title: Trust and autonomy in end of life: considering the interrelation between patients and their relatives.
abstract: OBJECTIVE
  Patients' autonomy is seen as a major issue in modern medicine but requires the ability to understand and rate an issue without being influenced by others. However, near the end of life, patients often decide considering the consequences for their relatives.
  
  
  RESULTS
  Our study results and recent literature suggest that existing relational patterns determine experiences, family dynamics, and decision-making processes at the end of life. Relatives as a resource can promote patients' autonomy. In doubt of the patients' judgment or prioritizing their own needs, relatives can undermine patient's autonomy in a paternalistic way. Trust in others should be seen as a reciprocal process.
  
  
  CONCLUSIONS
  With respect to the patient's autonomy, healthcare providers need to consider the family structure and its relations.
authors.affiliation: Clinic for Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany *Gabriella Marx and Sonja Owusu Boakye contributed equally to the writing of this article.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Marx
authors.forename: Sonja
authors.initials: S
authors.lastname: Owusu Boakye
authors.forename: Antje
authors.initials: A
authors.lastname: Jung
authors.forename: Friedemann
authors.initials: F
authors.lastname: Nauck
mesh_terms: D032722:Advance Care Planning; D003657:Decision Making; D018450:Disease Progression; D005195:Family Relations; D006801:Humans; D026684:Personal Autonomy; D011369:Professional-Patient Relations; D013727:Terminal Care; D035502:Trust