We Disagree About What Should Happen
When people disagree about treatment or care, start with three questions:
Who can decide? What decision needs to be made? What would the person want?
Find Out Who Can Decide
Ask the care team:
- Can the person make this decision for themselves right now?
- If not, who’s authorized to decide?
- What document or state rule establishes that?
- What decision needs to be made now?
If the person can make the decision, the decision is theirs.
If they can’t, the authorized decision-maker should base the decision on what the person would have wanted, as far as that can be known.
Make Sure Everyone Is Arguing About the Same Thing
Ask the clinician to explain what’s happening, what’s being recommended, the likely benefit, the burden, and the alternatives.
Then ask:
“What exactly needs to be decided today?”
Different people may be arguing about different decisions without realizing it.
If someone has been away during the decline, ask the clinician to explain what’s changed and when.
Bring It Back to the Person
Ask:
“What did they say they’d want in a situation like this?”
Use what they said before, treatments they accepted or refused, what mattered most to them, and what they considered too much.
The question isn’t what everyone wants for the person. It’s what the person would choose if they could answer now.
If nobody knows what they’d want, use I Don’t Know What They Would Want →
If guilt, old family conflict, or a promise someone made is driving the disagreement, say that plainly. Arguing about the treatment may not resolve a different conflict.
Ask for a Family Meeting
If the disagreement continues, say:
“We aren’t agreeing about what should happen. Can we meet with the doctor and the people involved in this decision?”
Ask for the physician and social worker or palliative-care team to be involved when available.
If someone can’t be there, ask them to join by phone or video so everyone can hear the same information directly.
Before the meeting ends, confirm what’s been decided, what’s still unresolved, and what happens next.
Ask that the decision be documented in the chart. Otherwise, the conversation may start over with the next team.
If the Conflict Is Still Stuck
Ask:
“Who can help us work through this disagreement?”
Ask whether the hospital or facility has an ethics consultation process and how to request one.
An ethics consultation can help clarify the disagreement and the patient’s values. It doesn’t automatically decide the case for the family or the medical team.
If the dispute is about who has legal authority, use I Need Legal Help →
A social worker, patient advocate, palliative-care clinician, chaplain, or legal help may also be useful, depending on the problem.
If the Person Is Being Pressured or Shut Out
If the person can still make decisions but others are speaking over them, controlling information, or preventing them from saying what they want, tell the care team privately.
“I’m concerned their own wishes aren’t being heard. Can someone speak with them alone?”
Disagreeing with the family doesn’t by itself mean someone can’t make a decision. If their capacity is being questioned, ask what specific concern led to that and how it’ll be evaluated.
If the person is being kept from medical information, see My Family Is Deciding What I Get to Know →
If there are threats, coercion, or abuse, see I Think Someone Is Being Abused, Neglected, or Exploited → rather than trying to solve it through a family meeting. If anyone is in immediate danger, call 911.
Learn More
Step-by-step help for supporting someone with medical planning and making decisions when they can’t speak for themselves.