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.

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

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.