Making Decisions for Those Who Cannot

Cover image for: Making Decisions for Those Who Cannot
CPD55m of CPD
First Published
Updated10 July 2018
Expires 10 January 2019

Course Overview

This Video Learning Activity reviews the importance of capacity and the role of the nurse in the 'social contract' between the health care team and those in their care.​ ​The concept of proxy decision making and substituted judgement will be explored in order to better understand the role of the nurse as an advocate for their patients.

Topics include:

  • Understanding the importance of capacity
  • The social contract between healthcare and those under their care
  • The role of proxy decision makers
  • Decisions made in the best interests of patients
  • Substituted judgment
  • Standards of pure autonomy

Target audience

Nurses and midwives in all areas of professional practice, as both the nursing and midwifery professions are committed to ethical decision-making and practice.


Explore how ethical decision-making can occur when those who will be affected by the outcomes cannot speak for themselves, and how nurses have a vital role to play in this process.


In the majority of cases, patients in the contemporary healthcare system will actively participate in the decisions regarding their treatment. This is a fundamental right and the cornerstone of a healthcare system and society in general that places maximum value on the autonomy of an individual. However, there are also cases where individuals cannot exercise autonomy, commonly because they lack the capacity to process information and make rational choices regarding their care. In such circumstances, alternative decision-making frameworks must be employed and decisions are ultimately made by proxy. Nurses and midwives often contribute to decisions made on behalf of their patients, and so it is essential they remain cognisant of the underlying ethical reasoning that informs this process.

Health professionals in Australia that are registered with AHPRA are required to obtain continuing professional development (CPD) hours/points each year that relates to their context of practice, in order to comply with mandatory regulatory requirements.

Learning Outcomes
  • Identify those circumstances where decision-making by proxy is required
  • Describe the three commonly-used standards of decision-making by proxy and discuss their limitations
  • Discuss how nurses contribute to decision-making in a manner that produces meaningful outcomes

The presenter and all members of the planning team have disclosed that they have no relevant financial commercial relationships to products or devices related to the content of this educational activity. Wherever possible, generic or non-proprietary names of medication have been used. Courses include expert peer reviews of the content where applicable.

  • Video Recording Completed: 01/01/2013
  • Video Recording Location: Tasmania, Australia
  • Course First Published: 29/04/2013
  • Course Reviewed: July 2018
  • Course Republished: 11/07/2018
  • Course Expiry Date: 11/01/2019
  • Corrections / changes made: 06/07/2018
    • Small edits made to align video with current Ausmed practices

This CPD/CNE activity will expire on 11/01/2019 after which CPD/CNE hours will not be valid.


Portrait of Darren Wake
Darren Wake

Peripatetic and always intellectually restless, Darren Wake has pursued varied careers in journalism, media production, academic philosophy and nursing. As a nurse, he worked in the speciality areas of critical care, community care, remote area healthcare and education. As a formally qualified academic philosopher Darren taught undergraduate units in law and ethics in healthcare, although his principle research focus revolved around logic and the philosophy of language. Darren’s media production output can be found scattered about the Ausmed website and in his long forgotten days as a word monkey, he wrote for European publications such as The Scotsman, The Great Outdoors, Country Walking and The Times. In 2014 Darren consulted to the Department of Health for the development of Consumer Directed Care policy and guidelines for remote area communities in the Northern Territory. These days he is the managing editor of a small independent publishing company based in the United Kingdom, and lives in Tasmania. In his spare time, Darren is currently studying a formal course in celestial navigation, just in case the inevitable zombie apocalypse messes with the world’s GPS satellite system. See Educator Profile

CPD55m of CPD
First Published
Updated10 July 2018
10 January 2019
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