Which approach best respects patient autonomy when a patient’s decision conflicts with family wishes?

• A. Change the decision to align with family.
• B. Override the decision using legal authority.
• C. End communication with the patient.
• D. Respect the patient’s autonomous decision if competent, and discuss concerns with family.

Answer: (D)

Respecting patient autonomy means honoring a competent patient’s right to make their own decisions, even when family members disagree. If the patient has decision-making capacity, their informed choice guides the plan of care. The clinician should ensure understanding by clearly explaining prognosis, options, risks, and benefits, and then support the patient in discussing these with the family.

The family’s role becomes supportive rather than prescriptive. Discuss concerns with the family in a non-coercive way, focusing on understanding the patient’s values and preferences, and, with the patient’s permission, involve them in conversations. Preserve confidentiality unless the patient consents to share information.

This approach is central in palliative care because it centers the patient’s goals and values, promotes trust, and avoids unnecessary conflict or harm. If the patient were not competent, then surrogate decision-making or advance directives would guide the course, but the question focuses on when the patient is competent.