Sibling Rivalry and Conflict in Decision-Making

Michael Gordon, MD, MSc, FRCPC, FRCP Edin, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.

Not all families work in harmony. Health care providers look to families for direction and support for those we care for especially when the patient is no longer able to make decisions for themselves. This is usually the result of a medical condition that affects the brain such as dementia, a common occurrence in those who require long-term care. When there is conflict between family members, health care and social service professionals must use their best communalization skills and sensitivities to help families resolve their differences so that the best possible care can be provided to those they love.
Keywords: sibling rivalry, conflict, decision-making.


The point of the article was not about what model of care would or should or could be provided- it is an amalgamation of many scenarios of a similar kind- it occurs in late stage dementia as well as after severe strokes and as in the famous US case of Terri Schiavo. The point I was trying to make was that sometimes (I find fairly often) there are conflicts between members of the substitute family that has to be understood and acknowldged and dealt with by the health care providers whatever mode of care is being provided and which ever one you subscribe to. Putting in a feeding tube in late life situations is one of the most common sources of anguish and conflict that I have encountered over many years of dealing with geriatric and palliative care situations.

Hope the is helpful.

Michael Gordon

The "curative model" to me implies the removal of the noxious agent from the patient. This is in contrast to the medical model in which the noxious agent is treated medically, possibly for cure. This is in contrast to the palliative model and the rehabilitative models of therapy which do not anticipate cures. I was uncertain after reading the article whether the conflict exists in the family, or in the caregivers and their objectives.