Article Text

Download PDFPDF
The moral agency of institutions: effectively using expert nurses to support patient autonomy
  1. Sonya Charles
  1. Correspondence to Dr Sonya Charles, Department of Philosophy and Comparative Religion, Cleveland State University, 2121 Euclid Avenue, RT 1335 Cleveland, OH 44115, USA; s.charles07{at}


Patient autonomy—with an emphasis on informed consent and the right to refuse treatment—is a cornerstone of modern bioethics. Within discussions about patient autonomy, feminist bioethicists have argued for a relational approach to autonomy. Under a relational framework, we must look beyond the individual moment of choice to include the role relationships and specific contexts can play in supporting or undermining autonomy. Given the day-to-day interactions they have with patients, nurses play a significant role in helping patients understand the nature of their illnesses and make truly informed decisions. However, the skills of expert nurses also support patient autonomy in more subtle ways. Specifically, nurses develop skills of attunement that help them to find subtle ways to support patient autonomy. However, in order to effectively do this, nurses need institutions that support their professional autonomy. In this paper, I look at the ways nurses have been inhibited in their professional autonomy both as a profession and as individual practitioners. I argue that turning our attention to institutions and the role they play in supporting or undermining nurses' autonomy can help promote nurses’ professional autonomy and thereby enhance patient autonomy.

  • Autonomy
  • Interests of Health Personnel/Institutions
  • Philosophy of Nursing

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Linked Articles