Theresa A. Harvath responds: Maslow's hierarchy of needs may be a useful guide in caring for older adults, but his prioritization of human needs hasn't been substantiated by research. Nonetheless, I've often observed Maslow's hierarchy used in the defense of care plans that usurp the autonomy of older adults, especially those with cognitive impairment. I'm not suggesting that patient safety is unimportant or that safety and autonomy are mutually exclusive; rather, I think that under the guise of "safety" concerns, we sometimes compromise a patient's autonomy.

Patient advocacy involves defending patients' rights to act in ways that might pose some risk to their safety. Most of us see autonomy as the right of any cognitively intact adult, but we're reluctant to grant that same right to patients with compromised cognitive ability, even when they can clearly communicate. It is my hope that nurses will use Maslow's hierarchy as it was intended-to understand what motivates human behavior-rather than as a fixed protocol that might curtail a patient's right to both safety and quality of life.