Who is the patient? A family case study of a recurrent dilemma in family practice.

This article presents a family case study of a recurrent dilemma in family medicine. The ethical dilemma involves what role the physician should play in mediating a conflict in a family when the health needs and wishes of the individual patient do not parallel those of the other family members. Who is the patient, the individual or the family? It is the authors' conviction that in meeting the needs of the presenting patient, the family context is of great importance. To this end, the authors delineate a framework for analyzing ethical conflicts of this nature, utilizing key ethical principles in combination with a systems perspective to aid in the clarification of such choices. The principles examined include autonomy, nonmaleficence, and justice. Also taken into account are the relevant facts, values, and the biases of the physician. Exploration of these factors allows the physician a comprehensive and logical approach for resolving such conflicts. Such a framework, however, can only provide guidance; it does not guarantee easy or uniformly acceptable alternatives to difficult issues.