Never override a competent patient's autonomous refusal to do what the nurse believes is best.
Before you read
Test yourself first: 5 questions
Question 1 of 5
Acting in the client's best interest and actively doing good reflects which ethical principle?
Answer: B. Beneficence is acting to benefit the client (doing good). Nonmaleficence is avoiding harm; autonomy is self-determination; justice is fairness.
Question 2 of 5
Giving a client all information to make their own decision reflects which ethical principle?
Answer: B. Autonomy — the client's right to self-determination and informed decision-making. Beneficence = doing good; nonmaleficence = avoiding harm; justice = fairness.
Question 3 of 5
A competent adult client with end-stage renal disease refuses further dialysis. The family insists the nurse continue treatment. What action by the nurse reflects the principle of autonomy?
Answer: B. Autonomy means a competent client has the right to refuse treatment, even life-sustaining therapy. The nurse honors the client's informed decision and notifies the provider, while supporting the family. Overriding the client's wishes to satisfy the family violates autonomy.
Question 4 of 5
Distributing limited resources (e.g., ICU beds) fairly among clients reflects which ethical principle?
Answer: B. Justice is fairness in the distribution of resources and care. Autonomy is self-determination; beneficence is doing good; fidelity is keeping commitments.
Question 5 of 5
Keeping a promise made to a client (e.g., returning to check on them) reflects which ethical principle?
Answer: B. Fidelity is faithfulness and keeping commitments/promises. Veracity is truthfulness; justice is fairness; autonomy is self-determination.
Keep the streak going with more questions like these, each with a full rationale.
What is ethical principles (autonomy/beneficence)?
The core principles are autonomy (self-determination), beneficence (doing good), nonmaleficence (do no harm), justice (fairness), fidelity (keeping promises), and veracity (truthfulness). Nurses balance these principles, with patient autonomy often taking priority in care decisions.
Key points to remember
- Autonomy is the patient's right to make their own informed decisions, including the right to refuse care.
- Beneficence is the duty to act in the patient's best interest and promote good.
- Nonmaleficence is the duty to do no harm and prevent injury.
- Justice is fair, equal treatment and allocation of resources without discrimination.
- Fidelity is keeping commitments to the patient; veracity is being truthful and honest.
- When autonomy and beneficence conflict, a competent patient's autonomous choice is generally respected.
Nursing priorities
- Respect and support the competent patient's decisions, even when the nurse disagrees (autonomy).
- Provide truthful, complete information so the patient can make an informed choice (veracity).
- Act to benefit the patient and protect them from harm in care planning (beneficence and nonmaleficence).
- Treat all patients fairly and without bias regardless of background or ability to pay (justice).
- Follow through on commitments and use the chain of command or ethics committee for unresolved dilemmas.
Patient teaching
- Your choices about your care will be respected; you have the right to accept or refuse treatment.
- We will be honest with you about your condition and options so you can decide.
- All patients are treated fairly and without discrimination.
Red flags: report now
- Never override a competent patient's autonomous refusal to do what the nurse believes is best.
- Never deceive a patient or withhold information they are entitled to about their care.
- Report immediately any care that risks harm or shows discrimination in treatment.
References
Clinical references for this topic
