Therefore, clinicians must be mindful of the potential for this dynamic and advocate for the patient to ensure that he or she feels free to make an independent decision.
In this case, Dave has elected to make his decision based on the wishes of his family.
Expressing respect for patients’ autonomy means acknowledging that patients who have decision-making capacity have the right to make decisions regarding their care, even when their decisions contradict their clinicians’ recommendations .
Beauchamp and Childress remind us that autonomy requires both “liberty (independence from controlling influences) and agency (capacity for intentional action)”  and that liberty is undermined by coercion, persuasion, and manipulation .
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Despite surgery, chemotherapy, radiation, and hormonal treatments, his prostate cancer has metastasized to his bones.
Patients often wish to take their family members’ opinions into account when making medical decisions, as they would with many other important decisions.
Respecting patient autonomy thus includes respecting both how patients wish to make a decision and the decision made, even if the decision is to allow their family’s desires to supersede their own [4, 5].
If Dave’s family were exercising undue influence, Dr.
Barelle would be obligated to identify that as unacceptable and discuss it with Dave.