When patients & families request that “everything” be done


  • Understand what “everything” means
    • ”Every treatment with even the slightest possibility of benefit” (rare)
    • “Everything that you, as my physician, feel is worthwhile"
    • "Everything to relieve symptoms, even though it may shorten life”
  • Communicate prognosis
    • Use clear & direct language (“Your mother is dying”)
    • Maintain consistent messaging
    • Avoid discussing minutiae of management
  • Propose a philosophy of treatment
    • Offer medical recommendations with appropriate limits to therapy
    • Discuss what will be done before covering what will not be done
    • Illustrate how the recommendations support the patient’s values
  • Support emotional response
    • Validate emotions & invite conversation (“What is the toughest part of this for you?“)
    • Reaffirm commitment to caring for the patient no matter what happens
  • Negotiate disagreements
    • Review understanding & seek common ground
    • Seek external input for persistent, unresolved conflict (eg, from ethics committee)