Patient's Decision Prevails (Answer B)
In a case where an adult patient with decision-making capacity has agreed to an abortion for anencephaly, the patient's autonomous decision is legally binding and ethically authoritative, regardless of family objection. The relative has no legal authority to override this decision 1.
Legal Framework for Patient Autonomy
The fundamental principle is clear: refusal or acceptance of treatment by an adult with capacity is legally binding, even if the decision results in death 1. This same principle applies to acceptance of treatment over family objection 1.
Key Requirements for Valid Consent
The patient must demonstrate capacity through four elements 2:
- Understanding the information about the procedure
- Appreciation of how it applies to their situation
- Reasoning through the decision
- Communication of their choice
Capacity is decision-specific and must never be assumed absent based on diagnosis, emotional state, or family pressure 2.
The Relative's Role is Advisory Only
While some cultures emphasize family-centered decision-making 1, modern medical ethics and law in most jurisdictions prioritize individual patient autonomy when the patient has capacity 1.
When Family Input Matters
Family consultation is appropriate only when 1:
- The patient lacks capacity to make decisions
- The patient has delegated authority through a lasting power of attorney for health decisions
- The patient is seeking family input voluntarily
In this case, none of these conditions apply—the patient has capacity and has made a clear decision 1.
Addressing Coercion Concerns
The provider should ensure the patient's decision is voluntary and free from coercion 1. If there is concern that family pressure might be influencing the patient:
- Speak with the patient privately, away from the relative 1
- Assess whether the relative's objection is causing duress that impairs the patient's capacity 1
- Document the patient's independent confirmation of their decision 2
However, family disagreement alone does not invalidate a capacitated patient's autonomous choice 1.
Documentation Requirements
Create a clear record including 2:
- Confirmation of the patient's capacity for this specific decision
- Evidence the decision was voluntary and not coerced
- The patient's understanding of the diagnosis and procedure
- Family objection noted but clarification that it does not override patient autonomy
Common Pitfall to Avoid
Do not delay or deny the procedure based on family refusal when the patient has capacity and consents 1. The provider's duty is to the patient, not to family members who disagree with the patient's autonomous choice 1. Requiring family agreement in this scenario would constitute an unethical violation of patient autonomy and potentially illegal battery if treatment is withheld against the patient's wishes 1.