Abstract
Autonomy, which gives individuals the right to make informed decisions about their
medical treatment, is a central principle in Western bioethics. However, we often
encounter patients for whom a family member seems to dominate medical decision-making,
to the extent that clinicians become concerned that the patient is subject to excessive
pressure or even coercion. In this article, we describe one such case and how we assess
a decision-making process that involves family influence. This entails acknowledging
that many individuals weigh their family members’ preferences and/or well-being heavily
in making medical decisions, and family norms for decision-making differ. A family
member who tells their loved one “You can't give up now” is typically not ursurping
the patient's liberty to make a different decision. However, there are some family
influences which may be autonomy-limiting, including credible threats, or in situations
of abuse. Aside from these scenarios, our role is not to alter a couple's long-standing
dynamics and decision-making processes. However, for the patient who wants to assert
herself, we can set the stage in a family meeting and amplify her voice. We must also
attend to the emotional level of family members’ statements. “I won't let you give
up” might be more a statement of grief rather than a true reflection of their values
or intent. Supporting the family member's coping may help to bring together what initially
seem to be divergent goals. Exploring these decision-making dynamics is key to providing
good palliative care.
Key Words
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Article info
Publication history
Published online: June 08, 2021
Accepted:
June 3,
2021
Identification
Copyright
© 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
