Care Demands by Families and Family Healthcare Proxies: A Dilemma for Palliative Care and Hospice Care Staff

Dr.Michael Gordon Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

The end of one's life is always a challenge for all involved; the patient reaching what may be recognized as the last stages of life, family members who in general only want the best for their loved one, and health care professionals who are professionally, legally, and ethically dedicated to provide the best care possible. For health care providers who combine the philosophy of palliative and hospice care with the care of elders, even greater challenges commonly occur because of the complex nature of family dynamics, relationships, and belief systems, that often influence family expectations and thus patient care. The challenge to healthcare providers is to navigate the many potential minefields when such challenges exist. When successful, the satisfaction that result from achieving a clinically compassionate, caring, and comfortable death for the patient and give solace to the family are well worth the effort.
Key Words:Hospice care, palliative care, end-of-life care, family conflicts, ethical and legal duties of staff, palliative sedation, client-centered care, patient-centered care.


Your comments are much appreciated. It is a real challenge sometimes but keeping one's composure and trying to address the issues in a structured manner often helps defuse the situation. It rarely works trying to "justifying" why what happened happened rather than focusing on what can be done to rectify if possible the situation. And yes, profuse thanks after the end occurs is frequently the result. I have enormous admiration for the front line staff that can handle such potentially inflammatory situations with grace and recogition that families are sure they are doing what they are doing "for their loved" one and although perhaps off-base in how they think they will achieve their goal- they are usually very loving people.

Been there, done that. Can be very tricky to keep calm and collected! Another aspect is the effect on the professional care-givers, nurses, aides, physio, O.Ts., and so on, Their welfare is of prime importance also, and this may be brought up to disturbed relatives. We also have meetings with staff to discuss their safety, and also comfort, with abusive situations. It is also surprising how often those "out of control menaces" thank you profusely for the caring way the team acted! ! !