The family as window onto the world of the patient: involving patients and families in the decision-making process.

The need to involve family members as patient advocates and as surrogates when patients are unable to speak for themselves is not an issue. What continues to be debated are the methods for involving family members in the decision-making process. Such decisions can be complex and the environment in which they are made can be chaotic, while clinicians' approach to decision-making is often seen as insensitive. Families struggle with the emotional burden of their role and clinicians struggle to translate complex information into comprehensible, meaningful, and practical language. There is a need to examine clinical practice to determine which approaches to involving family members are preferable from a philosophical as well as a practical point of view. The paper explores the many facets of the surrogate decision-making role and suggests a reorientation of current models of the professional-surrogate relationship.