CHPN Ethical & Legal Issues in End-of-Life Care 3 — Questions and Answers
Question 1: A hospice patient who appeared to have decision-making capacity now seems confused after a medication change. What is the nurse's priority action?
- Proceed with previously stated wishes only
- Reassess decision-making capacity before acting on new decisions (Correct answer)
- Immediately activate the advance directive
- Contact the healthcare proxy for all decisions
Correct answer: Reassess decision-making capacity before acting on new decisions
Capacity can fluctuate; the nurse must reassess capacity before determining who directs care decisions, as capacity is decision- and time-specific.
Question 2: Double effect is an ethical principle commonly applied in hospice when:
- A patient requests euthanasia
- Opioids given for pain may hasten death as a foreseeable but unintended effect (Correct answer)
- A DNR order is revoked by the family
- A surrogate refuses all medications
Correct answer: Opioids given for pain may hasten death as a foreseeable but unintended effect
Double effect justifies an action with a good primary intent (pain relief) even if a foreseeable secondary harm (possible earlier death) may occur.
Question 3: A family member tells the nurse she wants to be listed as the patient's healthcare proxy, but the patient designated a friend in writing. The nurse should:
- Update the proxy to the family member per her request
- Honor the patient's written designation (Correct answer)
- Allow the attending physician to decide
- Convene an ethics committee meeting
Correct answer: Honor the patient's written designation
The patient's documented designation of a healthcare proxy is legally binding and takes precedence over family preferences.
Question 4: Which behavior by a hospice nurse MOST clearly represents a breach of the ethical principle of veracity?
- Administering morphine for dyspnea
- Telling a patient their condition is stable when it is rapidly declining (Correct answer)
- Withholding a painful procedure
- Discussing prognosis without family present
Correct answer: Telling a patient their condition is stable when it is rapidly declining
Veracity (truthfulness) requires honest communication; deliberately giving false information about the patient's condition violates this principle.
Question 5: In hospice, 'voluntarily stopping eating and drinking' (VSED) is considered ethically:
- Equivalent to active euthanasia
- A patient's autonomous right and legally permissible in all US states (Correct answer)
- An obligation the team must facilitate without discussion
- Prohibited under the Patient Self-Determination Act
Correct answer: A patient's autonomous right and legally permissible in all US states
VSED is widely recognized as a legal expression of a competent patient's right to refuse treatment, distinct from euthanasia or assisted suicide.
Question 6: A hospice nurse discovers that a patient is being financially exploited by a family member who is also the healthcare proxy. The nurse's FIRST obligation is to:
- Report suspected elder abuse to the appropriate authority (Correct answer)
- Discuss concerns only within the hospice team
- Contact the patient's attorney
- Revoke the healthcare proxy designation
Correct answer: Report suspected elder abuse to the appropriate authority
Nurses are mandated reporters; financial exploitation of a vulnerable adult must be reported to adult protective services or the relevant state authority.
Question 7: What is the legal status of oral advance directives (verbally stated wishes with no written documentation) in most US states?
- They carry the same legal weight as written directives
- They may inform decision-making but are generally not legally binding (Correct answer)
- They must be witnessed by two people to be valid
- They are automatically converted to POLST orders by the physician
Correct answer: They may inform decision-making but are generally not legally binding
Oral statements can guide surrogate decision-making and substituted judgment, but most states require written documentation for a legally enforceable advance directive.
CHPN Ethical & Legal Issues in End-of-Life Care 3
A hospice patient who appeared to have decision-making capacity now seems confused after a medication change.
What is the nurse's priority action?