Competent Patients' Refusal of Nursing Care

Nursing Ethics 13 (6):608-621 (2006)
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Competent patients’ refusals of nursing care do not yet have the legal or ethical standing of refusals of life-sustaining medical therapies such as mechanical ventilation or blood products. The case of a woman who refused turning and incontinence management owing to pain prompted us to examine these situations. We noted several special features: lack of paradigm cases, social taboo around unmanaged incontinence, the distinction between ordinary versus extraordinary care, and the moral distress experienced by nurses. We examined this case on the merits and limitations of five well-known ethical positions: pure autonomy, conscientious objection, paternalism, communitarianism, and feminism. We found each lacking and argue for a ‘negotiated reliance’ response where nurses and others tread as lightly as possible on the patient’s autonomy while negotiating a compromise, but are obligated to match the patient’s sacrifice by extending themselves beyond their usual professional practice



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Ethics in nursing.Martin Benjamin - 1981 - New York: Oxford University Press. Edited by Joy Curtis.


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References found in this work

The Abuse of Casuistry: A History of Moral Reasoning.Kenneth W. Kemp - 1988 - Philosophy and Rhetoric 24 (1):76-80.
Autonomy and the social self.Linda Barclay - 2000 - In Catriona Mackenzie & Natalie Stoljar (eds.), Relational Autonomy: Feminist Perspectives on Autonomy, Agency, and the Social Self. New York: Oxford University Press.
Principlism and communitarianism.D. Callahan - 2003 - Journal of Medical Ethics 29 (5):287-291.
Confronting Death Who Chooses, Who Controls?Robert Burt & Dax Cowart - 1998 - Hastings Center Report 28 (1):14-24.

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