Provision 1

Respect for human dignity requires the recognition of specific patient rights, in particular, the right to self-determination. Recipients of care have the moral and legal right to determine what will be done with and to their own person; to be given accurate, complete, and understandable information in a manner that facilitates an informed decision; and to be assisted with weighing the benefits, burdens, and available options in their treatment, including the choice of no treatment. They also have the right to accept, refuse, or terminate treatment without undue influence, duress, deception, manipulation, coercion, or prejudice, and to be given necessary support throughout the decision-making and treatment process. Such support includes the opportunity to make decisions with family and persons of their choosing, and to partner with nurses and other healthcare professionals.

Nurses have an obligation to be familiar with the moral and legal rights of recipients of care. Within their scope of practice, nurses preserve, protect, and support those rights by assessing the patient’s understanding of the information presented and explaining the implications of all potential options. When a recipient of care lacks capacity, an alternate decision-maker should base decisions on the patient’s previously expressed wishes and known values, taking into consideration the nuances associated with minors. In the absence of an alternate decision-maker, healthcare professionals make decisions that reflect the best interests of the recipient of care, considering the patient’s personal values to the extent that they are known. The recipients of care should be involved in their own care at the level to which they can engage cognitively and developmentally. Age does not preclude participation in decision-making. Support of patient autonomy also includes respect for the patient’s method of decision-making. Diverse cultures have a range of beliefs that affect decision-making. Nurses respect and integrate patient values and decision-making processes that are rooted in the patient’s individual culture. Respecting the patient’s right to self-determination can be challenging, especially when there are conflicting opinions about the best course of action.

Nurses assist recipients of care in reflecting on end-of-life decisions. Resuscitation status, advance directives, withholding and withdrawing life-sustaining treatment, palliative care, medical aid in dying, and foregoing nutrition and hydration require careful consideration. Nurses promote advance care planning conversations and should be knowledgeable about the benefits and limitations of various advance directive documents. The nurse provides interventions to relieve pain and other symptoms in the dying patient consistent with palliative care practice standards and may not act with the sole intent to end life. Nurses have valuable experience, knowledge, and insight regarding effective and compassionate care at the end of life and should actively engage in related research, scholarship, education, practice, and policy development. Supportive care is particularly important at the end of life in order to prevent and alleviate the cascade of symptoms and suffering that are commonly associated with dying. Support is extended to the family and to significant others and is directed toward meeting needs comprehensively across the continuum of care.

The nurse recognizes that outside of public health concerns, laws restricting or impeding individual rights may be in conflict with ethical practice. Individuals are interdependent members of their communities. Nurses recognize situations in which the right to self-determination may be outweighed or limited by the rights, health, and welfare of others, particularly the public’s health. The limitation of individual rights is always considered a serious departure from the standard of care, justified only when there are no less-restrictive means available to preserve the rights of others and protect the public.