Increasing emphasis on patient self-management, including having patients advocate for their needs and priorities, is generally a good thing, but it is not always wanted or attainable by patients. The aim of this critical ethical review is to deepen the current discourse in patient self-advocacy by exposing various situations in which patients struggle to self-advocate. Using examples from oncology patient populations, we disambiguate different notions of self-advocacy and then present limits to the more demanding varieties (i.e., health-related, trust-based, and psychological); we argue that these limits create ethical dilemmas with respect to whether it is always desirable to encourage patients to self-advocate. We conclude that self-advocacy can be both under and overrated with respect to how much it benefits the patient with cancer, with many instances being indeterminate. Ultimately, providers must understand the patient's perspective relative to the challenges they are experiencing and work with them to meet their needs.

越来越重视患者的自我管理，包括让患者主张自己的需求和优先事项，通常是一件好事，但患者并不总是希望或能够实现这一点。这项批判性伦理审查的目的是通过揭露患者难以自我倡导的各种情况来加深当前关于患者自我倡导的讨论。使用肿瘤患者群体的例子，我们消除了自我倡导的不同概念的歧义，然后对要求更高的种类（即与健康相关的、基于信任的和心理的）提出了限制；我们认为，这些限制造成了道德困境，即是否总是需要鼓励患者自我倡导。我们的结论是，就自我倡导对癌症患者的益处而言，自我倡导可能被低估，也可能被高估，许多情况是不确定的。最终，提供者必须了解患者对他们所经历的挑战的看法，并与他们合作以满足他们的需求。