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Jacob Needs a Baclofen Pump When a Parent Overrules Their Child’s Best Interests Patient self-determination and personal autonomy are central components of ethically appropriate care. If patients have decision-making capacity, are able to understand the consequences of those decisions and accept the risks that might occur, it is typically ethically appropriate to support those decisions. But how far does this principle extend? At what point do the best interests of the patient, and thus the principle of beneficence, overcome the patient’s right to autonomy? This case looks at a demanding mom’s impact on care for her eight-year-old son Jacob, who has suffered from severe medical complications his entire life, as well as on his medical team.