SESSION DESCRIPTION
When patients face overwhelming decisional burden and severely constrained options, standard advance care planning and shared decision-making frameworks reach a limit. This session introduces a practical, ethically grounded alternative: maternalism operationalized through informed non-dissent. Grounded in relational autonomy, the model guides interprofessional teams through clinician-directed planning that preserves patient values, reduces family guilt, and maintains active dissent monitoring. Case illustrations ground the framework in real palliative care encounters.
OBJECTIVES
- Identify the four-quadrant clinical grid that maps available options against decisional burden, and recognize Quadrant 4 encounters where standard ACP and SDM approaches reach a structural limit.
- Describe the bioethical construct of maternalism grounded in relational autonomy and explain how informed non-dissent operationalizes clinician-guided planning while preserving patient control through active dissent monitoring.
- Apply the minimum ethical conditions of the framework through relational assessment, transparency, active dissent monitoring, and equity safeguards to interprofessional serious illness encounters in their own clinical settings.
FACULTY
Chris Onderdonk, MSW, LCSW, APHSW-C
Palliative Care Social Worker, UC San Diego Health
Affiliate Faculty, UCSD Sanford Center for Compassionate Communication
Past Chair, Social Work Hospice and Palliative Care Network Board
Kyle Edmonds, MD, FAAHPM
Clinical Professor, UC San Diego Health Sciences
Member, AAHPM Board of Directors