Abstract
Autonomy, and associated respect for patient autonomy, have gained increased prominence in nursing and healthcare practice in recent years. There is a growing understanding that patients have a right to self-determination and choice with regard to the care, support and treatment they receive. This right is supported by healthcare policy, enshrined in professional codes of conduct, and mandated by national and international legislation. However, while respect for patient autonomy, and associated patient choice, is accepted as a core tenet of professional practice, the actual reality of supporting autonomy can create tensions for nurses and other healthcare professionals. Such tensions arise when patient choice conflicts with professional advice, policy and best available clinical evidence. Respecting autonomy may, on occasion, lead to concerns regarding professional accountability and responsibility for patient welfare. This chapter aims to explore the complex reality of respecting patient autonomy in ‘real-world’ nursing and healthcare contexts. A case vignette is used to apply theoretical and professional considerations to a patient story; thereby highlighting some of the complexities regarding patient autonomy. The chapter explores autonomy in relation to the associated concepts of choice, freedom, decision-making, advocacy, professional accountability and legislative guidance. The chapter concludes by offering some proposals for reconciling professional accountability with respect for patient autonomy. These proposals draw on recent research, a more relational, as opposed to isolated, understanding of autonomy, and contemporary health and social care guidance.
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Notes
- 1.
For further discussion of Kantian ethics please see Chap. 2.
- 2.
For further discussion of such ethical issues within the context of mental health nursing please see Chap. 11.
- 3.
For an introduction to the ethics of care please see Chap. 5.
- 4.
A more detailed review of the differences in legislation is beyond the scope of this chapter. For an overview of debates regarding the compatibility of capacity legislation in the UK with UNCRPD (2006) see, The Essex Autonomy Project position paper, Achieving CRPD Compliance (2014), available at http://autonomy.essex.ac.uk/uncrpd-report
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Acknowledgement
The authors would like to acknowledge the contribution of Professor P. Anne Scott as co-supervisor on the referenced PhD work. The PhD study was partly funded by the School of Nursing and Human Sciences, Dublin City University and Science Foundation Ireland (SFI) (SFI 05/CE3/B754 and SFI 10/CE/B1821). Acknowledgements are also extended to personnel at the Health Information and Quality Authority (Ireland), and the wider project team members, for their insights during participation in the Autonomy Guidance project. Finally, we thank the many patients, health and social care professionals and academic colleagues whose comments and experiences have contributed to the ideas presented.
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Greaney, AM., O’Mathúna, D.P. (2017). Patient Autonomy in Nursing and Healthcare Contexts. In: Scott, P. (eds) Key Concepts and Issues in Nursing Ethics. Springer, Cham. https://doi.org/10.1007/978-3-319-49250-6_7
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