In a family meeting, after you explained the situation is worse, I see many doctors ask,

"What would he WANT?"

I think this is a BAD question, although I'm aware it is well-intentioned.

I will tell you why...(thread)

1/

What you should do at this point is exploring goals/values of the patient.

But if you use "want", that q is (automatically) asking about treatment options, not goals/values.
(I want chemo, I want dialysis, etc).

2/

For example, your laptop got broken, and you came to a store to buy a new one.

An attendant comes and explains to you.
"model A is 1.4GHz processor/500GB storage/$1000, model B is 2.9GHz processor/1000GB storage/$1500. Which do you WANT?"

Can you answer the question?

3/

I cannot, because I don't understand what "GHz processor" or "GB storage" really means.

Rather than that, I would find it more helpful if he asks me
"What is the main purpose of the laptop?"
"How much is your budget?"

4/

Then, I can answer "I use it for PowerPoint and Excel, but I don't edit music or movie. I can afford $1200."

He could say, "OK, then you should buy this model A"

This is more helpful, isn't it?

I think we should do a similar thing in medicine.

5/

"What would he WANT?" is NOT the right Q.

Instead, we should ask the followings,
- "What are you most worried about?"
- "What are you hoping for?"
- "What is most important to him?"
- "Tell me about him."
- "What makes his life meaningful?"

6/

You need to let them talk and listen carefully.
After that, you should try to phrase the goals of care with your own words.

"Based on what you told me, we should probably focus on comfort and make sure he doesn't suffer any more"

7/

Then you make a recommendation.
"In order to achieve that goal, I would recommend....."

I say it again.
"What would he WANT?" is a BAD question.

It is more harmful than useful.

Please do not use "WANT" !!

8/8