CHPN Ethical & Legal Issues in End-of-Life Care 5 — Questions and Answers
Question 1: An ethics committee consultation is MOST appropriate when:
- The patient requests a different nurse
- There is unresolvable conflict between the patient's wishes and the family's demands (Correct answer)
- A medication error occurs
- The physician orders an unexpected medication
Correct answer: There is unresolvable conflict between the patient's wishes and the family's demands
Ethics committees are designed to mediate complex conflicts involving competing values, interests, or surrogate disagreements that the care team cannot resolve.
Question 2: Which statement about do-not-resuscitate (DNR) orders and hospice care is accurate?
- A DNR order is automatically in place for all hospice patients
- A DNR must be separately ordered and documented; hospice enrollment does not automatically create one (Correct answer)
- Hospice patients with DNRs cannot be admitted to inpatient units
- Family members can initiate a DNR order without physician involvement
Correct answer: A DNR must be separately ordered and documented; hospice enrollment does not automatically create one
Hospice enrollment and DNR orders are distinct; a DNR requires a separate physician order even when a patient is enrolled in hospice.
Question 3: A hospice nurse is asked by media to comment on a patient's condition. The nurse's BEST response is to:
- Provide a general comment without naming the patient
- Decline to comment and direct the inquiry to the organization's spokesperson (Correct answer)
- Share information only if the patient has died
- Confirm admission but withhold diagnosis
Correct answer: Decline to comment and direct the inquiry to the organization's spokesperson
HIPAA prohibits any disclosure of patient information to media; the nurse must decline and refer all inquiries to the designated spokesperson.
Question 4: A patient with terminal cancer states she wants 'everything done' but also signed a DNR last week. How should the care team proceed?
- Follow the DNR, as it supersedes verbal statements
- Clarify with the patient what 'everything done' means and assess whether the DNR reflects her current wishes (Correct answer)
- Revoke the DNR immediately based on the new statement
- Transfer care to an acute setting
Correct answer: Clarify with the patient what 'everything done' means and assess whether the DNR reflects her current wishes
Apparent conflicts between documents and verbal statements require clarification of current wishes to ensure care aligns with the patient's actual preferences.
Question 5: The ethical principle of justice in hospice care MOST directly requires that:
- All patients receive identical care plans
- Resources and services are distributed fairly and equitably across patient populations (Correct answer)
- Nurses always prioritize the youngest patients
- Pain medication is rationed based on life expectancy
Correct answer: Resources and services are distributed fairly and equitably across patient populations
Justice demands fair, equitable distribution of resources without discrimination based on age, race, diagnosis, or other protected characteristics.
Question 6: A hospice patient who is actively dying suddenly regains capacity and revokes her advance directive. The care team should:
- Continue with the advance directive since death is imminent
- Honor the revocation and discuss her current wishes immediately (Correct answer)
- Request a psychiatric evaluation before honoring the revocation
- Notify the healthcare proxy to override the revocation
Correct answer: Honor the revocation and discuss her current wishes immediately
A competent patient may revoke an advance directive at any time, and the team must immediately respect that revocation and engage the patient in goals-of-care discussion.
Question 7: Which scenario represents a violation of the ethical principle of non-maleficence in hospice care?
- Administering opioids to manage refractory pain
- Continuing aggressive chemotherapy in a dying patient solely to satisfy family wishes, despite causing distress (Correct answer)
- Discussing prognosis honestly with a patient
- Withholding a non-beneficial intervention
Correct answer: Continuing aggressive chemotherapy in a dying patient solely to satisfy family wishes, despite causing distress
Non-maleficence prohibits causing unnecessary harm; continuing burdensome treatment with no benefit and at the family's insistence, not the patient's, causes harm.
CHPN Ethical & Legal Issues in End-of-Life Care 5
An ethics committee consultation is MOST appropriate when: