Abstract

Respect for patient autonomy continues to gain momentum in nursing and healthcare practice. The general public is more aware of the right to self-determination and choice regarding the care, support, and treatment they can receive. This right is supported by healthcare policy, enshrined in professional codes, mandated by legislation, and underpinned by a human rights-based care agenda. While respect for patient autonomy, as well as associated patient choice, is accepted in professional practice, supporting autonomy can create tensions for nurses and healthcare professionals. Such tensions arise when patient choice conflicts with professional care obligations and available clinical evidence, raising concerns about professional accountability for patient welfare. This chapter explores the complexities of respecting patient autonomy in ‘real-world’ nursing and healthcare contexts. We argue that equating autonomy with independence is unrealistic in the lives we live. A case study highlights practical concerns. We propose ways of reconciling professional accountability with respect for patient autonomy. We draw on recent research, a more relational understanding of autonomy and contemporary health and social care guidance. We conclude that Autonomy by Negotiation represents a more accurate account of our autonomy as social beings