CHPN Ethical & Legal Issues in End-of-Life Care 2 — Questions and Answers
Question 1: A patient with advanced dementia has no advance directive. Her adult children disagree about whether to continue artificial nutrition. Who has legal decision-making authority?
- The attending physician
- The surrogate identified by state hierarchy law (Correct answer)
- The majority-vote of all children
- The ethics committee
Correct answer: The surrogate identified by state hierarchy law
When no advance directive exists, state surrogate hierarchy laws designate who has legal authority, typically starting with spouse then adult children.
Question 2: Which ethical principle is PRIMARILY invoked when a hospice nurse withholds information about a prognosis at a family's request?
- Beneficence (Correct answer)
- Autonomy
- Non-maleficence
- Fidelity
Correct answer: Beneficence
Withholding information to prevent perceived harm reflects beneficence, though it conflicts with the patient's autonomy right to know.
Question 3: A POLST (Physician Orders for Life-Sustaining Treatment) differs from an advance directive in that a POLST:
- Requires notarization to be valid
- Is a physician order actionable across care settings (Correct answer)
- Can only be completed by a healthcare attorney
- Appoints a healthcare proxy
Correct answer: Is a physician order actionable across care settings
A POLST is a signed medical order immediately actionable by EMS and other providers, unlike an advance directive which is a legal document expressing preferences.
Question 4: A terminally ill patient requests information about medical aid in dying. The nurse personally opposes it. What is the most appropriate initial response?
- Decline to discuss the topic entirely
- Provide factual information and refer to appropriate resources (Correct answer)
- Encourage the patient to reconsider
- Notify the ethics committee immediately
Correct answer: Provide factual information and refer to appropriate resources
Nurses must provide non-judgmental information and referrals even when personally objecting, to support patient autonomy.
Question 5: Under the Patient Self-Determination Act (PSDA), which obligation applies to hospice organizations?
- Require all patients to complete advance directives
- Inform patients of their rights to make healthcare decisions and refuse treatment (Correct answer)
- Provide legal counsel to create advance directives
- Transfer non-compliant patients to acute care
Correct answer: Inform patients of their rights to make healthcare decisions and refuse treatment
The PSDA mandates that healthcare organizations inform patients of their rights to make decisions and have advance directives, but cannot require completion.
Question 6: When a competent patient's wishes conflict with family demands in hospice care, the nurse should:
- Defer to the family to preserve relationships
- Honor the patient's expressed wishes as the primary decision-maker (Correct answer)
- Escalate to hospital administration
- Request a psychiatry consult to assess capacity
Correct answer: Honor the patient's expressed wishes as the primary decision-maker
A competent patient retains ultimate decision-making authority; family preferences do not override a capacitated patient's autonomous choices.
Question 7: Which legal document specifically grants another person authority to make healthcare decisions when the patient loses capacity?
- Living will
- Durable power of attorney for healthcare (Correct answer)
- Do-not-resuscitate order
- POLST form
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (healthcare proxy) designates a specific person to make medical decisions if the patient becomes incapacitated.
CHPN Ethical & Legal Issues in End-of-Life Care 2
A patient with advanced dementia has no advance directive.
Her adult children disagree about whether to continue artificial nutrition.
Who has legal decision-making authority?