How should a nurse approach conflicts between patient autonomy and family wishes?

• A. Prioritize family wishes over patient wishes.
• B. Do not discuss with ethics committee.
• C. Diminish the patient's autonomy to avoid conflict.
• D. Prioritize patient expressed wishes unless capacity is compromised; facilitate communication, document decisions, and involve ethics as needed.

Answer: (D)

Honoring patient autonomy while assessing capacity and managing family input is the central idea. When a patient has decision-making capacity, their expressed wishes should guide care even if family members disagree; the nurse’s role is to facilitate clear, respectful communication so the patient understands options and consequences, and to document the patient’s preferences and the capacity assessment carefully. If capacity is intact, the patient’s choices prevail, and the team should support those choices, involve the family as the patient desires, and keep everyone informed.

If capacity is compromised or uncertain, surrogate decision-making rules come into play, using the patient’s known wishes or best interests as appropriate. In such cases, the ethics team can be consulted to help resolve conflicts and ensure decisions align with ethical and legal standards. This approach protects autonomy, maintains patient dignity, and provides a clear, transparent process for all involved.

Overriding the patient’s wishes, avoiding ethics discussion, or diminishing autonomy to appease family conflicts undermine ethical nursing practice and patient rights, which is why the best approach is to prioritize expressed wishes when capacity is present, with proper communication, documentation, and ethics support as needed.