How Do I Resolve When A Patient Cannot Give Informed Consent And Family Members Disagree?

Question

Answer

I have seen this before with some of my patients with advanced dementia.  I feel like they are not able to provide that informed consent and I have talked to some family members.  They have either said yes or no.  Sometimes I will get a no because they have had therapy before, it was not helpful and only frustrating to them.  In those situations, I will talk to the family member and describe how I develop patient-centered goals and how I am going to approach therapy, as well as how I will respond to that person and try to get them to lead as much as possible.  Sometimes, they end up agreeing and sometimes they do not.  If they do not, that is okay.  They have their reasons.  It is not my decision to make.  Like the report that I shared earlier where the person wrote in and said that the person had longstanding deficits and the wife did not want the patient to have treatment.  Later, the patient was readmitted and they were asked to do treatment without the wife’s consent.  I think that is wrong.  If I were ill, I would want my husband to be my advocate and determine, based on what he knows about me and my history, what would be best for me.  I feel like not honoring that family is equivalent to not honoring the patient’s wishes.  I think we should honor the family’s responses to whether or not we should have therapy.