Question

A fully alert and competent 89 year old client is in end-stage liver disease. The client says, "I'm ready to die," and refuses to take food or fluids. The family urges the client to allow the nurse to insert a feeding tube. What is the nurse's moral responsibility?

a) The nurse should obtain an order for a feeding tube.
b) The nurse should encourage the client to reconsider the decision.
c) The nurse should honor the client's decision.
d) The nurse must consider that the hospital can be sued if she honors the client's request.

Answer 1

The nurse's moral responsibility is to honor the competent patient's decision to refuse food and fluids, respecting the principle of autonomy. Detailed documentation of the patient's wishes should guide the healthcare team in following the patient's end-of-life preferences, ensuring the patient's right to die with dignity is respected.

Step-by-step explanation:

In the scenario presented, the nurse's moral responsibility is to honor the client's decision. This reflects the ethical principle of autonomy, which asserts that competent individuals have the right to make decisions about their own healthcare. It is important to respect the wishes of the patient, especially in end-of-life care, even if these wishes conflict with the desires of the family or pose difficult ethical considerations for healthcare providers.

Decision-making autonomy is a key consideration in healthcare, especially regarding end-of-life decisions and considerations of dying with dignity. When a competent and fully alert elderly client chooses to refuse food and fluids, indicating a readiness to die, the nurse should assess the client's competency and understanding of the choice. If the client is deemed competent, then the client's wishes should be respected, possibly with support from ethical and legal advice.

While the risk of legal action and protest from the family or society at large sometimes creates pressure, the principle of patient autonomy remains central. In this case, forceful treatment such as inserting a feeding tube against the patient's will would violate the patient's right to self-determination. However, it is essential to have detailed documentation of the patient's wishes, possibly through an advanced directive or living will, which can guide healthcare professionals in such situations.