Family involvement in medical decision making.

BACKGROUND AND OBJECTIVES: The standard medical ethics model of decision making is based on the four principles of beneficence, nonmaleficence, autonomy, and justice. The recognized relationship is the physician and patient. This study considered the role(s) family plays in medical decision making.
METHODS: Thirteen semi-structured interviews were conducted with a total of 39 patients and family members. Codebook and template analysis of the transcripts identified common themes.
RESULTS: Patients and families identified three roles for family involvement in medical decision making--supporting the patient, being affected by the decision, and advocating for autonomy.
CONCLUSIONS: Through these roles, patients acknowledge the context of family life in medical decision making, while families actively promote patient autonomy. Consideration of nonmedical burdens related to family roles and relationships takes an equal or higher priority than consideration of medical burdens. Family is, and should be treated as, a significant moral participant in medical decision making.