Final answer:
The correct response is 'No, if they refuse service.' Patients or SDMs are required to sign a refusal of service to document informed decisions when they are capable of making such choices. Informed consent is integral to patient autonomy and ethical healthcare practice.
Step-by-step explanation:
The question pertains to whether a patient or Substitute Decision Maker (SDM) is required to sign the Refusal of Service section of the Advance Care Record (ACR). The correct choice in this context would be (d) No, if they refuse service. The signing of a refusal is necessary to document that the patient or SDM has been informed of the risks involved in refusing service and has elected not to proceed with the treatment or procedure offered by the healthcare provider.
In relation to ethical considerations, such as the right to decline testing or treatment (like decolonization procedures for MRSA), it is critical to respect patient autonomy. Healthcare practitioners must ensure that patients are fully informed through the informed consent process about the potential risks and benefits, as well as alternatives to the proposed care. Only when patients are conscious, and capable of making an informed decision, are they required to sign the refusal. If a patient is unconscious, consent or refusal cannot be obtained and decisions may be made by an SDM or as per the healthcare provider's judgment in accordance with legal and ethical guidelines.