Archive for the ‘Autonomy’ Category

Autonomy and the Nursing Role

September 20, 2010

In health care ethics, autonomy has primarily been conceptualized in the context of physician-patient relationships.  The central ethical concerns have revolved around paternalism and issues of consent.  Thinking of autonomy as the capacity for informed consent, including lack of coercion and capacity for effective deliberation is a relatively “thin” conception.  It attributes to the patient just enough moral status to block paternalistic intervention. More recent work has developed a “thicker” notion of autonomy.  These authors have embedded the key moral dimensions of autonomy in a more psychologically realistic picture.  The resulting conception of autonomy helps us sort out the sticky cases of diminished capacity (both temporary and progressive), and distinguish “authentic” choices from those made under the emotional pressure of a moment.  While these developments in the literature are both philosophically interesting and practically useful for health care professionals, they continue to focus on patient choice of treatment as the paradigmatic context in which autonomy is manifest.  The vivid cases discussed in the literature are major interventions for life threatening conditions, not mundane choices like whether and how to follow a prescribed treatment for psoriasis.  The physician’s perspective dominates this literature.  Physicians provide treatment options in a way that nurses cannot; and a nurse’s relationship with the patient takes place within the context of those larger decisions.  Nurses thus have a different perspective on patient action, deliberation, and choice.  Does this difference make a difference for the way in which we should conceptualize autonomy?

A traditional conceptualization of nursing emphasized the role of the nurse in helping the patient achieve something s/he could not do alone.  For Weidenbach, this was the “need-for-help,” and for Orem is was the “self-care deficit.”

Parse and her followers have argued against that traditional conceptualization of the nursing role.  They think that the patient should be unconditionally (existentially) free to define health for him or herself.  the emphasis is on choices, not capacities.

Doesn’t this model realign the concept of autonomy with the physician’s perspective?