Patient autonomy in nursing and healthcare contexts

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.