to change, what might it cost the person, and does it fit what matters to them?”
If you’re making this decision for yourself, see I Need Help Deciding About Treatment →
Name the Decision
First make sure this is actually your decision to make. If the person can still make this decision, it belongs to them.
Start with the decision in front of you.
“What exactly are we being asked to decide, does it have to be decided now, and what happens if we wait?”
Ask what the reasonable options are, including not starting or stopping treatment, and what happens medically if you don’t do it.
Don’t let several different decisions become one large yes-or-no question.
If you’re being asked whether to attempt CPR, that’s one of these decisions. Ask:
“If their heart stops, how likely is CPR to work for them, and what would recovery probably look like?”
If you aren’t sure whether they can make this decision, or who decides if they can’t, use Can This Person Still Make Their Own Medical Decisions? →
If you’re making the decision for them, try to make the choice they would make, based on what they’ve said, valued, and wanted.
Ask What the Treatment Is Supposed to Accomplish
Ask:
“What’s this treatment supposed to accomplish, and how likely is it to do that?”
“What are the most likely serious side effects or complications?”
The goal may be to cure or control the illness, help the person live longer, relieve a symptom, restore an ability, or get through a crisis.
A treatment can be medically possible without being likely to accomplish what matters to the person.
Ask What the Clinician Recommends
Ask:
“Based on what you know about this person and what matters to them, what do you recommend, and why?”
Then ask how certain they are, what concerns them most about the other choices, and what would make them change the recommendation.
Ask What Life Is Likely to Look Like
“What would the person’s life probably look like if this works, and if it doesn’t?”
Don’t stop at whether the person might survive. Ask what they may be able to do afterward: communicate, eat or drink, breathe without machines, move, recognize people, care for themselves, or return home.
Choosing not to start a treatment isn’t the same as choosing no care. Comfort and symptom treatment can continue.
Ask What the Treatment Will Require
A treatment may sound manageable until the care afterward is included.
Ask what care might be needed afterward, where it’s likely to happen, and who’s expected to provide it. That may include rehabilitation, a nursing facility, transportation, equipment, supervision, or hands-on caregiving.
A plan isn’t complete if it depends on care, equipment, transportation, or caregiving that hasn’t actually been arranged.
Connect the Choice to What Matters
Ask:
- What’s the person hoping this treatment will make possible?
- What are they most afraid of?
- What outcome would make the treatment no longer worth it?
Then ask:
“How does each option affect the things that matter most to this person?”
If a Time-Limited Trial Could Help
Sometimes treatment can be tried for a defined period while everyone watches for a specific result.
Before starting, agree on:
- what the treatment is supposed to accomplish
- how long it’ll be tried
- what would show it’s helping, and what would show it isn’t
- what happens in either case
- what happens if things are still unclear at the end of the trial
“If the treatment doesn’t meet the goal by that point, what will we do?”
If the Decision Is Complicated
Ask for a family meeting when several clinicians, treatments, or family members are involved.
Say:
“Can we have a meeting with the main clinicians so we can hear the same information at the same time?”
If anyone in the meeting needs an interpreter, see We Need an Interpreter →
If the hospital has a palliative care team, ask whether they can help lead the meeting.
During the meeting, ask:
“What does the team agree on, what’s still uncertain, and what decision needs to be made next?”
A family meeting can prevent conflicting messages before they become a conflict.
If family members disagree about what should happen, use We Disagree About What Should Happen → If no one knows what the person would have wanted, use I Don’t Know What They Would Want →
If You Need More Time or Another Opinion
“How much time do we safely have to make this decision?”
If time allows, ask for another conversation or another medical opinion.
Then ask:
“Does waiting change the risks or remove any options?”
A second opinion may confirm the recommendation or offer another option. Either can help.
After You Decide
Deciding well and feeling certain aren’t the same thing. If you’re sorting through the decision afterward, ask for the social worker or chaplain.
Learn More
Information about life-sustaining treatments, weighing benefits and burdens, and deciding whether to start or stop treatment.