Resolving Conflicts Between Client Wishes and Care Plans: Ethical Framework

Stepwise Approach

1. Verify the Care Plan: Ensure it reflects current clinical evidence, interdisciplinary input, and documented goals. Update if outdated.
2. Engage in Shared Decision-Making: Discuss with client (and legal surrogate if incapacitated). Explain benefits, risks, alternatives. Listen to values, fears, preferences. Use teach-back.
3. Assess Decision-Making Capacity: If capacity is questionable, formal evaluation by psychiatrist/ethics consult. Document.
4. Consult Ethics Committee: For intractable conflicts involving autonomy vs. beneficence, futility, or surrogate disagreement.
5. Seek Legal Guidance: If court-appointed guardian, advance directive ambiguity, or statutory mandates (e.g., mandatory reporting).
6. Decide in Best Interest: Weigh medical benefit, quality of life, previously expressed wishes, cultural/religious values. Document rationale.
7. Document Thoroughly: Record client's expressed wishes, team recommendations, ethics/legal consultations, final decision, and dissenting opinions.
8. Implement and Reassess: Execute plan; monitor outcomes; revisit as condition or preferences change.

Core Principles

• Autonomy (respect choices of capable persons)
• Beneficence/Nonmaleficence (maximize benefit, minimize harm)
• Justice (equitable access, resource stewardship)
• Fidelity (honor commitments, maintain trust)