Ethics and Communication Flashcards

An ICU patient with end-stage liver disease lacks capacity. No advance directive exists and no family is available. Who typically serves as the default decision-maker?

Answer: A court-appointed guardian or, per state law, the attending physician

When no surrogate or advance directive exists, state law typically designates the attending physician or a court-appointed guardian to make decisions in the patient's best interest.

The doctrine of double effect is MOST relevant when a critical care nurse administers high-dose opioids to a dying patient primarily to:

Answer: Relieve refractory pain, with death as an unintended secondary effect

The doctrine of double effect justifies an action with a harmful secondary effect (hastened death) when the primary intent is to relieve suffering.

A patient in the ICU who has decision-making capacity refuses a blood transfusion on religious grounds. The team believes he will die without it. What is the ethical obligation?

Answer: Respect the patient's refusal and provide supportive care aligned with his wishes

A capacitated adult's refusal of treatment, even life-saving treatment, must be respected as an exercise of autonomy.

Which statement BEST describes the concept of therapeutic privilege in the ICU context?

Answer: Withholding information from a patient when disclosure would cause serious psychological harm

Therapeutic privilege allows withholding information if disclosure would directly harm the patient, but it is considered ethically controversial and rarely justified.

During an interdisciplinary ICU family meeting, the nurse's PRIMARY role is to:

Answer: Represent the patient's perspective and clarify misunderstandings

The bedside nurse has unique insight into the patient's condition, values, and concerns, making them vital advocates and clarifiers in family meetings.

Which approach BEST supports shared decision-making with a family whose cultural background discourages direct disclosure of terminal diagnoses to the patient?

Answer: Explore the patient's own preferences about information disclosure before making assumptions

Asking patients whether and how they want information disclosed respects both autonomy and cultural values without stereotyping.

A family requests that the ICU team 'do everything' for their loved one. What is the MOST effective initial nursing response?

Answer: Explore what 'everything' means to the family and clarify realistic goals of care

The phrase 'do everything' often reflects hope and fear rather than a specific medical directive; clarifying meaning guides appropriate care planning.