Section of Palliative Care and Medical Ethics

For Health Care Providers: End-of-Life Conversations


If you need to make a referral to the Section of Palliative Care and Medical Ethics or if you need additional information, please call Dr. Jane Schell at 412-692-4834.

Some Important Phrases to Remember When Talking to Patients about Surrogate Decision Makers

To open the conversation with the patient:

  • If something happens and you become critically ill or you are in the ICU and I cannot talk to you about what treatments are appropriate, whom should I talk to?
  • Have you asked this person if he or she is willing to make decisions for you if you are really sick?


If the surrogate is NOT the patient’s closest relative:

  • Have you told X that you wanted Y rather than him or her to do this?
  • Have you spoken with X about what you would want if you became sicker and needed to be in the ICU or on machines?
  • If YES, can you tell me what you spoke about or what you told him or her about your wishes?


If the patient says that his or her surrogate would know what he or she wants but the patient has not spoken directly about this with the surrogate:

  • In my experience, having a real conversation is very helpful for your X. When people have not spoken to their loved one and something happens, it is very hard for the loved one to be sure of what they wanted. It would be much easier for your X if you would talk to him or her.


Additional tips:

  • If appropriate, reassure the patient.
  • Get a commitment that the patient will talk with the surrogate about these issues.
  • Give the patient materials to take home and review with the family.
  • Be open if the patient wants to talk about advance care planning now.

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