Practice Essentials

Communicating with relatives

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4527 (Published 11 October 2017) Cite this as: BMJ 2017;359:j4527
  1. Muna Al-Jawad, consultant in elderly medicine1,
  2. Rebecca Winter, clinical teaching fellow and elderly medicine registrar2,
  3. Ellen Jones, family carer3
  1. 1Brighton and Sussex University Hospitals, UK
  2. 2Brighton and Sussex Medical School, UK
  3. 3Brighton, UK
  1. Correspondence to: M Al-Jawad Muna.AlJawad{at}bsuh.nhs.uk

What you need to know

  • Conversations with relatives require a careful balancing of patient autonomy and recognition of the network of support that many people rely on.

  • Conversations can be emotional and anxiety-provoking for all involved.

  • It helps relatives if clinicians can explain the ethical rationale behind decisions, especially related to confidentiality.

A doctor’s first duty is to his or her patient, but this needs to be balanced with respect and understanding for the network of other people who provide care and emotional support.1

The four commonly accepted principles of healthcare ethics are summarised in box 1. In relation to communication with relatives, respect for autonomy is, in our opinion, the ethical principle that may be most problematic in clinical settings. This article aims to provide doctors with help when communicating with relatives and explores some ethical guidance for doing this while supporting the expectations of relatives such as those set out in box 2. The term “relative” is used to mean a close friend or family member who is part of the patient’s network. Where legal considerations are highlighted, these are based on guidance within the UK. We recognise that there are cultural differences in concepts such as autonomy and collusion, but they are beyond the scope of this article.

Box 1: Overview of ethical principles in medicine2

  • Respect for autonomy—Respecting the decision making capacity of a patient; enabling individuals to make reasoned informed choices

  • Non-maleficence—Avoiding the causation of harm to the patient

  • Beneficence—To have the welfare of the patient as the goal

  • Justice—Fairness and equality of the distribution of health resources

Box 2: A relative’s expectations

I have considerable experience of NHS services as a relative. I have a daughter with a chronic health condition. I am currently family carer for my mother, who has late stage dementia. I have supported other relatives who have had cancer, heart disease, and severe …

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