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To support the process of effective family decision making, it is important to recognize and understand informal roles that various family members may play in the end-of-life decision-making process.

To describe some informal roles consistently enacted by family members involved in the process of end-of-life decision making in intensive care units.

Ethnographic study. Data were collected via participant observation with field notes and semistructured interviews on 4 intensive care units in an academic health center in the mid-Atlantic United States from 2001 to 2004. The units studied were a medical, a surgical, a burn and trauma, and a cardiovascular intensive care unit.

Health care clinicians, patients, and family members.

Informal roles for family members consistently …