Legal & Ethical Nursing Situations:
Realistic Cases + Answers
Informed Consent Scenarios
Case 1: Emergency Surgery Consent
Situation: A 45-year-old patient arrives in the ED unconscious after a motor vehicle accident.
He requires emergency surgery for internal bleeding. His wife is present but extremely
distressed and keeps saying, "Just do whatever you need to do, I can't think straight."
Ethical Issues:
Emergency consent vs. informed consent
Surrogate decision-making capacity
Time-sensitive medical decisions
Answer & Nursing Actions: The nurse should recognize this as an emergency situation where
implied consent applies due to the life-threatening nature of the patient's condition. However,
the wife's emotional state may impair her decision-making capacity as a surrogate. The nurse
should:
1. Document the emergency nature of the situation
2. Ensure the physician explains the procedure, risks, and alternatives clearly to the wife
3. Allow time for questions despite urgency
4. Support the wife emotionally while maintaining professional boundaries
5. If the wife cannot make an informed decision, consider if other family members are
available
6. Document all consent discussions and decisions thoroughly
Legal Considerations: Emergency doctrine allows treatment without formal consent when
delay would endanger life. State laws vary on surrogate decision-maker hierarchy.
Case 2: Minor's Consent for Reproductive Health
,Situation: A 16-year-old female comes to the clinic requesting birth control. She specifically
states she doesn't want her parents to know. The state allows minors to consent for reproductive
health services.
Ethical Issues:
Minor's autonomy vs. parental rights
Confidentiality obligations
State-specific consent laws
Answer & Nursing Actions: The nurse should respect the minor's legal right to confidential
reproductive health services while ensuring informed consent:
1. Verify state laws regarding minor consent for reproductive services
2. Provide comprehensive education about contraceptive options, risks, and benefits
3. Assess the minor's understanding and decision-making capacity
4. Discuss the importance of involving a trusted adult (not necessarily parents)
5. Provide information about confidentiality protections and limitations
6. Document consent process thoroughly
7. Ensure follow-up care is accessible and confidential
Legal Considerations: Many states allow minors to consent for reproductive health, STI
testing, and prenatal care without parental involvement.
Case 3: Psychiatric Patient's Treatment Refusal
Situation: A patient with bipolar disorder, currently manic, refuses lithium treatment. The
patient states, "I feel great, I don't need medication. You can't force me to take it."
Ethical Issues:
Mental illness impact on decision-making capacity
Right to refuse treatment
Beneficence vs. autonomy
Answer & Nursing Actions: The nurse must carefully assess the patient's decision-making
capacity while respecting autonomy:
, 1. Assess the patient's understanding of their condition, treatment options, and
consequences
2. Evaluate if the manic episode is impairing judgment
3. Use therapeutic communication to explore the patient's concerns
4. Involve the psychiatrist in capacity assessment
5. If patient has capacity, respect the refusal while continuing education
6. If capacity is impaired, follow facility protocols for involuntary treatment
7. Document all assessments and interventions thoroughly
8. Consider involving family or patient advocate if appropriate
Legal Considerations: Patients retain the right to refuse treatment unless determined to lack
decision-making capacity through proper legal procedures.
Advance Directives Cases
Case 4: Conflicting Family Wishes vs. Living Will
Situation: An 82-year-old patient with a valid living will specifying "no life-sustaining
treatment" is on a ventilator after a stroke. The adult children are demanding "everything be
done" and threatening to sue if treatment is withdrawn.
Ethical Issues:
Patient autonomy through advance directives
Family pressure and emotional distress
Legal validity of advance directives
Answer & Nursing Actions: The nurse should advocate for the patient's previously expressed
wishes while supporting the family:
1. Review the living will with the healthcare team to ensure clarity
2. Facilitate family meetings with the physician and social worker
Realistic Cases + Answers
Informed Consent Scenarios
Case 1: Emergency Surgery Consent
Situation: A 45-year-old patient arrives in the ED unconscious after a motor vehicle accident.
He requires emergency surgery for internal bleeding. His wife is present but extremely
distressed and keeps saying, "Just do whatever you need to do, I can't think straight."
Ethical Issues:
Emergency consent vs. informed consent
Surrogate decision-making capacity
Time-sensitive medical decisions
Answer & Nursing Actions: The nurse should recognize this as an emergency situation where
implied consent applies due to the life-threatening nature of the patient's condition. However,
the wife's emotional state may impair her decision-making capacity as a surrogate. The nurse
should:
1. Document the emergency nature of the situation
2. Ensure the physician explains the procedure, risks, and alternatives clearly to the wife
3. Allow time for questions despite urgency
4. Support the wife emotionally while maintaining professional boundaries
5. If the wife cannot make an informed decision, consider if other family members are
available
6. Document all consent discussions and decisions thoroughly
Legal Considerations: Emergency doctrine allows treatment without formal consent when
delay would endanger life. State laws vary on surrogate decision-maker hierarchy.
Case 2: Minor's Consent for Reproductive Health
,Situation: A 16-year-old female comes to the clinic requesting birth control. She specifically
states she doesn't want her parents to know. The state allows minors to consent for reproductive
health services.
Ethical Issues:
Minor's autonomy vs. parental rights
Confidentiality obligations
State-specific consent laws
Answer & Nursing Actions: The nurse should respect the minor's legal right to confidential
reproductive health services while ensuring informed consent:
1. Verify state laws regarding minor consent for reproductive services
2. Provide comprehensive education about contraceptive options, risks, and benefits
3. Assess the minor's understanding and decision-making capacity
4. Discuss the importance of involving a trusted adult (not necessarily parents)
5. Provide information about confidentiality protections and limitations
6. Document consent process thoroughly
7. Ensure follow-up care is accessible and confidential
Legal Considerations: Many states allow minors to consent for reproductive health, STI
testing, and prenatal care without parental involvement.
Case 3: Psychiatric Patient's Treatment Refusal
Situation: A patient with bipolar disorder, currently manic, refuses lithium treatment. The
patient states, "I feel great, I don't need medication. You can't force me to take it."
Ethical Issues:
Mental illness impact on decision-making capacity
Right to refuse treatment
Beneficence vs. autonomy
Answer & Nursing Actions: The nurse must carefully assess the patient's decision-making
capacity while respecting autonomy:
, 1. Assess the patient's understanding of their condition, treatment options, and
consequences
2. Evaluate if the manic episode is impairing judgment
3. Use therapeutic communication to explore the patient's concerns
4. Involve the psychiatrist in capacity assessment
5. If patient has capacity, respect the refusal while continuing education
6. If capacity is impaired, follow facility protocols for involuntary treatment
7. Document all assessments and interventions thoroughly
8. Consider involving family or patient advocate if appropriate
Legal Considerations: Patients retain the right to refuse treatment unless determined to lack
decision-making capacity through proper legal procedures.
Advance Directives Cases
Case 4: Conflicting Family Wishes vs. Living Will
Situation: An 82-year-old patient with a valid living will specifying "no life-sustaining
treatment" is on a ventilator after a stroke. The adult children are demanding "everything be
done" and threatening to sue if treatment is withdrawn.
Ethical Issues:
Patient autonomy through advance directives
Family pressure and emotional distress
Legal validity of advance directives
Answer & Nursing Actions: The nurse should advocate for the patient's previously expressed
wishes while supporting the family:
1. Review the living will with the healthcare team to ensure clarity
2. Facilitate family meetings with the physician and social worker
