A patient refuses a recommended life-sustaining treatment due to personal beliefs. What ethical principle applies and what is the nursing action?

• A. Respect for autonomy; explore concerns, confirm decision-making capacity, involve the healthcare team, document, and involve ethics as needed.
• B. Override the patient's decision if clinician disagrees.
• C. Withhold information.
• D. Do not discuss it.

Answer: (A)

Autonomy is the guiding principle here—the patient has the right to accept or refuse medical treatment, even life-sustaining care, based on personal beliefs. The nursing action is to support an informed, voluntary decision. Begin by exploring the patient’s concerns and beliefs to understand the reasoning behind the choice. Next, assess decision-making capacity: does the patient understand the medical situation, appreciate the consequences, reason about options, and clearly express a choice? If capacity is present, respect the decision and ensure it is informed by providing necessary information about risks, benefits, and alternatives, while coordinating with the healthcare team to honor the patient’s wishes. Document the discussion and the refusal clearly, and involve ethics as needed if there are questions about capacity or emerging conflicts. If capacity is lacking, follow appropriate surrogate decision-making processes and policies. Avoid overriding the decision, withholding information, or avoiding discussion, as that would violate the patient’s autonomy.