# An alert and oriented patient with metastatic cancer states, "I do not want any more chemotherapy, even though my family wants me to keep trying." The family asks the nurse to override the patient. Which response by the nurse best reflects the Patient Bill of Rights?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=374912&lang=en  
> language: en  
> subject: NCLEX-RN  
> category: MOC

## Question

An alert and oriented patient with metastatic cancer states, "I do not want any more chemotherapy, even though my family wants me to keep trying." The family asks the nurse to override the patient. Which response by the nurse best reflects the Patient Bill of Rights?

## Option

1. "I will speak with the oncologist about restarting chemotherapy because your family is concerned for you."
2. "I understand this is a difficult situation. As long as you have decision-making capacity, you have the right to refuse treatment, even when family disagrees. I will support your decision and help facilitate a family meeting if you would like." **✔ Correct answer**
3. "You really should listen to your family, since they know what is best for you long-term."
4. "Once your spouse signs the consent form, the chemotherapy will resume regardless of your statement."

**Correct answer: 2**

## Explanation

An alert patient with decision-making capacity has the absolute RIGHT TO REFUSE TREATMENT under the Patient Bill of Rights — family cannot override. The nurse advocates by validating the right, supporting the decision, and offering a family meeting if helpful. Choices 1, 3, 4 violate autonomy. A spouse cannot override a competent patient (4) — proxy authority only activates when the patient loses capacity per advance directive.

## In-depth explanation

Autonomy is the cornerstone of the Patient Bill of Rights. Capacity to make ONE decision must be assessed for that decision (alert + understands risks/benefits/alternatives + communicates choice). Even with terminal illness or family pressure, a competent adult retains the right to refuse. The nurse role is advocate, not enforcer.

## Clinical scenario

Adult patient with **alert mental status and decision-making capacity**; metastatic cancer. Patient declines further chemotherapy; family requests the nurse override the decision. The nurse uses **Patient Bill of Rights** principles.

## Key concepts

- **Patient Bill of Rights** — AHA-derived rights including informed consent, refusal of treatment, privacy, advance directives, pain management, and access to records.
- **Right to refuse treatment** — A competent adult patient may refuse any treatment, even life-sustaining therapy; family cannot override.
- **Decision-making capacity** — Decision-specific: alert, understands risks/benefits/alternatives, communicates a stable choice; reassessed for each decision.

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