High-cost treatment decisions can expose a gap between the outward form of consent and the conditions that make agreement practically possible. A patient may endorse a treatment plan while depending on relatives for payment, housing, transport, caregiving, or other resources that make refusal materially consequential. Financial dependence alone, however, does not establish coercion, and family influence is not inherently autonomy-reducing. This article develops a conceptual account for distinguishing voluntary family agreement, financially constrained but still voluntary choice, undue economic influence, and coercive economic leverage. It integrates evidence on financial toxicity, treatment trade-offs, shared decision-making, relational autonomy, family involvement, and coercion. The ethical significance of dependence is argued to turn on patient-authored preferences, the source and form of influence, control over indispensable resources, the feasibility of refusal, and whether institutional alternatives can alter the patient’s option set. Apparent agreement becomes more concerning when another actor conditions essential resources on compliance and refusal carries serious, practically unavoidable consequences. Even then, authenticity, context, and the origin of the constraint remain decisive. Financial dependence is therefore best understood as a vulnerability that can enable coercion without constituting coercion itself.
