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Difficulty: HardEthical Practice

The intensive care unit nurse is caring for an unresponsive client with end-stage multi-organ failure. The client's spouse, who is the legally designated durable power of attorney for healthcare (DPOA), directs the medical team to withdraw mechanical ventilation according to the client's previously expressed wishes. A sibling of the client angrily objects, threatens a malpractice lawsuit, and demands that all life-sustaining measures continue. Which actions by the nurse demonstrate adherence to ethical and legal nursing principles? Select all that apply.

  1. Organize an immediate consultation with the hospital ethics committee and social services to facilitate family mediation.Answer
  2. B
    Suggest to the spouse that delaying the withdrawal of life support for a few days might help the sibling accept the decision.
  3. Affirm to the sibling that while their distress is understandable, the spouse has the legal authority to make medical decisions for the client.Answer
  4. D
    Suspend the withdrawal of mechanical ventilation until the risk of litigation has been evaluated by the hospital's legal department.
  5. E
    Assure the sibling that they will eventually realize withdrawing care is the most compassionate choice for the client.
  6. Ensure the client receives continuous palliative comfort measures and pain management throughout the withdrawal process.Answer

Answer

The correct actions include organizing an ethics consultation for mediation, affirming the spouse's legal authority to the sibling, and ensuring continuous palliative comfort measures.
The correct actions prioritize the client's autonomy by respecting the decisions of the legally appointed surrogate (DPOA). In complex ethical conflicts involving family members, consulting the ethics committee provides necessary interdisciplinary mediation. Communicating the legal reality to the sibling maintains veracity, and providing continuous palliative care ensures nonmaleficence and beneficence during the withdrawal of life support.

Step-by-Step Solution

1
Identify the legal decision-maker.
The spouse is the legally designated durable power of attorney for healthcare (DPOA).
The DPOA has the legal authority to make decisions based on the client's previously expressed wishes, superseding the sibling's demands.
2
Evaluate the conflict based on ethical principles.
The nurse must uphold the client's autonomy (via the DPOA) while managing the sibling's moral distress therapeutically.
Ethical practice requires respecting legal advance directives while minimizing harm and promoting a supportive environment.
3
Select interventions that support the legal framework and ethical care without using non-therapeutic communication.
Consulting the ethics committee, verifying legal authority, and maintaining palliative care are selected.
These actions address the clinical, legal, and psychosocial needs of the situation without inappropriately altering the plan of care based on family threats.

Key Concept

Surrogate Decision-Making and Interdisciplinary Ethics
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Topics

Ethical Practice

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