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Compromised Autonomy: When Families Pressure Patients to Change Their Wishes

Blackler, Liz LCSW-R, MBE

Journal of Hospice & Palliative Nursing: August 2016 - Volume 18 - Issue 4 - p 184–191
doi: 10.1097/NJH.0000000000000264
Ethics Series

Living with a life-threatening illness is extraordinarily challenging. This challenge intensifies when patients struggle to weigh personal and familial interests when facing difficult medical decisions. When patients are unduly pressured by their families to make medical decisions that are not in line with previously held values, beliefs, or perspectives, autonomy is compromised. A case example, based on a clinical ethics consultation, is used to highlight the complexities of compromised autonomy secondary to family coercion and manipulation at the end of life. Decision making in the context of family involvement and relational autonomy will be explored along with effects of caregiver stressors, patient/family disagreements, and the nuances of substituted judgment. The article closes with a discussion of universal strategies for best working with and advocating for patients who are experiencing compromised autonomy.

Liz Blackler, LCSW-R, MBE, is senior clinical social worker and ethics consultant, Memorial Sloan Kettering Cancer Center, New York, New York.

Address correspondence to Liz Blackler, LCSW-R, MBE, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 177, New York, NY 10065 (

The author has no conflicts of interest to disclose.

© 2016 by The Hospice and Palliative Nurses Association.