Competent patients' refusal of nursing care

Denise M. Dudzinski, Sarah E. Shannon

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)608-621
Number of pages14
JournalNursing Ethics
Issue number6
StatePublished - Nov 2006
Externally publishedYes


  • End-of-life care
  • Ethics
  • Nursing
  • Obesity

ASJC Scopus subject areas

  • Issues, ethics and legal aspects


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