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“She's Not Ready to Give Up Yet!”: When a Family Member Overrides the Patient's Medical Decisions

  • Julie W. Childers
    Correspondence
    Address correspondence to: Julie W. Childers, MD, Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, The University of Pittsburgh, 200 Lothrop Street, 9W, Pittsburgh, PA 15213, USA.
    Affiliations
    Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, The University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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  • Robert Arnold
    Affiliations
    Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, The University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    Search for articles by this author

      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.

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