Suggestions for Thought

Case Presentation

Noncompliance Versus Autonomy

Cora is a 45-year-old woman who looks years older than her stated age. She has very limited monthly income and no health insurance. Cora smokes 2 ½ packs of cigarettes per day. She has severe COPD with constant dyspnea and frequent exacerbations. The nurse who sees her at a local free clinic speaks to Cora often about the importance of quitting smoking because he is interested in slowing the progression of Cora’s disease.  Cora continues to smoke and returns repeatedly for increasingly severe problems.  The staff label Cora as noncompliant. During a particularly severe exacerbation, the frustrated nurse says to Cora, “You know you are committing suicide by continuing to smoke.” Cora’s replies, “You don’t understand. I live alone. I have no money, no friends, no family, and will never be able to work. I know the damage I’m doing, but smoking is the only pleasure I have in life.”

Think About It

Do Nurses Coerce Patients?

• In attempting to persuade Cora to stop smoking, to what degree is the nurse violating Cora’s right to autonomy?

As you respond to this question, please consider how you balance the important coaching/teaching role of the nurse with the ethical principle of respect for autonomy.  Do you think that offering information violates a patient’s autonomy? As you formulate your response, consider the differences between the concepts of teaching, persuading, and coercing. 

• Does Cora have the right to choose to continue smoking?

In addition to considering respect for autonomy, as you think about your answer to this question, refer back to the U.S. Declaration of Independence for background and read the ANA Code of Ethics for Nurses Provision 1, Interpretive Statement 1.4 for guidance.

• If rights and responsibilities are correlative, how should the clinic respond to Cora’s continuing to smoke? Would you suggest that the clinic continue to serve Cora, even though she is not following the plan of care?

Think very carefully as you contemplate this question.  Consider whether people should be denied health care because of personal choices.  Think about your own lifestyle habits and the Golden Rule principle of treating others as you would like to be treated. 

• To what degree is coercion employed in situations such as Cora’s? Is coercion an appropriate strategy?

To answer this question, you will need to search for the dictionary meaning of the word “coercion.”  Certainly, some professionals employ coercion, but it is ethically appropriate?  Is it compatible with the nursing role that you have learned about?

• What would you do if you were the nurse?

Aside from your initial reaction to the case, reflect on respect for persons as well as the ethical principles of respect for autonomy, beneficence, and non-maleficence.  As you imagine your actions, you might also read the ANA Code of Ethics for Nurses Provision 1, Interpretive Statement 1.4.