A client with terminal cancer has signed an advance directive indicating that no parenteral nutrition or hydration be implemented
For several days the client has refused food and fluids, pushing the caregiver's hands away when attempts are made to feed the client or offer any kind of fluid. The family is considering placing a gastrostomy tube because they feel the client is "starving to death.". The nurse should: 1. Honor the family's wishes and have them sign a consent form.
2. Talk to the physician so the family's wishes can be acted upon.
3. Honor the client's refusal and help the family come to terms with the situation.
4. Take the case to the hospital's ethics committee.
3. Honor the client's refusal and help the family come to terms with the situation.
Rationale:
A nurse is morally obligated to honor a competent patients' refusal of food and fluids who has signed an advance directive. This position is supported by the ANA's Code of Ethics for Nurses, through the nurse's role as a client advocate and through the moral principle of autonomy. Clients, not their families, should make decisions about their own health care and treatment. The physician may or may not be involved, but would not disregard the client's refusal. An ethics committee is usually considered when there is an ethical dilemma, and more input is needed to make a decision.
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