Saint Louis University Journal of Health Law & Policy

Document Type

Symposium Article


Families faced with end-of-life (EOL) decisions on behalf of a family member are charged with honoring a care recipient’s wishes, which may or may not be clear to them. The process of decision making is challenging for surrogate decision makers and their families, and it often results in suboptimal decisions that fail to meet the best interests of the patients, cause stress for family members, and burden the legal and medical systems. Effective family communication, something that legal representatives, medical professionals, and social workers are often in positions to influence, can enhance the quality of EOL care planning and decisions. To this end, we first establish the significance of the family, an interdependent system, for decisions oriented around individual autonomy and independence. We then explore theory and research in family communication that can offer insight into family interaction about EOL preferences and decisions. Communication theory and research provide insight into how individuals and family members communicatively navigate multiple goals in conversations about EOL preferences and manage privacy and disclosure, deal with uncertainty, and negotiate contradictions in the planning and decision-making processes. We advance recommendations for practice associated with each area of research and theory.