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In this situation, the most important thing that doctors can do is to talk to the patient and family. Doctors may:
- Meet with the patient separately and discuss the treatment options with the patient. Explore the reasons for not wanting the treatment.
- Ensure that the patient has capacity to make their own medical decisions
- Explore the family’s rationale for wanting the patient to receive more treatment than the patient wants. Encourage the family to think about what is in the patient’s best interests.
- Explain the values and principles of informed consent (autonomy and self-determination).
- Advise the family that doctors are bound by the principles of informed consent and that, while they may be very concerned for the patient’s wellbeing, they need to respect the wishes that have been expressed.
- Encourage the patient to explain to the family why they do not want the treatment.
- Talk to the patient about nominating a person who could make the medical treatment decisions that they would want made should they become unable to do so themselves. This person does not have to be a family member but should be someone who is able and willing to take part in advance care planning discussions, is contactable and is able to make the decisions in the future if required.
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