Maternalism in Palliative Care: A Case for Relational Autonomy and Informed Non-Dissent

BACKGROUND: Clinicians often face situations in which patients or families desire aggressive care that medical teams believe offers no meaningful benefit. Traditional shared decision-making frameworks may inadequately address these tensions. CASE: A 53-year-old woman with metastatic lung cancer desired full resuscitation despite progressive multisystem organ failure. She identified as a "fighter" but faced a clinical dilemma: adequate pain control required accepting respiratory compromise. DISCUSSION: We apply the bioethical construct of maternalism, integrating relational autonomy and informed non-dissent to support clinician-guided decision making that preserves patient values while unburdening families from impossible choices. CONCLUSION: Maternalism offers palliative care clinicians a theoretically grounded approach for navigating value-laden decisions when patients cannot or choose not to bear the weight of deciding.