This finished IHP 420 Module 2 paper analyzes a patient's refusal of amputation through the four abilities of decision-making capacity, informed consent doctrine, the right to refuse treatment, a principles analysis and a recommended course of action, with references. Searches like "ihp 420 module 2 assignment", "ihp420 module 2 consent and capacity assignment" and "ihp 420 module 2 example" land here.
The IHP 420 Module 2 example, in full
The Right to Say No: Informed Consent, Capacity and a 77-Year-Old's Refusal of Amputation
[Student Name]
Southern New Hampshire University
IHP 420: Ethical and Legal Considerations of Healthcare
Module Two Assignment
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
The Right to Say No: Informed Consent, Capacity and a 77-Year-Old's Refusal of Amputation
The Case
Mr. Kovac is a composite 77-year-old retired machinist with diabetes and peripheral artery disease who was admitted with wet gangrene of his left foot and rising signs of infection. Vascular surgeons recommend a below-knee amputation within 48 hours, explaining that without it the infection is likely to spread and could kill him. Mr. Kovac refuses. He says he watched his brother lose a leg and spend his last years in a nursing home, that he would rather take his chances with antibiotics, and that he understands he might die. His daughter asks the team to override him, saying he is not thinking clearly. The attending surgeon requests an ethics consultation.
The Central Distinction
The team's first instinct is that anyone who refuses a life-saving operation must lack capacity. That reasoning is circular. Capacity is judged by the way a person reaches a choice, not by whether the team likes the choice he reaches. The question is whether Mr. Kovac can understand, appreciate, reason about and communicate a choice about this specific decision.
The Legal Framework
Two lines of law govern the case. Informed consent requires that patients receive the information a reasonable patient would want to know about a proposed treatment, its risks, its alternatives and the consequences of refusing. An influential federal appeals decision adopted this patient-centered standard, holding that disclosure is measured by what the patient needs to decide, not by what physicians customarily say (Canterbury v. Spence, 1972). The right to refuse follows from the same principle. A Massachusetts appeals court later upheld the right of a woman with gangrene to refuse amputation, finding that she understood the consequences and that her decision, however others viewed it, did not show incompetence (Lane v. Candura, 1978). A competent adult's refusal must be respected even when death may follow.
If a patient lacks capacity, decisions pass to a surrogate under state law, usually a health care agent named in an advance directive or a family member in the order set by statute, who must decide as the patient would have wished.
Applying the Four Abilities
The standard clinical approach looks for four abilities: expressing a stable choice, grasping the relevant facts, recognizing that those facts apply to oneself, and weighing the options in light of one's values (Appelbaum, 2007). The table applies them to Mr. Kovac, based on the psychiatric consultant's interview.
Table 1
Assessment of Mr. Kovac's Decision-Making Capacity
| Ability | Evidence from the interview | Present? |
|---|---|---|
| Communicate a choice | Consistently refuses amputation over three conversations | Yes |
| Understand information | Explains in his own words what gangrene is and what amputation involves | Yes |
| Appreciate the situation | States that he may die of the infection and that this applies to him | Yes |
| Reason about options | Compares amputation, antibiotics alone and comfort care, and links his choice to his values about independence | Yes |
Checking for Reversible Causes
Because infection can cause delirium, the team must check that Mr. Kovac's reasoning is not clouded by fever, low blood pressure, low oxygen or medications. His vital signs are stable, he is oriented, a brief cognitive screen is normal and he has received no sedating drugs. His refusal is also consistent with values he expressed before this admission, including a conversation with his primary care physician documented two years ago. These findings support the conclusion that he has capacity for this decision.
The Ethical Analysis
Beneficence and nonmaleficence point toward surgery: amputation offers the best chance of survival. But respect for autonomy holds that a capable adult's informed choice about his own body must be honored, and it carries special weight when the decision reflects long-held values about what makes life worth living (Beauchamp & Childress, 2019). Overriding him would also cause harm of a different kind, violating his bodily integrity and trust in the institution. Justice is not at issue here. The ethical conclusion aligns with the legal one: the refusal should be respected. What beneficence still requires is that the team continue to offer the best care consistent with his choice.
What Informed Refusal Requires of the Team
Respecting a refusal does not end the team's obligations; it changes them. For the refusal to be informed, Mr. Kovac must be told, in plain language, what is likely to happen without surgery: spreading infection, possible sepsis, and a real chance of death within days to weeks, as well as what the team can still do for him. He should also hear what life after a below-knee amputation can look like today, including prosthetic fitting and rehabilitation, since his view is shaped by his brother's experience decades ago and he may not know how much care has changed. The goal is not to wear down his decision but to make sure it rests on accurate information. The conversation should be documented in his own words, including the reasons he gives, so that anyone reviewing the record later can see that the refusal was informed and consistent with his values.
Recommendations
The ethics consultation recommends the following. The surgical team should have one more conversation, with his daughter present if he agrees and without pressure, to make sure he knows that he can change his mind and to explore whether a different option, such as a more limited operation, would be acceptable. The team should document the capacity assessment, the information disclosed and his refusal in detail. He should receive antibiotics, wound care and pain control, and palliative care should be offered. The team should ask him to complete an advance directive naming a health care agent and stating his wishes if he later loses capacity, so that his daughter is not left to guess. The daughter should be supported, and the team should explain gently why her father's choice must be honored.
Conclusion
Mr. Kovac's refusal is difficult for his family and his surgeons, but the law and ethics agree. A capacity assessment using the four abilities shows that he understands and appreciates his situation and reasons from consistent values. Under the doctrine of informed consent and the Massachusetts gangrene decision, a capable adult may refuse even life-saving treatment. The hospital's role is to ensure the refusal is informed, document it carefully, continue to care for him and plan for the possibility that he loses capacity later.
References
Appelbaum, P. S. (2007). Assessment of patients' competence to consent to treatment. New England Journal of Medicine, 357(18), 1834-1840. https://doi.org/10.1056/NEJMcp074045
Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972).
Lane v. Candura, 6 Mass. App. Ct. 377, 376 N.E.2d 1232 (1978).
How this IHP 420 Module 2 example is structured
The paper begins with the facts, then states the central distinction: disagreement with a decision is not evidence of incapacity. It explains the legal framework of informed consent and refusal with two landmark cases, then applies the four abilities of capacity to the patient in a table. An ethical analysis weighs autonomy against beneficence. The recommendation sets out concrete steps, including what happens if capacity is lost later.
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IHP 420 Module 2 questions, answered
What does the IHP 420 Module 2 assignment usually ask?
This assignment commonly presents a patient who refuses recommended treatment and asks students to apply informed consent and decision-making capacity: whether the patient can consent or refuse, what information must be disclosed, the legal and ethical principles involved, and how the organization should respond.
What is the difference between capacity and competence?
Capacity is a clinical judgment, made by a clinician, about whether a person can make a particular decision at a particular time. Competence is a legal determination made by a court. In everyday practice, clinicians assess capacity; only a court can declare someone legally incompetent.
Can a patient refuse life-saving treatment?
In the United States, an adult who has decision-making capacity may generally decline any treatment, life-saving treatment included, however much family or clinicians disagree. The team's job is to confirm that the refusal is informed and that capacity is present, and to document both carefully.