Using the family covenant in planning end-of-life care: Obligations and promises of patients, families, and physicians


Physicians and families need to interact more meaningfully to clarify the values and preferences at stake in advance care planning. The current use of advance directives fails to respect patient autonomy. This paper proposes using the family covenant as a preventive ethics process designed to improve end-of-life planning by incorporating other family members—as agreed to by the patient and those family members—into the medical care dialogue. The family covenant formulates advance directives in conversation with family members and with the assistance of a physician, thereby making advance directives more acceptable to the family, and more intelligible to other physicians. It adds the moral force of a promise to the obligation of respecting a patient’s preferences about end-of-life care. These negotiations between patient, family, and physician, from early planning phases through implementation, should greatly reduce the incidence of family disagreements on what the patient would have wanted. The family covenant ensures advance directive discussions within the family, promotes and respects the autonomy of other family members, and might even spur others in the family to complete advance directives through additional covenants. The family covenant holds the potential to transform moral quagmires into meaningful moral conversation. J Am Geriatr Soc 51:1155–1158, 2003.



    Upload a copy of this work     Papers currently archived: 94,385

External links

  • This entry has no external links. Add one.
Setup an account with your affiliations in order to access resources via your University's proxy server

Through your library

  • Only published works are available at libraries.

Similar books and articles

The Family Covenant and Genetic Testing.D. J. Doukas & J. W. Berg - 2001 - American Journal of Bioethics 1 (3):2-10.
The family covenant and genetic testing.David J. Doukas & Jessica W. Berg - 2001 - American Journal of Bioethics 1 (3):2 – 10.


Added to PP

47 (#333,921)

6 months
47 (#104,528)

Historical graph of downloads
How can I increase my downloads?