People are forced to make difficult decisions about end of life planning

Sometimes an emergency situation will require family members to become involved in or make difficult decisions. The family of an individual receiving end of life care can often be a source of conflict because there is so much emotion and often different perspectives.

It can sometimes be difficult to identify who is family and therefore who should be involved.

One study suggests that conflict of some nature in intensive care settings occurred in 78% of 102 cases monitored, suggesting it is reasonably common.

Conflict can be complex and involve the individual or be between family members, family and staff or among staff members.

Families have to cope with their own grief, they may have differences of opinion about the diagnosis, end of life care planning and the wishes of the person who is dying.  

Families might request that information is kept from the person who is dying.

“It is not acceptable to conspire with families to keep bad news from individuals unless this has been clearly expressed as a wish from the person who is dying during a period where they had mental capacity to make this decision.”

It is most important that the individual and their preferences, wishes and needs are the centre and focus of care and support.

To reduce or avoid conflict:

1. Conversations about end of life planning should take place as early as possible, while the individual has mental capacity and can express their wishes and preferences. These should be documented.
2. Individuals may communicate that they have changed their minds and they have the right to do this at any time. Be alert to a person being put under pressure by family members to do something they don’t want to do and raise this with your manager if you have concerns.
3. Support the individual and family to communicate and focus on the preferences and wishes of the individual. Honouring these wishes may be painful or not what a family member would want but it’s not about them, it is about the individual who is dying and your role is to support this individual.
4. Every family is different and when strangers look after their loved ones, it takes trust. Listen to their concerns and build trust. If they need additional support, encourage them to seek additional support services for themselves.