It’s difficult to make healthcare decisions on behalf of someone you love when they are terminally ill. It’s even more difficult when family members disagree about the proper methods of care and end-of-life choices. Unfortunately, disagreements are common, and they can create conflict during an already stressful time.
“Caring for a dying loved one can be overwhelming,” said Catherine Hall, MSW, LCSW, Clinical Social Worker with
Carolinas HealthCare System’s Levine Cancer Institute. “But adding in family disputes can turn the experience into one of the most trying times in a person’s life. Dealing with potential conflicts about care before problems arise is the key to ensuring your loved one gets the best care he or she deserves.”
Why Disagreements Arise:
• Burden of Care:
“In most family situations with multiple children, the majority of the time one of the siblings bears the burden of the care,” said Hall. “This can cause resentment from the person bearing that burden as well as feelings of guilt for family members who are not as involved or who live far away.”
• Condition of the Loved One:
Family members may not all agree on what's wrong with a loved one and what should be done about it. For example, you may feel your family member is still capable of living independently while a sibling may feel it’s time to consider an assisted living facility.
• Sibling Roles:
“When the family gets together even adult siblings revert back to their roles from childhood,” said Hall. “The eldest child may take control of the care decisions, bringing resentment from the younger siblings.”
• Financial Matters:
Financial disagreements over how to pay for a family member’s care can impact where they receive care, where they live during care or even what non-care services, like a housekeeper or lawn service, are provided.
Managing Disagreements
“For some families conflict is unavoidable,” said Hall. “Feelings may remain from past arguments or estranged siblings may have a difficult time coming back together. But if conflicts over care are causing problems in your family, there are various ways to seek help.”
• Let Your Loved One Decide:
It’s best to have conversations with your ailing loved ones before end-of-life care decisions need to be discussed among family members. Encourage your family member to make an advance directive: written, end-of-life instructions that include a living will and healthcare power of attorney, which is a legal document outlining who a patient’s surrogate decision makers are in the event he or she is unable to make his/her own medical decisions. “As hard as it might be to talk about end-of-life decisions, knowing a loved one’s preferences ahead of time can make decision making easier for the entire family,” said Hall.
• Divide the Burden of Care:
Primary caregivers should ask other family members for specific things they can do to help. For example, siblings who live far from the family can offer financial support, while closer relatives can offer more physical support.
• Hold Meetings:
Regular communication between family members can often resolve or avoid disputes. “Open discussion at a family meeting can help define each sibling’s role and make future plans,” said Hall. Include out-of-town family members in the meeting via online video conference or phone so all siblings can participate and let their voices be heard. At the end of the meeting, recap the decisions made and schedule a follow-up meeting.
• Meet with Doctors:
Discuss treatment risks and consequences with the physician. “Sometimes a professional opinion can make a big difference in understanding how treatment may or may not help a loved one,” said Hall. A second opinion from a consulting doctor may be needed to convince some family members.
• Counseling:
In some cases, a counselor, social worker, chaplain or hospice professional can help a family sort through the difficult decisions. He or she can help facilitate communication, whether it’s speaking to a relative who’s at odds with the family over treatment or arranging for a family meeting.
• Mediation:
Sometimes, despite the best efforts, family members just can’t agree on treatment. In these cases, the family may want to hire a mediator, who has special training and experience to handle such situations. To find a mediator, contact the
Association for Conflict Resolution at (703) 234-4141.
