The autonomy of all health care professionals is being challenged by consumers who are claiming that the current health care system is dehumanizing. As a result, consumers are demanding more active participation in decision-making in matters regarding their own health care. Nurses, among all health care professionals, are in the best position to provide the type of care consumers are demanding. Nurses by philosophy are committed to providing humanistic, individualized care of the total patient even when cure is not possible. Because of the unique relationship which develops between the nurse and the patient, nurses are involved in making many decisions of a moral, rather than clinical, nature. Thus, moral competence is an essential component of nursing practice. This dissertation addresses some of the difficulties which arise in nursing practice and education in relation to the issues of autonomy and moral competence.

Many writers have claimed that nurses, because of the multiple obligations which arise from their position in the health care hierarchy, are not free to practice nursing. In this dissertation the claim is being made that the more basic issue for nurses, in relation to autonomy and moral practice, is that they are not free to practice nursing because of a lack of self-determination in decision-making. This claim is supported by (1) a philosophical analysis of the Code for Nurses, the publicly stated standards of moral competence, and (2) an examination of the values implicitly transmitted to nursing students as a part of the socialization process in nursing education. It is shown that both practitioners and students of nursing are not prepared to practice autonomously because of an inherent value conflict, within the profession, between dependence and autonomy. It is argued that nurses have moral obligations to individual clients and to society which necessitate autonomous functioning. It is concluded that, if nursing is to remain viable, certain changes must occur in nursing education.