CHPN Ethical & Legal Issues in End-of-Life Care 4 — Questions and Answers
Question 1: A hospice patient is enrolled and then unexpectedly loses Medicaid eligibility. Under the Medicare Hospice Benefit, what must occur?
- Hospice services terminate immediately
- The patient transitions to the Medicare Hospice Benefit if eligible (Correct answer)
- Hospice must provide free care indefinitely
- The attending physician assumes all billing responsibility
Correct answer: The patient transitions to the Medicare Hospice Benefit if eligible
Patients may transition between payers; if Medicare-eligible, they can enroll in the Medicare Hospice Benefit to maintain continuity of hospice services.
Question 2: Which scenario BEST illustrates the ethical concept of surrogate 'substituted judgment'?
- A surrogate decides based on what she thinks is medically best
- A surrogate chooses based on what the patient would have wanted given their known values (Correct answer)
- A surrogate defers all decisions to the medical team
- A surrogate requests maximum interventions regardless of prognosis
Correct answer: A surrogate chooses based on what the patient would have wanted given their known values
Substituted judgment requires surrogates to represent the patient's own values and preferences, not impose their own views.
Question 3: A patient in a state where medical aid in dying is legal asks their hospice nurse to be present at the time of self-administration. The nurse's organization prohibits participation. What should the nurse do?
- Participate anyway to support the patient's autonomy
- Follow the organization's policy and ensure the patient has access to supportive resources (Correct answer)
- Report the patient to the state medical board
- Immediately discharge the patient from hospice
Correct answer: Follow the organization's policy and ensure the patient has access to supportive resources
Nurses may follow organizational policies limiting participation while ensuring patients are not abandoned and can access appropriate support.
Question 4: Which of the following BEST describes the legal concept of 'informed refusal' in hospice care?
- A patient's refusal is only valid when a family member witnesses it
- A competent patient may refuse any treatment after being informed of the consequences (Correct answer)
- Refusal of opioids requires a psychiatric evaluation
- Physicians may override refusal to prevent imminent harm
Correct answer: A competent patient may refuse any treatment after being informed of the consequences
Informed refusal grants a competent patient the legal and ethical right to decline any treatment after understanding its risks and alternatives.
Question 5: A hospice nurse suspects a colleague is diverting controlled substances from patients. The MOST appropriate action is to:
- Confront the colleague privately
- Report suspicions to the supervisor and follow facility protocol (Correct answer)
- Document observations and take no further action
- Notify the patient's family immediately
Correct answer: Report suspicions to the supervisor and follow facility protocol
Suspected diversion must be reported through proper organizational channels to protect patients and comply with legal and regulatory obligations.
Question 6: Under HIPAA, disclosing a deceased hospice patient's PHI to a family member is:
- Always prohibited once the patient has died
- Permissible if the family member was involved in the patient's care and disclosure is not contrary to the patient's known preferences (Correct answer)
- Requires a court order in all cases
- Only allowed if the family member is named in the will
Correct answer: Permissible if the family member was involved in the patient's care and disclosure is not contrary to the patient's known preferences
HIPAA allows disclosure of deceased patients' PHI to involved family members when it aligns with the patient's prior wishes and serves a legitimate purpose.
Question 7: A patient with ALS has a valid DNR but requests aggressive suctioning during a respiratory crisis. This request MOST likely reflects:
- A revocation of the DNR order
- A desire for comfort-focused interventions that do not constitute resuscitation (Correct answer)
- Non-compliance requiring ethics consultation
- A contradiction requiring physician review before acting
Correct answer: A desire for comfort-focused interventions that do not constitute resuscitation
Suctioning for comfort is not a resuscitative measure; a DNR does not prohibit comfort interventions, and both requests can coexist appropriately.
CHPN Ethical & Legal Issues in End-of-Life Care 4
A hospice patient is enrolled and then unexpectedly loses Medicaid eligibility.
Under the Medicare Hospice Benefit, what must occur?