I had this same exact situation when I was in the CVICU. I was very frank with the spouse because everyone else was straight up lying to her about his prognosis. They would constantly say this guy will be like this forever he will need to go to a SNF if he even makes it out. And then when she was present they would say things like “we expect to be able to wean off of continuous dialysis and start coming off his continuous medications” (dude was on rocket fuel). I gave her only the facts about his current state and what is expected further down if we can’t get his sepsis under control (which we couldn’t) I did my best to arrange a meeting with her and all of the docs (cardiac renal ID pulm and who even knows who else) it’s nearly IMPOSSIBLE to get anyone to the bedside longer than 5 minutes let alone at the same time. Eventually there was a meeting with most of the team and she withdrew care per the patient’s wishes. I’m all for advocating for your patient and giving objective facts about their condition. That is within your scope and someone needs to do it.