Patient Autonomy in Nursing and Healthcare Contexts

  • Anna-Marie GreaneyEmail author
  • Dónal P. O’Mathúna


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.


Autonomy Professional accountability Caring Choice Vulnerability Human rights 



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.


  1. Agich GJ (2003) Dependency and autonomy in old age. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  2. American Nurses Association (ANA) (2015) Code of ethics for nurses. ANA, Silver SpringsGoogle Scholar
  3. Ashley V (2012) Philosophical models of autonomy. Essex Autonomy Project, Essex. Available via Accessed 14 June 2016
  4. Beauchamp T, Childress J (2013) Principles of biomedical ethics, 7th edn. Oxford University Press, New YorkGoogle Scholar
  5. Brody H (2002) My story is broken; can you help me fix it. In: Fulford KWM, Dickenson DL, Murray TH (eds) Healthcare ethics and human values: an introductory text with readings and values. Blackwell publishers, Oxford, pp 133–140Google Scholar
  6. Chiovitti RF (2008) Nurses’ meaning of caring with patients in acute psychiatric hospital settings: a grounded theory study. Int J Nurs Stud 45(2):203–223CrossRefGoogle Scholar
  7. Department of Health (2005) Mental capacity act. HMSO, LondonGoogle Scholar
  8. Dooley D, McCarthy J (2012) Nursing Ethics: Irish cases and concerns, 2nd edn. Gill and Macmillan, DublinGoogle Scholar
  9. Dworkin G (1988) The theory and practice of autonomy. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  10. Gilligan C (1982) In a Different Voice: psychological theory and women’s development. Harvard University Press, BostonGoogle Scholar
  11. Government of Ireland (2015) Assisted decision-making (capacity) act. The Stationery Office, DublinGoogle Scholar
  12. Greaney AM (2014) Autonomy as lived: An empirical-ethical analysis of patient autonomy in the clinical context of individuals engaged with self-testing technology. PhD Dissertation. Dublin City University. Available via Accessed 25 May 2016
  13. Greaney AM, O’Mathuna D, Scott P (2012) Patient autonomy and choice in healthcare: self-testing devices as a case in point. Med Health Care Philos 15(4):383–395CrossRefGoogle Scholar
  14. Harnett PJ, Greaney AM (2008) Operationalizing autonomy: solutions for mental health nursing practice. J Psychiatr Ment Health Nurs 1(15):2–9CrossRefGoogle Scholar
  15. Health Information and Quality Authority (Ireland) (2016) Supporting people’s autonomy: a guidance document. Health Information and Quality Authority, DublinGoogle Scholar
  16. Health Service Executive (HSE) (2013) National consent policy. HSE, DublinGoogle Scholar
  17. Holm S (1997) Ethical problems in clinical practice. Manchester University Press, ManchesterGoogle Scholar
  18. International Council of Nurses (ICN) (2012) The ICN code of ethics. ICN, GenevaGoogle Scholar
  19. Kant I (1998) Groundwork of the metaphysics of morals. Translation by M. Gregor and Introduction and Commentary by C. Korsgaard. Cambridge University Press, CambridgeGoogle Scholar
  20. Mill JS (1859) On liberty. J.W. Parker and Son, LondonGoogle Scholar
  21. Mol AM (2008) The logic of care: health and the problem of patient choice. Routledge, LondonCrossRefGoogle Scholar
  22. Morgan S (2010) Making good risk decisions in mental health and social care. Health Care Risk Rep 5(2010):16–17Google Scholar
  23. Nursing and Midwifery Board of Ireland (NMBI) (2014) Code of professional conduct and ethics for registered nurses and registered midwives. NMBI, DublinGoogle Scholar
  24. Nursing and Midwifery Council (UK) (NMC) (2015) The code: professional standards of practice and behaviour for nurses and midwives. NMC, LondonGoogle Scholar
  25. Olsen DP (2003) Influence and coercion: relational and rights-based ethical approaches to psychiatric treatment. J Psychiatr Ment Health Nurs 10:705–712CrossRefGoogle Scholar
  26. Schildmann J, Ritter P, Salloch S, Uhl W, Vollmann J (2013) ‘One also needs a bit of trust in the doctor…’ a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making. Ann Oncol 24:2444–2449CrossRefGoogle Scholar
  27. Sellman D (2011) What makes a good nurse. Jessica Kingsley Publishers, LondonGoogle Scholar
  28. Tauber AI (2005) Patient autonomy and the ethics of responsibility. MIT Press, CambridgeGoogle Scholar
  29. United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) (2006) General comment No. 1. Article 12: Equal recognition before the law. Committee on the Rights of Persons with Disabilities: Eleventh sessionGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Nursing and Healthcare SciencesInstitute of TechnologyTraleeIreland
  2. 2.School of Nursing and Human SciencesDublin City UniversityDublin 9Ireland

Personalised recommendations