Autonomy is about a person’s right to make their own decisions. As with any decision, people need to have the right information to be capable of making an informed choice. Decisions should also be made without undue influence, and the person making the decision should also be deemed capable of doing so.

It is difficult to stand by when a patient decides (against advice) to take a course of action that is not considered acceptable or appropriate, such as pursuing alternative therapies instead of conventional medicine. However, if the patient is capable of making such a decision and is well informed of the consequences of their actions, they cannot be forced to do anything else.

Many palliative care patients are vulnerable and can be persuaded to make choices that they would not normally make, such as accepting more treatment from the doctor having told the nurse they don’t want to continue with it. Part of a nurse’s role wherever possible, is to advocate for a patients right to decide their own course of action, whether it is something that the nurse feels is appropriate or not.

Resources

• Information on Improving patient information and decision making is available from the Consumer Health Forum
• The Jean Hailes Foundation for Women’s Health has information on Making Informed Decisions 
• Kidney Australia has a Fact Sheet about Informed Consent for Medical Tests 
• The Cochrane Collaboration has a Cochrane Review on Decision aids for people facing health treatment or screening decisions 
• The National Health & Medical Research Council (NH&MRC) has information on:
  • Making Decisions about Tests and Treatments: Principles for better communication 
  • General Guidelines for Medical Practitioners on Providing Information to Patients
• The Southern Cross Bioethics Institute website provides access to information on bioethical legislation in Australia, much of which is relevant to palliative care, but can be different in each state and territory, such as the Consent to Medical Treament and Palliactive Care Act 1995 (SA) and the Medical Treatment Acrt 1994 (ACT). 
• The General Medical Council in the UK has produced a guidance for doctors that may be of interest: Treatment and Care Towards the End of Life – Good practice in decision-making.
• Palliative Care Australia has conference presentations from the ‘Together 2009’ national conference, including ethics and law

Related CareSearch pages

Nurses Hub
Communication
Advanced Care Planning
Working with Families

CareSearch Review Collection
Decision Making

Free Full Text Article

Brown E, Pink J. Real life ethics: autonomy versus duty of care. Br J Gen Pract. 2008 Apr;58(549):288-9.

References

• Tonelli MR, Misak CJ. Compromised autonomy and the seriously ill patient. Chest. 2010 Apr;137(4):926-31.
• Willmott L. Advance directives and the promotion of autonomy: a comparative Australian statutory analysis. J Law Med. 2010 Feb;17(4):556-81.
• Dawson KA. Palliative care for critically ill older adults: dimensions of nursing advocacy. Crit Care Nurs Q. 2008 Jan-Mar;31(1):19-23.
• Valente SM. End-of-life challenges: honoring autonomy. Cancer Nurs. 2004 Jul-Aug;27(4):314-9.
• Breier-Mackie S. Patient autonomy and medical paternity: can nurses help doctors to listen to patients? Nurs Ethics. 2001 Nov;8(6):510-21.

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This page was created on 27 August 2010
Last updated 27 August 2010*