A client receiving palliative management for advanced heart failure is alert, oriented, and firmly states the intention to disable their implantable cardioverter-defibrillator (ICD) to allow for a natural death. The client's adult child privately insists that the nurse administer a prescribed PRN dose of intravenous lorazepam, stating, "Once my parent is asleep, I will take over as medical proxy and refuse the deactivation." Which action by the nurse best demonstrates adherence to ethical nursing practice?
- Decline the request to administer the sedative and advocate for the client's right to direct their own end-of-life care.Answer
- BAdminister the prescribed sedative to manage the client's distress and allow the adult child to activate their proxy status.
- CRefuse to participate in the device deactivation, prioritizing the physiological preservation of the client's life.
- DComfort the adult child by stating, "Everything will be fine; your parent will likely change their mind before the deactivation."
Answer
The correct action is to decline the request to administer the sedative and advocate for the client's right to direct their own end-of-life care.
The correct answer directly upholds the ethical principle of autonomy. An alert and oriented client has the legal and ethical right to refuse life-sustaining treatments, which includes the deactivation of an ICD. The nurse's role is to act as an advocate for the client, protecting them from coercive actions—such as a family member's attempt to artificially induce incapacitation to seize decision-making power.
Step-by-Step Solution
Key Concept
Autonomy and Informed Refusal in End-of-Life Care
Estimated Time:1m 30s