You must mediate a family dispute about whether an elderly relative should undergo a risky procedure given a 10% mortality rate, when the relative wants it and the mother does not. How would you proceed?

You must mediate a family dispute about whether an elderly relative should undergo a risky procedure given a 10% mortality rate, when the relative wants it and the mother does not. How would you proceed?

• A. Determine decisional capacity and allow the relative to decide.
• B. Impose your own view because it is a family matter.
• C. Ask the relative’s mother to decide for him.
• D. Do nothing and let the family resolve it without your input.

Answer: (A)

The key idea is respecting a patient’s autonomy by carefully assessing decisional capacity and then honoring the patient’s informed choice if capacity is present. Start by determining whether the elderly relative can understand the procedure and its risks, appreciate the consequences, reason about options, and communicate a stable preference. If he demonstrates adequate capacity, his decision to proceed with the risky procedure should guide the plan, even if the mother disagrees, because his preferences govern autonomous medical decisions. To mediate effectively, ensure the relative receives clear, unbiased information about the 10% mortality risk, possible benefits, alternatives, and potential outcomes, and confirm understanding. If capacity is confirmed, obtain informed consent and support the family in processing the discussion without overriding the patient’s wishes. If decisional capacity is lacking, surrogate decision-making comes into play. In that case, decisions should reflect what the patient would want (substituted judgment) or, if that isn’t knowable, act in the patient's best interests. In this scenario, the best course is to assess capacity first and, if present, allow the relative to decide. Why the other approaches aren’t appropriate: imposing your own view is paternalistic and disregards autonomy; asking the mother to decide for him ignores the patient’s preferences and rights; doing nothing fails to address the patient’s rights or the obligation to facilitate informed decision-making.

The key idea is respecting a patient’s autonomy by carefully assessing decisional capacity and then honoring the patient’s informed choice if capacity is present. Start by determining whether the elderly relative can understand the procedure and its risks, appreciate the consequences, reason about options, and communicate a stable preference. If he demonstrates adequate capacity, his decision to proceed with the risky procedure should guide the plan, even if the mother disagrees, because his preferences govern autonomous medical decisions.

To mediate effectively, ensure the relative receives clear, unbiased information about the 10% mortality risk, possible benefits, alternatives, and potential outcomes, and confirm understanding. If capacity is confirmed, obtain informed consent and support the family in processing the discussion without overriding the patient’s wishes.

If decisional capacity is lacking, surrogate decision-making comes into play. In that case, decisions should reflect what the patient would want (substituted judgment) or, if that isn’t knowable, act in the patient's best interests. In this scenario, the best course is to assess capacity first and, if present, allow the relative to decide.

Why the other approaches aren’t appropriate: imposing your own view is paternalistic and disregards autonomy; asking the mother to decide for him ignores the patient’s preferences and rights; doing nothing fails to address the patient’s rights or the obligation to facilitate informed decision-making.