Patient Advocacy is as old as nursing itself. The idea of speaking up on behalf of someone who may not be able to speak up for themself. When I was a new OR nurse, my preceptor told me that taking care of operative patients was a big challenge, because they were unconscious for most of the stay and completely helpless. The patient can’t tell you what’s wrong, they have no voice. Throughout history, nurses have championed for those that aren’t heard, whether for more sanitary conditions in wartime, better access to healthcare for the poor, or just helping an individual make the best decisions for themselves.

If you remember your nursing theory, you may recall Maslow and his hierarchy of needs. Often depicted as a triangle, the foundation is physiological: breathing, food, water, sex, sleep, homeostasis, excretion. Going up in order of priority are safety, love/belonging, esteem and finally self actualization, the instinctual need of humans to make the most of their abilities and to strive to be the best they can (Wikipedia).

This has not always been the case in healthcare. The Victorian medical establishment had a strong sense of doing what they thought was best for you whether you liked it or not. Up until the 1960s in our country, doctors usually controlled the course of treatment with little input from the patient or their family. In 1967, Louis Kutner, an attorney, suggested the first living will. What he wanted to establish was “the rights of dying people to control decisions about their own medical care.” At that time, terminally ill patients would receive treatment until their doctor said it was time to stop.

In 1976 Barry Keene, a state senator from California, helped pass the first living will legislation, due to the experiences of his mother-in-law not being able to make decisions for herself during a terminal illness. During the next year, 7 states had passed legislation. The first legal challenge was in NJ with the Quinlan family. In 1976, Chief Justice Robert Hughes of the NJ Supreme Court ruled that if a patient could not make their own decisions it was better left to their family, with input from the healthcare team, then the courts. Today, patients and their families can determine for themselves what the best course of treatment is and when to stop it.

None of this could be possible without nurses. We help assess patients and their families to see if they understand the information they’re getting. Helping people get services they need in the community, helping the underserved get better access to healthcare. Every day, as a nurse, you probably help someone to help themself. This is a core principle of nursing.