Do Family Wishes Trump Verbal Advance Directive?

An Ethics Case Report Amidst COVID Pandemic

  • Sarosh Saleem, Dr Shalamar Medical & Dental College, Lahore
  • Nuzhat Irfan Malik, Dr. The Indus Hospital, Karachi
  • Nida Ilyas Shamsi, Dr The Indus Hospital, Karachi
Keywords: COVID 19, Clinical Ethics, End of Life, Advance Directives, Informed Consent, Ethical Dilemma


COVID 19 has brought about a complex array of clinical as well as ethical challenges for the healthcare community around the world. We are reporting a case, managed by a team of experienced clinicians at a local tertiary care hospital, where the patient’s wishes conflicted with those of the family. The case under discussion may be approached from legal, social, and clinical perspectives. However, the lessons learned range from an individual to the policy level. The issue of the validity of a verbal advanced directive by the patient was called to attention when the patient lost the capacity and the wishes of his family conflicted. Effective communication with patients and their families, adequate documentation, and prompt involvement of a clinical ethics committee are recommended to avoid conflicts. The significance of ethics education and clinical/hospital ethics committees in healthcare organizations cannot be undermined. 

Author Biographies

Sarosh Saleem, Dr, Shalamar Medical & Dental College, Lahore

Assisstant Professor, Bioethics, Shalamar Medical & Dental College, Lahore


Nuzhat Irfan Malik, Dr., The Indus Hospital, Karachi

Specialist Radiologist & Chair, Clinical Ethics Committee,

The Indus Hospital, Karachi

Nida Ilyas Shamsi, Dr, The Indus Hospital, Karachi

Consultant Family Medicine,  The Indus Hospital, Karachi, Indus Health Network