Managing family conflict

The usual flashpoints

• One person doing 90% of the care while others visit and comment.
• Disagreement about treatment — pushing on versus comfort care.
• Money: costs, wills, property, who pays for what.
• Information control — who gets told what, and when.
• The distant relative who arrives late with strong opinions.
• Old sibling roles snapping back into place at the bedside.

Ground rules that reduce heat

1. 1Separate the decision from the history. Deal with this week's problem, not 1998.
2. 2Return to the patient's own wishes as the deciding standard, wherever they can express them.
3. 3Use facts from the care team rather than each person's interpretation.
4. 4Divide responsibilities in writing so contribution stops being a matter of opinion.
5. 5Agree a channel — one group message for updates — and keep arguments out of it.
6. 6Bring in a neutral third party if two attempts have failed: social worker, chaplain, family therapist, mediator.

When someone is abusive

Conflict is normal; abuse is not. If a family member is threatening, financially exploiting, or physically harming the patient or a caregiver, contact the care team, social services or safeguarding. Protecting a vulnerable adult overrides keeping the peace.