Abstract
Family involvement in healthcare decision-making for competent patients occurs to varying degrees in many communities around the world. There are different attitudes about who should make treatment decisions, how and why. Legal and professional ethics codes in most jurisdictions reflect and support the idea that competent patients should be enabled to make their own treatment decisions, even if others, including their healthcare professionals, disagree with them. This way of thinking contrasts with some cultural norms that put more emphasis on the family as a decision-making entity, in some circumstances to the exclusion of a competent patient. Possible tensions may arise between various combinations of patient, family members and healthcare professionals, and healthcare professionals must tread a careful path in navigating family involvement in the decision-making process. These tensions may be about differences of opinion about which treatment option is best and/or on who should have a say or influence in the decision-making process. While some relevant cultural, legal and policy considerations vary from community to community, there are ethical issues that healthcare professionals need to grapple with in balancing the laws and professional codes on decision-making and the ethical principle of respecting patients and their autonomy. This paper will highlight and propose that a partial resolution to these issues may lie in relational understandings of autonomy, which in principle justify interventions by healthcare professionals and family that support patients in decision-making.
Highlights
In most jurisdictions, legislation and professional ethical codes emphasize the right of competent patients to decide between treatment options for themselves, even if their decisions differ from the doctor’s recommendations or go against the advice of caring family members
The ethnic majority in Singapore are of Chinese descent, and the strong influence of Confucian principles has meant that family involvement in treatment decision-making is rather pervasive, the extent, type and whether the involvement is supportive of the patient having a say vary (Chia 2011; Koon and Krishna 2014)
In practice there are some examples of decisions being made in cooperative harmony involving the patient, family and healthcare professionals, and other cases, when patients have been diagnosed with a serious illness or are nearing end of life, where patients may be excluded from decisions, and sometimes family members may not agree (Tai 1997; Fan 1997)
Summary
Some Unresolved Ethical Challenges in Healthcare Decision-Making: Navigating Family Involvement. Received: 1 November 2019 / Revised: 14 February 2020 / Accepted: 19 February 2020 / Published online: 5 March 2020 # The Author(s) 2020
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