Between Divine Will and Medical Responsibility: A Conceptual Framework for Faith-Informed Family Decision-Making involving Serious Illness in the Philippines.

Faith shapes how patients and families interpret serious illness, prognosis, treatment burden, hope, and moral responsibility, yet existing approaches insufficiently explain how spiritual meanings interact with relational authority and structural constraints. This conceptual article develops the Faith-Informed Relational Health Decision Framework for adult serious-illness decision-making in the Philippines. Integrating shared decision-making and relational autonomy, the framework distinguishes patient decision-making with capacity, family-assisted deliberation, and legitimate surrogate representation when capacity is absent. Its primary unit of analysis is the deliberative process surrounding a particular serious-illness decision episode. The framework organizes deliberation across four interacting dimensions: clinical evidence and prognosis, spiritual interpretation, relational participation and power, and structural access to care. Faith-clinical deliberative alignment describes the process quality through which these dimensions are integrated without prognostic distortion, coercion, spiritual dismissal, displacement of patient values, or abandonment of professional responsibility. Alignment denotes deliberative integration rather than agreement, consensus, treatment adherence, or conformity with clinical recommendations. Complementary alignment, tense but negotiable deliberation, and critical misalignment are proposed as overlapping and changeable heuristic configurations. The framework also differentiates sustaining miracle hope, contingent miracle hope, and exclusive miracle expectation. Sustaining and contingent hope may overlap, whereas exclusive expectation is understood as possible decisional closure rather than automatically as irrational, unethical, or critically misaligned. Ethical concern depends on decisional capacity, prognostic understanding, voluntariness, treatment burden, patient goals, professional limits, and openness to alternative outcomes. The framework offers a culturally responsive, structurally aware, and empirically examinable basis for research and practice concerning religion, family relationships, and serious-illness care.