Why Should Medical Care Be Family-Centered?: Understanding Ethical Responsibilities for Patients' Family Members.

TL;DR: This paper argues for a framework in which providers have non-instrumental responsibilities for their patients’ family members but their responsibilities for themselves and their patients remain primary.

Abstract: The movement toward family-centered care in medicine has brought more attention to the importance of patients' families in clinical practice. However, an issue central to the movement-why families matter-remains underexplored in both the family-centered care and the wider biomedical ethics literature. Given the possibility-and reality-of conflicts between patient and family interests, the need to think about how far providers should go in attending to a family's welfare and wishes, and the focus that family-centered care has placed on further inclusion of families into care, a clearer understanding of providers' responsibilities for family members is needed. In this paper, I argue for a framework in which providers have non-instrumental responsibilities for their patients' family members but their responsibilities for their patients remain primary. To reach this conclusion, I first identify both role- and relationship-based reasons for thinking providers have non-instrumental responsibilities for family members. I then explain why clinicians should still largely prioritize the wishes and interests of their patients over those of their families and provide a reasoning structure for use in situations where wishes and interests conflict.