The nurse's role as patient advocate: obligation or imposition?

In order to secure professional standing, nursing has sought to discover and prove the value and uniqueness of the nursing contribution to patient well-being. A prominent feature of this quest has been the assertion by nurses and nurse writers that the nurse has a specific and special function as patient advocate. There is a substantial amount of literature to support this view, which is further reinforce by the United Kingdom Central Council (UKCC) for Nursing, Midwifery and Health Visiting which states that advocacy forms an integral part of the nurse's duty to patients. This paper provides a critical analysis of some of the features central to advocacy in order to promote clarification of the concept. These include the patient's rights and interests in health care, the moral status of patient autonomy, the obligations owed to patients by nurses and the work of independent advocacy schemes. It is suggested that the literature tends to confuse advocacy with beneficence which dilutes the significance of advocacy in health care, and that nurses have no special function as patient advocate. Furthermore, due to the rigorous demands of the advocate role, the UKCC neither can nor should impose such an obligation on its members, who would be better served by improved support when they endeavour to discharge the full range of beneficent obligations owed to patients within their care.