Patient-and-family-centered care (PFCC) is critical in end-of-life (EOL) settings. PFCC serves to develop and implement patient care plans within the context of unique family situations. Key components of PFCC include collaboration and communication among patients, family members and healthcare professionals (HCP). Ethical challenges arise when the burdens (e.g., economic, psychosocial, physical) of family members and significant others do not align with patients’ wishes. This study aims to describe the concept of vulnerability and the ethical challenges faced by HCPs in these circumstances. Further, it assesses the contribution of clinical ethics consultation (CEC) in assisting HCPs to face these difficult ethical conundrums. Two clinical cases are analyzed using the Circle Method of CEC. The first regards the difficulty faced by the doctor in justifying treatments previously agreed upon between the patient and his/her friends. The second regards the patient’s concern about being a burden on their family. Family burdens in EOL settings challenge PFCC in that patient autonomy may be disregarded. This compromises shared decision-making between the patient, family and HCPs as a core component of PFCC. In their ability to promote a collaborative approach, CECs may assist in the successful implementation of PFCC.

中文翻译：

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护理人员和家庭成员在临终决策中的脆弱性：评估脆弱性如何影响临床选择以及临床伦理咨询的贡献

以患者和家庭为中心的护理 (PFCC) 在临终 (EOL) 环境中至关重要。PFCC 致力于根据独特的家庭情况制定和实施患者护理计划。PFCC 的关键组成部分包括患者、家庭成员和医疗保健专业人员 (HCP) 之间的协作和沟通。当家庭成员和重要其他人的负担（例如经济、社会心理、身体）与患者的意愿不一致时，就会出现伦理挑战。本研究旨在描述脆弱性的概念以及 HCP 在这些情况下面临的道德挑战。此外，它还评估了临床伦理咨询 (CEC) 在协助 HCP 应对这些困难的伦理难题方面的贡献。使用CEC的圆法对两个临床病例进行分析。第一个问题是医生在证明患者和他/她的朋友之前商定的治疗方法的合理性方面面临的困难。第二个是患者担心成为家人的负担。EOL 环境中的家庭负担对 PFCC 提出了挑战，因为患者的自主权可能会被忽视。这损害了患者、家属和 HCP 之间作为 PFCC 核心组成部分的共同决策。CEC 凭借其促进协作方法的能力，可以协助 PFCC 的成功实施。