Autonomy and paternalism: an ethical dilemma in caring for the elderly

As care providers, nurses must be on a never-ending search for opportunities to promote self-worth, self-dignity, and meaning for elderly clients. Nurses must focus on ending the process whereby the system drives the care given and get back to where the individual care needs drive the system. This advocacy role can be enhanced by ensuring that nurses have an adequate knowledge base and the integrity to assess whose values are determining the care being given to the elderly. The dignity and autonomy of individuals is promoted through informed consent and the opportunity for choice (Philips, 1987). When there is respect for the personhood of others, it becomes clear that a client is not a problem but a person with a problem (Gunter, 1979). Personhood, to this author, requires having a quality of life that possesses the ability for free choice and opportunities for responsible behaviour. Nurses have the unique opportunity to act as patient advocates by the very fact that they are in the only discipline within the multi-disciplinary team that is in 24-hour per day contact with the institutionalized individual. It is the responsibility of the nurse to ensure that no harm is done, not by removing the right to decide or the right to take a risk or the right to say no, but rather by ensuring the individual's right to autonomy and personhood are preserved.(ABSTRACT TRUNCATED AT 250 WORDS)