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In this paper, the consequences were there greater autonomy in nursing practice, are considered. Autonomous practice imples accountability which entabils both personal and professional responsibility: a personal responsibility to endorse ethical conduct consistent with professional practice; and and a professional responsibility to exercise discretionary powers to the ultimate benefit of the patient. of the patient. In this context, discretionary responsibility implies; recognizing a patient's wants may not be consistent with a patient's needs; abstaining form collusion with noncompliant patients; supporting the patient's right to refuse treatement only after full psychological exploration; understanding the psychological ramifications of informed consent from a practitioner and recipient point of view; maintaining appropriate personal and professional boundaries; and fostering collegiate relationships with the medical fratenity grounded on egalitarian principles. The author provides a philosophical and psychological analysis of responsibility in an effort to achieve a deeper understanding of the relationship this has with the concepts of ‘freedom’ and ‘accountability’