valuing of consent with a commitment to tolerance, that is a willingness to accept
that people will make choices that we find unacceptable. For as long as these
choices do not entail an unacceptable degree of harm to others we are obliged to
accept what they choose and the reasons they give for doing so. The dilemmas we
might face as a result of this are real, particularly when we see the demand that we
should respect a patient's autonomy conflicting with the beneficently motivated
duty of care we believe we have towards them.
7.10 The consent process: translating theory into practice
To translate a theoretical commitment to respect for autonomy into a prac-
tical reality requires that a nurse acquires certain skills and accepts a responsi-
bility to practice them. Given the contact the nurse has with patients and the
situations within which they meet and interact, the nurse will be required at dif-
ferent times to assess competence and voluntariness and autonomy, enhance
it where it is lacking, respect it where it is present, and find ways of promot-
ing the patients' interests and well-being where it is not present. The nurse
will be a primary provider of information, and will often be best placed to
judge the extent to which the patient has understood, digested and deliber-
ated upon it. The nurse is often a key figure in the consenting process. Her
involvement will require her to engage in a number of different types of activ-
ity and utilise a variety of skills.
Communication
One of the prerequisites to acquiring a morally and legally valid consent is to
communicate effectively with the patient. Only by doing so will you understand
them as an individual, and learn enough about the context from which they have
come to the health care setting. One needs to establish how they are coping with
being in the health care setting, and what they hope to gain from their contact with
health care professionals. Such information also needs to be effectively and
appropriately communicated within the multi-professional team caring for the
patient. Relevant information needs to be appropriately staged and given in such a
way as to inform without needlessly distressing.
Cultural literacy
Given the earlier claims about the extent to which a person's autonomy might be
compromised or simply overlooked as a result of their cultural context, there are
important reasons for nurses to understand the cultural context within which they
operate and the beliefs and practices of the different groups that live alongside
them. Cultural differences must be respected; however, tolerance and under-
standing does not commit one to permittingallchoices because they are defended
as culturally significant [24].
128 Nursing Law and Ethics