Autonomy and integrity: upholding older adult patients' dignity.
OBJECTIVE
The aim of this study was to deepen understanding of the relationship between autonomy and integrity in interactions between patients and individual health care workers in real-life care situations.


METHODS
The data reported here are from a 6- and 12-month follow-up of the teaching of ethics to health care professionals working with older people. The data collection method used was participant observation. Health professionals' caring behaviour in everyday situations was observed from the point of view of patients' autonomy and integrity. Theoretical frameworks relating to autonomy and integrity were used to analyse the data.


RESULTS
The structural framework was useful for identifying the two concepts and their relationship in everyday situations. The data suggest that the two concepts are ethically complex. Autonomy is grounded in respect for patients' ability to choose, decide and take responsibility for their own lives. Autonomy varies within and between individuals and is dependent on context and on those involved. It stresses the intrinsic value of patients, which marks their worth independently of others. Integrity, however, is bound to patients' very existence, no matter what their physical and mental conditions, and must be respected regardless of their ability to act autonomously.


CONCLUSIONS
The concepts of autonomy and integrity appear to presuppose one another and to be indivisible if older adult patients' dignity is to be maintained. This implies that when patients' autonomy is supported their integrity is protected and, consequently, their dignity upheld.
Randers
Ingrid
I
Department of Neurotec, Center of Excellence in Elderly Care Research, Karolinska Institutet, Stockholm, Sweden. ingrid.randers@telia.com
Mattiasson
Anne-Cathrine
AC
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003858:Dependency, Psychological; D004993:Ethics, Nursing; D005260:Female; D005500:Follow-Up Studies; D005851:Geriatric Nursing; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000523:psychology; D008875:Middle Aged; D009723:Nurse-Patient Relations; D026684:Personal Autonomy