Written by: Lynne E. Porter M.D., FACP

Harry had known George his entire life, since he came home from the hospital and grew up next door. George’s son Charlie was Harry’s best friend growing up, and they remained very close.

Charlie grew up, went to grad school, and wound up living far from home. Harry grew up, went to med school, and came home to practice.  Shortly after his return, George asked Harry to oversee the care he received from his Primary Care Physician (PCP). Because Harry and George’s PCP had a very good relationship, this was not a problem. After many good years, George gradually became profoundly limited in his activities of daily living because of severe cardiopulmonary disease. He understood that there could be no improvement, as did Harry.

Charlie, still living far away, wanted everything done to keep his father alive. George did not agree.  Harry was caught in the middle. Harry loved George, knew George was competent to make his own healthcare decisions, and knew his time was short and that he was suffering. George and Harry had a conversation. George wanted home hospice care and needed Charlie to agree. Harry knew he was right.

Harry called Charlie and told him to come home for a several day visit with his dad. They had serious decisions to make. Charlie came home.  Harry was referee while George explained to Charlie what his life was like and that he wanted Charlie’s support for his decision to use home hospice care. Charlie struggled with the truth but agreed in the end that he could support his dad’s decision. It was easier because Harry had clearly explained George’s struggle with quality of life issues because he was so sick. George got home hospice and Charlie, after a very good visit with his dad, went home at peace.

Disagreements over end of life decisions can irreparably rupture family relationships, if communication and consensus cannot be established. There are no easy solutions for any family; but doing nothing leads to pain, fear, and anger.

So, my colleagues, how do we better support families as they struggle towards agreement that lets everyone move forward in peace?