When You and Your Family Differ on Treatment Choices

Approved by the Cancer.Net Editorial Board, 04/2016

A person with cancer may have more than one option for treating the disease. In making this choice, patients often ask for the opinions of family members. In some cases, family members may disagree with each other and with the patient. And this can create conflict when family members need each other's support the most. This can be more complex when the patient is a child or an adult who is medically unable to make decisions. This article provides suggestions on how to communicate and work together to make treatment choices.

Guiding principles

If you are involved in selecting treatment, these questions may help you evaluate the choices:

  • Does the patient understand the risks of treatment and the potential consequences of his or her choices?

  • Are the patient's wishes openly stated and being respected?

  • Is this treatment in harmony with the patient's beliefs and values?

In each aspect, consider the patient's viewpoint first. As the person with cancer, you have the right to be heard and have your wishes respected. You also have the right to change your mind. As a family member, remember that the patient has asked for your view because he or she respects your opinion. But various factors may lead him or her to make a different decision. Even when you disagree, keep communicating with each other and support the patient in his or her choices.

Talk openly about the patient's priorities for treatment. These could range from surviving as long as possible to maintaining a specific quality of life, even if that means stopping treatment. If this is difficult for your family to discuss, ask a doctor, nurse, member of the clergy, social worker, or counselor to facilitate this conversation.

Barriers to talking about treatment options

It can be difficult to talk openly about treatment options for many reasons:

  • Emotions, such as sadness, fear, anger, and confusion

  • Family patterns of talking about health care, including differences in how generations communicate

  • Cultural, spiritual, or religious beliefs about health, illness, and death

  • Misconceptions or lack of knowledge about treatment, side effects, and prognosis

  • Fear of giving up independence and the effect on lifestyle and finances

  • Fatigue or exhaustion from current treatment

  • Denial or the belief that if you don't talk about it, it isn't really happening

  • Past experiences with cancer and other illness

Identify potential barriers and discuss them up front. This will help you get the information, support, and resources you all need to make the best choices.

Continuing to communicate

Making treatment decisions may require many conversations with doctors and other members of the cancer care team and with family and friends. One of the first questions to ask the oncologist is, “When do decisions need to be made?” Often, a decision is not needed immediately. This can reduce the level of anxiety for everyone involved in reviewing the various options.

Legal considerations

An advance directive is a legal document that tells the health care team what to do if the patient is unable to make decisions. The patient is the only person who can change or cancel these documents. Regardless of their health, all people should have advance directives, including the following:

  • Living Will. This document gives instructions about the health care that the patient does and does not want under specific circumstances.

  • Health Care Power of Attorney. This appoints a specific person to make medical decisions based on the patient's wishes. It only takes effect when the patient is unable to make his or her own decisions.

Learn more about putting your health care wishes in writing.

Special circumstances

State laws vary about the age at which a child can make his or her own medical decisions. Most laws consider the child's best interests, ability to make his or her own decisions, and ability to understand potential consequences of decisions. Typically, the parents make decisions for a child who is younger than the state's age limit.

If an adult patient is unable to make medical decisions, the family should look first for any advance directives indicating his or her wishes. If there are none, follow the intent of that person's wishes. The person's treatment facility should be able to refer you to a medical ethics committee or palliative care team that can guide you through the decision-making process. Attorneys and legal-aid clinics can also be helpful in addressing legal concerns.

More Information

Advanced Cancer Care Planning

Making Decisions About Cancer Treatment

Talking with Family and Friends

Caring for a Loved One

Managing Your Care