Author Douglas P. Olsen responds: I agree-a fully competent adult's decisions should be honored despite the nurse's disagreement (although, in psychiatry, legally competent adults are routinely forced into treatment). As with everything in ethics, though, the situation is more complicated in real life. Few nurses would stand by out of respect for autonomy and let patients make bad decisions. Nurses influence patients considerably and they need to judge how much and what type of influence is appropriate in each situation. In life-or-death cases more influence is justified. But I do not advocate ignoring self-determination and imposing my vision of "good" on patients who do not share my vision.