In Massachusetts, the patient’s designated health care proxy is recognized as the highest legal authority over the patient’s care and treatment—even if in conflict with a patient’s advance directive. Physicians practicing in other states should check with their legal counsel to determine the authority of proxies.
If no proxy has been designated and a conflict arises, the health care team needs to select a member to talk to the family. That individual should acknowledge the conflict, begin and sustain dialogue with family, listen to the family concerns, and offer emotional support. Discrepancies between the patient’s wishes and those of the family should be addressed.
If a resolution cannot be reached, contact the institution’s designated ethics or legal consultant. Institutional policies for dealing with conflict typically outline procedures for appointed individuals or the ethics committee to undertake. If it cannot be settled within the institution, the case is then brought to court.
Carefully document all discussions with family members and all decision points of the patient's treatment. Following a systematic process in accordance with institutional policy is essential in advocating and providing care and treatment for a patient.