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Difficulty: MediumEthical Practice

A 35-year-old client with end-stage renal disease is admitted to the medical-surgical unit. The client is alert, oriented, and calmly informs the nurse of the decision to discontinue all future hemodialysis treatments. The client articulates a clear understanding that this decision will lead to death. The client's adult sibling becomes extremely upset and demands that the nurse administer a sedative to the client so that dialysis can be forcibly initiated. Which action by the nurse represents the most appropriate ethical practice?

  1. Support the client's right to refuse medical treatment and notify the healthcare provider to discuss palliative care options.Answer
  2. B
    Administer a prescribed PRN sedative to the client to safely facilitate the life-saving hemodialysis procedure.
  3. C
    Tell the client that discontinuing dialysis is a permanent decision and question why they want to give up so easily.
  4. D
    Instruct the unlicensed assistive personnel (UAP) to sit with the client and explain the physical consequences of refusing dialysis.

Answer

Support the client's right to refuse medical treatment and notify the healthcare provider to discuss palliative care options.
The correct action demonstrates adherence to the ethical principle of autonomy. When a client is alert, oriented, and possesses decision-making capacity, they have the fundamental right to refuse any medical treatment, including life-sustaining measures like hemodialysis. The nurse's role as an advocate is to respect this decision, protect the client from coercion (such as the sibling's demands), and ensure the healthcare provider is informed so that appropriate comfort and palliative care measures can be initiated.

Step-by-Step Solution

1
Assess the client's capacity to make healthcare decisions.
The client is determined to be alert, oriented, and fully understands the consequences of stopping dialysis.
Capacity is required for a client to legally and ethically provide informed consent or refusal.
2
Identify the primary ethical conflict.
The conflict is between the client's autonomy (right to refuse) and the sibling's desire for beneficence/paternalism (forcing treatment to save a life).
Recognizing competing ethical principles is essential for determining the correct nursing action.
3
Prioritize the appropriate ethical principle.
Client autonomy is prioritized over the family member's wishes and the medical team's desire to prolong life.
Competent adults have an absolute right to refuse any medical intervention.
4
Implement the ethical nursing action.
The nurse advocates for the client by validating their choice and facilitating a discussion with the provider about end-of-life care.
Nurses must actively protect the client's rights while ensuring continuity of care through appropriate medical channels.

Key Concept

Client Autonomy and Informed Refusal
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Topics

Ethical Practice

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