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PERSPECTIVE

The Trouble with Families: Toward an Ethic of Accommodation

Carol Levine, MA, and Connie Zuckerman, JD

19 January 1999 | Volume 130 Issue 2 | Pages 148-152

Although some clinicians are extraordinarily sensitive to the legitimate roles of patients' families in medical crises, a persistent tendency to equate families with trouble is evident in both the literature and the practice of medicine. Some negative presumptions about families derive from western medicine's almost exclusive focus on the individual patient in codes of ethics, training, and practice. Modern bioethics has reinforced this individualistic approach. Physicians' primary responsibilities are unequivocally to their patients, but a complete understanding of the patient's personhood must include consideration of the significant persons who help define the patient's core identity. One source of tension between professionals and families lies in differing perceptions of the roles that family members should play and how they should play them. Members of a family may act as advocates, provide or manage care, serve as trusted companions on the journey through illness and death, and make decisions on behalf of an incompetent patient. Each role presents potential conflicts. Other sources of conflict include disagreement within a family; challenges to physician authority; fear of litigation; and differing religious, ethnic, or cultural traditions. An ethic of accommodation emphasizes the need to negotiate care plans that do not compromise patients' basic interests but that recognize the capacities and limitations of family members. Family caregivers want understandable and timely information, better training, compassionate recognition of their anxiety, guidance in defining their roles and responsibilities, and support for the setting of fair limits on their sacrifices. Health care professionals can better meet these needs through education and skills acquisition, the establishment of partnerships with families, and regular dialogue and communication.

Author and Article Information

From Beth Israel Medical Center, New York, New York.

Acknowledgments: The Families and Health Care Project at the United Hospital Fund is supported in part by grants from the Altman Foundation, the Nathan Cummings Foundation, and the New York Community Trust.

Requests for Reprints: Carol Levine, MA, Families and Health Care Project, United Hospital Fund, 350 Fifth Avenue, 23rd Floor, New York, NY 10118.

Current Author Addresses: Ms. Levine: Families and Health Care Project, United Hospital Fund, 350 Fifth Avenue, 23rd Floor, New York, NY 10118.

Ms. Zuckerman: Center for Ethics in Medicine, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003.

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