Clinical subjectivity. Advocacy with silent patients

Advocacy typically has been understood as assistance to patients in giving voice to their values. With silent patients, however, advocacy involves more: the nurse speaking with the patient's voice. That dimension of advocacy represents its greatest challenge as a moral position. Other positions offer easier approaches to moral issues with silent patients. Utilitarianism and beneficence require little, if any, access to patient subjectivity. For the nurse committed to regard for patient self-determination, access to the subjective world of silent patients is crucial. That access is possible only when the nurse's voice, like the patient's, arises from the experience of embodiment. Silent patients cannot be represented by the words of bodiless advocates. Embodiment--of nurse and patient--is the avenue to subjectivity and the essential basis for a moral commitment to advocacy.