Practice Expectation Spotlight

Promoting and respecting informed decision-making is an ethical responsibility outlined in the 2017 Edition Code of Ethics for Registered Nurses. As RNs, RN(AP)s and RN(NP)s, we play an important role in ensuring clients have the information they need to make decisions about their health. This role includes using our assessment and communication skills to obtain information from clients about their needs, circumstances, preferences, values, abilities, culture and health goals so that relevant and unbiased information about care options can be relayed to the client for their decision. During this process ethical issues can arise that require us to reflect on our responsibilities in relation to the Code of Ethics. Consider the following situations and how the ethical responsibilities outlined below may apply to them: 

  • A client prefers to postpone a medical appointment until it is warmer so they won't need to wear a winter coat. 
  • A client wants to change a medication regime, deemed effective by the health care team, because they do not want to gain any more weight than they already have. 
  • A client never looks at the pamphlets given to them about a recommended day program. 
  • A client is asking about alternatives to taking a sedative before bed even though the health care team has recommended and previously obtained consent to treat the client with the sedative.

What are ethical responsibilities related to informed decision-making? 
The following is a summary of some of the ethical responsibilities outlined in the 2017 Edition Code of Ethics related to promoting and respecting informed decision-making. As RNs, RN(AP)s and RN(NP)s we are expected to: 

  • Provide clients with the information they need to make informed and autonomous decisions related to their health and well-being. 
  • Ensure health information is given to clients in an open, accurate, understandable and transparent manner. 
  • Recognize and support a capable client’s right to refuse or withdraw consent for care or treatment at any time. 
  • Recognize that capable clients may place a different weight on individualism and may choose to defer to family, cultural expectations or community values in decision-making while complying with the law of consent.  
  • Be sensitive to the inherent power differentials between care providers and clients receiving care ensuring we do not misuse that power to influence decision-making.  
  • Provide education to support the informed decision-making of capable clients. Respecting the decisions a client makes, including choice of lifestyles or treatment that are not conducive to good health, and continue to provide care in a non-judgmental manner. 
  • When family members disagree with the decisions made by a person receiving care, we assist families in gaining an understanding of the client’s decisions.  
  • Respect the law on capacity assessment and substitute decision-making. 
  • For any person that is considered incapable of consenting to care, promote that client’s participation in discussions and decisions regarding their care in a manner that is adapted to the client’s capabilities.  

How can we use self-reflection to promote informed decision-making? 
Because of the inherent power differentials between care providers and clients, it is essential that we reflect on how our personal values, beliefs, and conscious or unconscious biases may be influencing the information obtained from and provided to clients.  As part of ensuring we do not consciously or unconsciously influence decision-making, consider the following questions for reflection: 

  • Have I obtained enough information from the client to understand their needs, circumstances, preferences and values? 
  • Do I need more information to understand how potential treatment options might impact the client from their perspective? 
  • Am I making any assumptions about my client?  
  • What are my values, beliefs and preferences in this situation? How do they differ from the values, beliefs and preferences of my client? 
  • Have I provided information about all options for care including the option to decline services? If not, why might I have limited the information provided?  
  • Is there new information or circumstances that may impact/ change the client’s decision–making? Have I shared this information with the client and/or other health care providers on the team? 

Informed decision-making is a complex ethical and legal concept. More information about ethical responsibilities and legal considerations related to informed decision-making can be found in the resources below: 

CNA (Canadian Nurses Association). 2017 Edition Code of Ethics

CNPS (Canadian Nurses Protective Society). CNPS

CRNM (College of Registered Nurses of Manitoba). Practice Expectations for RNs.  

CRNM (College of Registered Nurses of Manitoba). Professional Boundaries for Therapeutic Relationships. 

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