Nurses respect and promote the autonomy of persons and help them to express their
health needs and values and also to obtain desired information and services so that they
can make informed decisions.
1. Nurses must be committed to building trusting relations as the foundation of
meaningful communication, recognizing that building this relationship takes effort.
Such relationships are critical to ensure that a person’s choice is understood,
expressed and advocated.
2. Nurses should provide the desired information and support required so people are
enabled to act on their own behalf in meeting their health and health-care needs to the
greatest extent possible.
3. Nurses should be active in assisting person’s to obtain the best current knowledge
about their health condition.
4. Nurses must respect the wishes of those who refuse, or are not ready, to receive
information about their health condition. They should be sensitive to the timing of
information given and how the information is presented.
5. Nurses must ensure that nursing care is provided with the person’s informed consent.
Nurses must also recognize that persons have the right to refuse or withdraw consent
for care or treatment at any time.
6. Nurses must respect the informed choices of those with decisional capacity to be
independent, to choose lifestyles not conducive to good health and to direct their own
care as they see fit. However, nurses are not obligated to comply with a person’s
wishes when this is contrary to the law.
7. Nurses must continue to provide opportunities for people to make choices and
maintain their capacity to make decisions, even when illness or other factors reduce
the person’s capacity for self-determination. Nurses should seek assent of the person
when consent is not possible.
8. If nursing care is requested that is contrary to the nurse’s personal values, the nurse
must provide appropriate care until alternative care arrangements are in place to meet
the person’s desires.
9. Nurses must be sensitive to their position of relative power in professional
relationships with persons. Nurses must also identify and minimize (and discuss with
the health team) sources of coercion.
10. Nurses must respect a person’s advance directives about present and future healthcare
choices that have been given or written by a person prior to loss of decisional
capacity.
11. When a person lacks decisional capacity, nurses must obtain consent for nursing care
from a substitute decision-maker, subject to the laws in their jurisdiction. When prior
wishes for treatment and care of an incompetent person are not known or are unclear,
nurses’ decisions must be made based on what the person would have wanted as far
as is known, or failing that, decisions must be made in the best interest of the person
in consultation with the family and other health-care providers.
12. Nurses should respect a person’s method of decision-making, recognizing that
different cultures place different weight on individualism and often choose to defer to
family and community values in decision-making (American Nurses Association
[ANA], 2001). However, nurses should also advocate for the individual if that
person’s well-being is compromised by family, community or other health
professionals.