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Question

Difficulty: MediumEthical Practice

An alert and oriented older adult client is diagnosed with a severe, life-threatening infection in the lower extremity. The healthcare provider recommends an urgent surgical amputation. After the provider leaves the room, the client calmly tells the nurse, 'I have lived a long, full life. I do not want to have my leg cut off, even if it means I will die from this infection.' What is the most ethically appropriate action by the nurse?

  1. Acknowledge the client's decision, document the refusal, and notify the healthcare provider.Answer
  2. B
    Tell the client that refusing the surgery is a poor choice and repeatedly emphasize the benefits of the procedure.
  3. C
    Assume the refusal stems from age-related cognitive decline and contact the family to obtain surrogate consent.
  4. D
    Direct an unlicensed assistive personnel (UAP) to remain with the client and provide education about the surgical risks.

Answer

The most ethical action is to acknowledge the client's decision, document the refusal, and notify the healthcare provider.
The ethical principle of autonomy gives competent adult clients the right to make their own healthcare decisions, including the right to refuse life-saving treatment. Because the client is alert and oriented, the nurse must respect their self-determination, advocate for their wishes, document the refusal thoroughly, and inform the healthcare provider so the overall plan of care can be updated.

Step-by-Step Solution

1
Analyze the client's cognitive status and the nature of their decision.
The client is alert, oriented, and competent to make healthcare decisions, including the refusal of life-saving interventions.
Competency is the legal and ethical foundation that determines whether a client retains the right to direct their own medical care.
2
Identify the relevant ethical principle guiding the nurse's response.
The principle of autonomy applies, which grants competent adults the right to self-determination.
Nurses have an ethical duty to advocate for the client's right to make autonomous decisions, regardless of whether the healthcare team agrees with the choice.
3
Determine the appropriate nursing intervention.
The nurse must respect the client's decision, document the interaction thoroughly, and inform the provider.
This action fulfills the nurse's ethical obligation to the client while ensuring proper communication and continuity of care within the healthcare team.

Key Concept

Client Autonomy and the Right to Refuse Treatment
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Topics

Ethical Practice

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