How to Make a Decision When There Are No Good Choices

On an April morning in 2019, my sister rested in a California hospital bed and gazed with wonder at her beautiful new infant. A thirty-minute drive away, my father also rested in a hospital bed, fighting his years-long battle with stage IV melanoma. Across the country, I sat perched on the edge of a plastic blue chair in the airport waiting to board a plane from Boston. Knowing my dad was very ill and that my sister would want help with her new baby, I had decided to take a week off from my busy working-parent life. 

That decision was an obvious “good choice.” But for most of us, at various points in our life journeys, we are confronted with the need to make a decision with no good options. The pain that accompanies this kind of decision is unavoidable and routinely brings patients to my therapy office. For some, it’s an unhappy marriage. Staying means accepting loneliness and unmet emotional needs, but leaving means legal warfare and an uncertain financial and social future. Or it’s the decision of whether or not to reveal an extramarital affair entered into during an unhappy phase of life. Keeping the secret guarantees a marital chasm, but revealing it ensures breaking your partner’s heart. Or it’s deciding whether to meet the acute needs of one child even if doing so means failing another one. These are painful decisions because there are simply no good choices.

The choice to visit my family in California for a week had been obvious. But the day before I was scheduled to return home to Boston, my father slipped into a coma. As a hospice nurse explained to me, in a comatose state like his, my father could die the next day, or he could continue this way for a month.

I honestly didn’t know whether the right choice was to return home to a life that demanded my attention or to stay and keep vigil for my father. I had three little boys who were missing their mom, and I them. And my mother-in-law needed to head back to her home the day after I was supposed to return; without me or my mother-in-law there, my husband would be forced to either neglect a job our family needed, or our young children. Then there were my own work obligations. I had meetings with colleagues, projects with deadlines, and scheduled sessions with patients struggling with their own crises. Still, I couldn’t fathom leaving my father’s side and abandoning my siblings and mother. Going back to Boston felt wrong. So did staying in California. 

If ever there was a decision to get right, it was this one. I found myself hunting desperately for that answer. I texted close friends, interrogated the various hospice nurses that came to see my dad, did Google searches on “length of time one could remain in a coma before dying,” and spoke to each of my siblings, my mother, and my husband. I was searching for the choice that would unburden me of internal conflict, a solution that would allow me to do the right thing by all of the roles that mattered most to me. I found none. Regardless of how wise or thoughtful or strategic the choice I made was, and regardless of how much family and colleagues supported my choice, all the options before me felt reprehensible. 

So I turned to a skill I teach patients. 

It’s a practice drawn from acceptance and commitment therapy (or ACT, pronounced as one word). This treatment is an evidence-based psychotherapy that integrates cutting-edge psychological science with ancient Buddhist ideas. Central in both Buddhism and ACT is a recognition of the universality of human suffering and the awareness that practices of acceptance, mindfulness, and clarifying values help us transcend it. These kinds of skills have been shown to help people better manage mental illness, physical illness, profoundly stressful life circumstances, and even to play a better game of chess. 

Clarifying values is a core process in ACT. Psychologists define values as the purpose or attitude we take regarding our chosen actions. A value is not a goal or destination but rather a compass that guides our journey toward a more meaningful, purpose-driven life. Values reflect the ways we most want to show up in the world. In comparison to emotions, which come and go and sometimes mistakenly lead us into thinking there is danger, values provide a steady hand that reminds us about the kind of person we want to be. In comparison to logic, values do not require us to solve anything. They require only that we choose, with clear-eyed intention, how we take our life’s journey. 

We can always choose to put our values in the driver’s seat, even when we find ourselves on a path we didn’t choose, don’t much like, or that is truly unjust. We can put our values in the driver’s seat even while experiencing the searing pain of guilt, shame, sadness, or anger. 

In the turbulence of that difficult moment, I turned to the kinds of questions I ask patients to help them clarify their values. I asked myself what I wanted to stand for as I went through this painful series of events. I considered what I’d advise my kids to do in the face of my own mortal end. And I asked myself how I thought my father would want me to choose. 

Recognizing that there was no logical or emotionally “right” choice, I allowed myself to be guided by my father’s values of prioritizing the grandchildren he adored and persisting in the work ethic he had been so proud of. I returned to Boston. Was leaving his side a moral choice? A reasonable one? Years later, I’m still not sure. But I do know that there comes a time when there are simply no good options before us. So when I find my mind replaying how I made the decision, I remind myself that I acted on my values as best I could. And I remember I tried to use my values as a guide for honoring my father.