Autonomy is about a person’s right to make their own decisions. To do this effectively, they need to have enough information. Patients do not always fully understand what they have been told, or they may not have been told. [1] Decisions are best made without undue influence, and the person making the decision should also be deemed capable of doing so.

Patient choice and autonomy are considered key in palliative care. Part of the nurse’s role, wherever possible, is to advocate for a competent patient’s right to decide their own course of action, whether it is something that the nurse feels is appropriate or not. Decision making is complex and includes cultural and social aspects that are not always acknowledged. [2]

It may be difficult to stand by when a patient decides (sometimes against advice) to take a course of action that is not considered ‘acceptable’ or ‘appropriate’. However, if the patient is capable of making such a decision and is well informed of the consequences of their actions, they must be allowed to exercise their autonomy to do so.

Palliative care patients are often vulnerable and may be more easily persuaded to make choices that they would not normally make, such as accepting further treatment that they don’t really want. They may also continue to request treatment that they have been told is futile and may not help. Further examination of their understanding of the situation and their goals is required to help support them in their decision making.

  1. Anyfantakis D, Symvoulakis EK. Medical decision and patient's preference: 'much ethics' and more trust always needed. Int J Med Sci. 2011;8(4):351-2. Epub 2011 May 31.
  2. Wilson F, Ingleton C, Gott M, Gardiner C. Autonomy and choice in palliative care: time for a new model? J Adv Nurs. 2014 May;70(5):1020-9. Epub 2013 Oct 10.

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  • 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.

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Last updated 10 October 2018