Respect for autonomy: is it always paramount?

Following the argument proposed by Tschudin in 1986 that many nurses do not have the skills for ethical decision-making, this article identifies and discusses one ethical problem from practice. The problem concerns an extremely obese patient who refuses to be moved by a hoist. The nurse acquiesce to the patient's wishes and she is moved manually by four members of staff. The issues identified for discussion are: the paramountcy of the principle of respect for the patient's autonomy; the rights and obligations of the nurses; and the justification for influencing patient choice. The approach used by the ward nurses is analysed and the value of using an ethical decision-making model is considered.