MED 475 Module 4 Case Study: Family Conflict Over Care for a Seriously Ill Parent Example

When the Family Disagrees: A Palliative Care Case Study

Student Name

BS in Medical Studies, Arizona State University

MED 475: Palliative Care: Managing Complex Serious Illness

Instructor Name

Month Day, Year

When the Family Disagrees: A Palliative Care Case Study

The Case (Illustrative)

Mr. Robert Hale, 84, has advanced COPD and moderate-to-severe dementia and lives with his daughter Karen, who has cared for him for three years. After his third hospitalization for pneumonia this year, he eats little and has lost weight. His son, David, who lives out of state, wants a feeding tube and full treatment. Karen believes their father would not want that. A third child, Lisa, is undecided. Mr. Hale completed a living will ten years ago but did not name a health care agent.

What Is Driving the Conflict?

Family conflict at the end of life is common and predictable. In a statewide survey of spouses and adult children of people who died of lung cancer, prior family conflict, communication constraints and family members asserting control were significant predictors of conflict (Kramer et al., 2010). In this case, David's distance limits his information about his father's decline, Karen's caregiving strain affects how she communicates and the absence of a named agent leaves no clear decision maker. Guilt and grief may also shape David's wish to "do everything."

What Did the Patient Want?

The living will states that Mr. Hale would not want artificial nutrition or life support if he had an irreversible condition and could not communicate. His pastor recalls him saying he "never wanted to end up like his brother," who lived for years on a feeding tube. These sources point toward comfort-focused care. In advanced dementia, eating problems develop in most patients, and tube feeding is one of the burdensome interventions that proxies who understand the prognosis tend to avoid (Mitchell et al., 2009). Substituted judgment asks the children to choose what their father would choose, setting aside what they would want for themselves.

Plan for a Family Meeting

Communication guidance suggests asking before telling, responding to emotion and avoiding jargon in these meetings (Back et al., 2005). Acknowledging David's love and worry, rather than arguing with him, is more likely to reduce conflict.

Supporting the Caregiver

Karen shows signs of caregiver strain: she is sleeping poorly and has missed work. A respite plan, such as short-term respite through hospice or in-home aide hours, would protect her health and her ability to continue caregiving. Respite is a recognized part of hospice and palliative support for families.

Conclusion

The conflict reflects distance, strain and unclear authority more than disagreement about the facts. Centering Mr. Hale's documented wishes, communicating clearly with all three children and supporting Karen offer the best path to a decision the family can live with.

References

Back, A. L., Arnold, R. M., Baile, W. F., Tulsky, J. A., & Fryer-Edwards, K. (2005). Approaching difficult communication tasks in oncology. CA: A Cancer Journal for Clinicians, 55(3), 164-177. https://doi.org/10.3322/canjclin.55.3.164

Kramer, B. J., Kavanaugh, M., Trentham-Dietz, A., Walsh, M., & Yonker, J. A. (2010). Predictors of family conflict at the end of life: The experience of spouses and adult children of persons with lung cancer. The Gerontologist, 50(2), 215-225. https://doi.org/10.1093/geront/gnp121

Mitchell, S. L., Teno, J. M., Kiely, D. K., Shaffer, M. L., Jones, R. N., Prigerson, H. G., Volicer, L., Givens, J. L., & Hamel, M. B. (2009). The clinical course of advanced dementia. New England Journal of Medicine, 361(16), 1529-1538. https://doi.org/10.1056/NEJMoa0902234