"Doctor, what would you do if this is your mother?"

A very common question family asks us.

Should we answer that Q?

You don't have to if not comfortable, but they are overwhelmed and need some guidance...(thread)

1/ https://twitter.com/N1colewilliams/status/1359902204929454090

Some physician might say "I will not start dialysis. My mom wouldn't want it".

I do NOT think this is a good response, with the same reason why we should NOT ask "what would she want?"

Treatment options should be discussed with being connected to goals/values.

2/

My response would be..

"I will not start dialysis. My mom wouldn't want it (the same until here, but I will follow with) BECAUSE she will not be able to come home even with dialysis and that would not be acceptable to her"

3/

I take this as an opportunity to tell them how to convert goals/values to actual treatment options.

They are overwhelmed. They need some guidance.

By adding "BECAUSE ...", you can show them an example of how you can utilize goals/values information.

4/

As such, the response could be

"I will do dialysis, BECAUSE it is still too early for us to decide she can not come home. To be at home with family is very important to her".

Yes/no to dialysis is not important. The reason why you come to that decision is important.

5/5