Ethical and Emotional Dilemmas in the Medical Decision‐Making Process Among Family Members of Intensive Care Patients: A Qualitative Study
Gülcan Bahcecioglu Turan, Mizgin Demir, Fatma GürABSTRACT
Background
Intensive care units (ICUs) constitute a highly challenging environment for patients' relatives due to critical illnesses and uncertain prognoses, creating significant ethical and emotional strain. Family members often face profound ethical dilemmas and a substantial emotional burden when making medical decisions on behalf of the patient.
Aim
This study aimed to explore the ethical and emotional dilemmas experienced by family members of intensive care patients during the medical decision‐making process and the strategies they used to cope with these experiences.
Study Design
This qualitative descriptive study was conducted between January and March 2026 in the adult ICUs of a public hospital located in eastern Türkiye. Data were collected through semi‐structured, in‐depth interviews with 20 family members selected via purposive sampling. Interviews were discontinued upon reaching data saturation. The study was reported in accordance with the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines to ensure transparency and methodological rigour.
Findings
Four main themes reflecting participants' experiences were identified: ‘Ethical Dilemma and Responsibility’, ‘Intense Emotional Reactions and Internal Reflection’, ‘Information and Communication Process’ and ‘Coping and Support Mechanisms’. Participants reported being caught between critical decisions such as prolonging life and alleviating suffering. The weight, uncertainty and irreversibility of these decisions led to significant stress, anxiety and feelings of guilt. Social support, along with spiritual and individual coping strategies, played a crucial role in managing this process.
Conclusions
Family members of patients in intensive care experience a multilayered burden encompassing ethical, emotional and cognitive dimensions during medical decision‐making. Effective communication, guidance and social‐spiritual support mechanisms are critical in alleviating this burden.
Relevance to Clinical Practice
This study highlights the ethical and emotional burden experienced by family members during decision‐making in intensive care settings and underscores the importance of clear and empathetic communication by healthcare professionals. Additionally, the provision of psychosocial and spiritual support may facilitate decision‐making and reduce the burden on family members.