“What would you do if your mom were in this situation?” she asks from across the family meeting room table with tears running down her face.
As a palliative care physician, I hear this common question during family meetings — one that makes many clinicians uncomfortable.
Her mother hadn’t been acting like herself lately. Now they knew why — advanced cancer that had already spread to her brain. Their family had spent days trying to make sense of the worst news they may ever receive as a revolving door of doctors discussed prognosis, treatment options, and procedures.
Of course her family had questions, trying to navigate profound uncertainty. Even in the best-case scenario, would her mother ever walk independently again? Eat on her own? Regain enough strength to receive cancer treatment? Was placing a feeding tube a worthwhile next step, or would it prolong a life that looked very different from the one her mother would have wanted?
In situations like this, many clinicians, with good intentions, try to promote autonomy and avoid paternalism. So we retreat to what feels like a safer, blanket response: “I can’t answer that for you.”
But when patients ask what we would do, they’re rarely asking for us to decide for them. They’re asking us to help make sense of what lies ahead.
Respecting patient autonomy doesn’t require abandoning clinical judgment. Yet, in our efforts to avoid steering patients, many of us have overcorrected. We present medical interventions like an à la carte menu, broadly review risks and benefits, and then step back, asking patients and families to choose. Often, we act as if our job ends once we’ve described the options — mistaking information-sharing for shared decision-making.
Would you want CPR? A ventilator? Dialysis? Another line of chemotherapy?
Most patients and families have never faced these decisions before. What feels routine to us is often one of the most consequential moments of their lives. They are trying to navigate complex medical decisions while absorbing devastating news and grieving a future they planned for.
Neutrality alone isn’t empowering. More often, it’s isolating. When I ask patients and caregivers about their communication preferences, most tell me some version of the same thing: “Please just give it to me straight, doc.” Most patients don’t come to us seeking certainty. They want honesty and context. And often, they want guidance.
What I have found is that the most patient-centered approach isn’t neutrality — it’s values-based decision-making.
That means asking the hard questions, discussing best and worst-case scenarios honestly, and helping patients understand that just because we can do something in medicine doesn’t always mean we should. The goal isn’t to steer patients toward the outcome we’d choose for ourselves, but toward decisions that align with what matters most to them.
I see this frequently in conversations about code status. These conversations often reveal the difference between offering options and offering recommendations. A patient tells me their priorities are spending whatever time they have left with family and avoiding prolonged suffering. In these instances, I view my role as connecting options for medical intervention to those goals.
Sometimes that means saying, “Given your advanced cancer and what you’ve shared about what’s most important to you, I’d recommend allowing for a peaceful passing when you die. I worry CPR is unlikely to be effective, and that life support would make it harder to have meaningful time with your family.”
That’s not paternalism. It’s a medical recommendation grounded in the patient’s values. Patients remain free to disagree, and many do.
Importantly, values-based recommendations don’t always point toward less treatment. Frequently, I find myself advocating for interventions or paths that I might not choose for myself because they align with what matters most to the patient. The recommendation follows the patient’s goals — not my own preferences.
Sometimes, pursuing aggressive treatment despite a significant burden is exactly the right choice for someone who prioritizes the possibility of more time above all else. Sometimes it becomes part of the story that they want their children to carry with them after they’re gone.
When patients or caregivers ask, “What would you do?” they’re usually not asking us to make the decision for them. They’re asking us to pull back the curtain.
They’re asking us to share the perspective that comes from caring for countless patients who have faced similar choices. They’re asking us to help them understand not only what can be done, but what those choices may mean for the life they hope to live.
Respecting autonomy doesn’t require withholding guidance. Sometimes, the most compassionate thing we can do is offer a recommendation based on the values patients have entrusted us to understand. This isn’t undermining patient autonomy or shared decision-making. It’s recognizing that patients deserve more than options. They deserve our guidance, too.
How do you respond when a patient asks, "What would you do?" Share below!
