NCLEX-RNManagement of CareHard
A client with terminal cancer has a documented living will stating no artificial nutrition or hydration should be provided if she becomes unable to make decisions. The client is now unresponsive, and her adult children insist the nurse start tube feedings against the living will. What is the nurse's priority action as the client's advocate?
- AFollow the family's wishes since they are present and the client cannot speak for herself
- BAsk the physician to decide without referencing the living will
- CUphold the client's documented living will and involve the ethics committee if the family continues to disagree
- DStart tube feedings temporarily to avoid conflict, then discuss the living will later
Show answer & explanationAnswer & explanation
Correct answer: C. Uphold the client's documented living will and involve the ethics committee if the family continues to disagree
A validly executed living will reflects the client's autonomous wishes and takes legal precedence over family preferences. The nurse's advocacy role is to uphold the client's documented directive and involve the ethics committee or risk management if conflict persists with the family.
Why the other options are wrong
- A. Family wishes cannot override a legally valid advance directive; this violates client autonomy.
- B. The physician must also honor the living will; ignoring it is legally and ethically inappropriate.
- D. Starting unwanted treatment, even temporarily, violates the client's documented wishes and is an ethical breach.
Advance Directive vs Family Wishes
A client's legally valid living will or advance directive reflects autonomous wishes and takes precedence over family member preferences when the client cannot communicate.
- Living wills are legally binding when properly executed
- Family cannot override a valid advance directive
- Ethics committee can help mediate conflicts
- Nurse's advocacy role is to honor documented client wishes
Memory trick: The living will speaks even when the client can't—family can't override that pact.