Matt Morgan: Standing in the shoes of a relative may complicate decision making
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3344 (Published 01 September 2020) Cite this as: BMJ 2020;370:m3344
- Matt Morgan, intensive care consultant
- mmorgan{at}bmj.com
Follow Matt on Twitter: @dr_mattmorgan
The family room hangs in silence. I’ve explained the science, the medicine, and the human costs. It was a near impossible decision to make, with no right or wrong answer. An operation will probably kill her. Without an operation, she’s likely to die. Then came the familiar question relatives often ask: “If it were your daughter, what would you do?”
This kind of question can quickly cut through the scientific shell of medicine’s most difficult decisions. I was instantly transformed from an intensive care consultant into a dad. If I were to take on this role—if I were in fact this patient’s father and not her doctor—it would make the decision easy for me: choose the operation, choose the possibility of life, at all costs.
In intensive care we have to continually think about how our patients will be affected by the treatment and care we provide, to consider what their life will be like in the aftermath. Yet stepping into the shoes of a relative, rather than the patient, changes the fit of a decision in important ways. This kind of bias could cloud my interpretation of the data and may result in a loss of impartiality. There’s a reason why someone’s mum or dad cannot, or should not, be their doctor. Sometimes difficult decisions need measured objectivity—but discussed through a prism of humanity.
Rationality and impartiality
I’ve heard the same question asked in other contexts. On one occasion it was asked not by a relative but by a researcher at a meeting, who was presenting the results of a trial on the use of vitamin C in sepsis. Despite the trial showing no outcome benefits the researcher argued that this intervention should nevertheless be used, asking the audience, “If it were your daughter, would you want her to have the treatment?”
Many people raised their hands in affirmation, although the objective data were clearly set out on a slide in the background. But, when phrased like that, who could blame them? The blame should surely lie in the question’s construction. “Will you still give patients the treatment?” would have been better, and I suspect that it might have yielded a very different answer.
And so, I answer: “If it were my daughter I would think about what she would say, what she would want. I would imagine her sitting in the room with us right now, listening to this tough conversation. What would she say?”
I am rational as a doctor but irrational as a parent. Shared decision making remains essential. We need to share the discussion and the scientific data, but we must also maintain some impartiality when interpreting them.
Footnotes
Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.
Provenance and peer review: Commissioned; not externally peer reviewed.
Matt Morgan is an honorary senior research fellow at Cardiff University, a consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination.