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Autonomy

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.

Resources

Websites Guidelines / Documents / Factsheets Video

Related CareSearch pages

Nurses Hub
Communication
Advanced Care Planning
Working with Families

CareSearch Review Collection
Decision Making

Free Full Text Article

Ivanovi NA, Büche D, Fringer A. Voluntary stopping of eating and drinking at the end of life - a 'systematic search and review' giving insight into an option of hastening death in capacitated adults at the end of life. BMC Palliat Care. 2014 Jan 8;13(1):1.

Winkler EC, Hiddemann W, Marckmann G. Evaluating a patient's request for life-prolonging treatment: an ethical framework. J Med Ethics. 2012 Nov;38(11):647-51. Epub 2012 Jun 12.

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 11.

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

References

  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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Last updated 09 February 2017*