If there is a disagreement about either the interpretation or the authority of a patient’s living will, the medical team should meet with the family and surrogate and clarify what is at issue. The team should explore the family’s and surrogate’s rationale for disagreeing with the living will. Do they have a different idea of what should be done? Do they have a different impression of what would be in the patient’s best interests, given his or her values and commitments? Or does the family disagree with the physician’s interpretation of the living will?
If there is a disagreement about either the interpretation or the authority of a patient’s living will, the medical team should meet with the family and surrogate and clarify what is at issue. The team should explore the family’s and surrogate’s rationale for disagreeing with the living will. Do they have a different idea of what should be done? Do they have a different impression of what would be in the patient’s best interests, given his or her values and commitments? Or does the family disagree with the physician’s interpretation of the living will?
These are complex and sensitive situations and a careful dialogue can usually surface many other fears and concerns. However, if the surrogate or family merely does not like what the patient has requested, they do not have much ethical power to sway the team. If the disagreement is based on new knowledge, substituted judgment, or recognition that the medical team has misinterpreted the living will, the surrogate or family has much more say in the situation. If no agreement is reached, the hospital’s Ethics Committee should be consulted.
