Families and physicians are often left to makeend-of-life decisions for patients, and these choices are more complicated than many realize, according to a new study.

When it comes to end-of-life decisions, researchers at the University of Indiana School of Medicine find that the patients do not always get the last word. Interviews with 21 hospital doctors showed that many times, physicians take family wishes into account and, on occasion, inject their own opinions into the mix. It is not uncommon for these two complicated viewpoints to overrule the generally accepted ethical guidelines when it comes to granting patients’ wishes, according to the report. 

The full report, which contains examples of the complications that cloud end-of-life decisions and analysis of the ramifications of such decisions, can be found in the summer edition of the Journal of Clinical Ethics.