"What if she was your mother?" Toward better responses

J Crit Care. 2019 Feb;49:155-157. doi: 10.1016/j.jcrc.2018.10.031. Epub 2018 Nov 2.

Abstract

Critical care physicians may hear a surrogate decision-maker ask, "What would you do if she was your mother?" or "What if your father was this sick?" These kinds of questions ask more of the critical care physician than the surrogate might realize. There are deep-seated ethical, professional, and personal complexities that can challenge critical care physicians to answer these questions with honesty. This essay offers practical guidance for critical care physicians who aim to respond to such queries with honesty and beneficence. We discuss a variety of motivations that can accompany this unique kind of question from a surrogate. The surrogate may be seeking moral guidance-the true question being, "What should I do?" We offer a number of questions that the critical care physician might ask of the surrogate in order to attend to both the surrogate's moral dilemma and the patient's values and preferences for medical interventions. We also offer a number of questions to promote contemplation of these issues by the critical care physician herself. We argue that until the critical care physician: discovers the surrogate's motivation, connects this motivation to patient preferences, and asks herself important questions regarding death and dying, the physician's responses will not adequately attend to the issues prompted by such questions.

Keywords: Critical care medicine; End of life care; Integrity; Medical ethics; Professionalism; Surrogate decision-making.

MeSH terms

  • Clinical Decision-Making / ethics
  • Critical Care / ethics
  • Dissent and Disputes
  • Humans
  • Morals
  • Physicians
  • Professional-Family Relations*
  • Terminal Care / ethics*
  • Third-Party Consent