What to do if…
family members are giving doctors conflicting instructions during an end-of-life situation

What to do now

1. Ask the team to identify the decision route for the specific decision being discussed today.
   Say: “For this decision, who can legally consent or refuse, who will you consult, and what paperwork have you checked?”
   Ask the team to check for:

   • a registered health and welfare Lasting Power of Attorney in England or Wales, and whether it covers this decision;
   • any advance decision, advance directive, written refusal of treatment, or written statement of wishes;
   • welfare power of attorney or welfare guardian paperwork in Scotland, and whether it covers this decision;
   • the local Northern Ireland legal framework, if the patient is being treated there, and who is responsible for best-interests or other decision-making;
   • any advance care plan, DNACPR form, locally used ReSPECT or emergency care planning form, letter, or documented preferences.

2. Ask for capacity to be assessed and recorded for this decision.
   Say: “Has capacity been assessed for this specific decision today, such as resuscitation, ventilation, surgery, antibiotics, feeding, or comfort-focused care?”
   If the patient can still communicate in any way, ask staff what support is being used to help them express a view.

3. Request a same-day structured family meeting.
   Ask for the consultant or senior doctor, the nurse in charge, and palliative care if available.
   Say: “We are giving mixed messages. We need one documented plan based on the patient’s wishes, the legal position, and what is clinically possible.”

4. Bring documents and patient wishes to the ward now.
   Bring any power of attorney, guardianship, advance decision, advance directive, written refusal, advance care plan, DNACPR paperwork, locally used ReSPECT or emergency care planning form, letters, texts, or notes showing the patient’s wishes.
   Give copies to the ward and ask staff to record what has been received.

5. Separate legal authority from family updates.
   Ask staff to record:

   • who has any confirmed authority for this decision;
   • who else is being consulted about the patient’s wishes and values;
   • one named spokesperson for routine updates;
   • one backup contact if the spokesperson cannot be reached.

6. Keep the discussion anchored on the patient.
   Use one sentence repeatedly if the conversation starts to spiral: “We need to focus on what the patient would have wanted and what the doctors say is clinically possible.”

7. If relatives are still giving conflicting instructions, ask for the hospital escalation route.
   Say: “What is your process when family members disagree about an end-of-life decision?”
   Ask for a senior review, a documented decision, the reasons for it, and the name of the person responsible for explaining it to the family.

8. Use the hospital’s patient advice or liaison route if communication is breaking down.
   Ask the ward, switchboard, or hospital website for the patient advice, liaison, feedback, or complaints service. In England this is often PALS.
   Say: “This is an end-of-life situation with conflicting family instructions. We need help arranging a meeting, clarifying the decision route, and improving communication.”

9. Ask for values or faith support if that is part of the disagreement.
   Ask the ward to involve chaplaincy, spiritual care, or a faith or community representative the patient would have wanted. Keep the request focused on the patient’s values, not on who in the family is right.