| Course | NURS 6910 Introduction to Palliative Care: Principles of Hospice and Palliative Care |
|---|---|
| Week | Week 8 |
| Paper type | Discussion post with two peer replies |
| Length | About 760 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Master of Science in Nursing (MSN) |
| Updated | September 2026 |
Free sample paper for NURS 6910 Week 8
Week 8 Discussion: Initial Post
"I Am Finished With the Chair": Decision-Specific Capacity and a 79-Year-Old Woman's Request to Stop Dialysis
Six years of hemodialysis, three mornings a week, lie behind the composite patient in this case, a widowed 79-year-old seamstress. Since a fall in the spring she has needed a wheelchair, and her rides to the unit leave her exhausted for the rest of the day. At her last session she told the nurse, "I am finished with the chair. I want to stop." Her nephrologist is concerned: she has seemed low since her husband died last year, and he wonders whether depression, not she, is making the decision. The question for this post is whether she has capacity for this decision, and if she does, whether stopping is permissible.
Capacity is specific to a decision, not a global label, and Appelbaum (2007) sets out four abilities a clinician can test: whether the person states a choice, grasps the facts that bear on it, sees that those facts are about her own life and weighs the options against each other. She expresses a choice clearly and has repeated it on three visits. She understands: asked what would happen if she stopped, she said, "My kidneys don't work, so I would die, probably in a week or two, maybe more." She appreciates the information as applying to her, saying, "I know it means me, not someone in a book." And she reasons, comparing the options in her own terms: more months in the chair, tired and away from home, against a shorter time at home with her cat and her garden, which she can see from the window.
Depression deserves assessment rather than presumption. It can distort appreciation and reasoning, for example by making a person believe she deserves to suffer or that nothing could improve. A screen such as the PHQ-9 is a reasonable first step (Kroenke et al., 2001), and in this scenario a consultation with psychiatry or the palliative care team would help separate grief and fatigue from a depressive illness that could be treated. If depression were found to be driving her choice, treating it and revisiting the decision would be appropriate. But sadness about a burdensome treatment is not the same as incapacity.
If her capacity is confirmed, I believe stopping is ethically permissible, and the team's task becomes supporting her decision well. A guideline on shared decision making from the Renal Physicians Association (2010) supports withholding or withdrawing dialysis for patients with decision-making capacity who, after being informed, decline it, and it recommends offering palliative care to all patients who stop. Her care would continue: symptom management, time at home and, if she chooses, hospice.
For the thread: how does your unit decide when a request to stop dialysis should be tested for capacity, and who does the testing?
Reply to Priya
Priya, you argued that the nephrologist should continue dialysis until the depression question is settled, and I agree with part of that. Screening and a consultation should come first, and a short delay to complete them is reasonable. Where I disagree is the idea of continuing indefinitely until she stops being sad. Grief after a husband's death and exhaustion from six years of treatment may not resolve, and Appelbaum (2007) is clear that capacity concerns the abilities to decide, not whether the decision is one the clinician would make. If the assessment shows that she understands, appreciates and reasons, I think continuing against her wishes would substitute our values for hers. What time frame would your team consider reasonable for that assessment?
Reply to Daniel
Daniel, you raised the question of whether stopping dialysis is a form of suicide, and I think it deserves a direct answer. In mainstream bioethics and in US law, a capable patient's refusal of life-sustaining treatment has been treated differently from suicide, because the death results from the underlying disease rather than from an act intended to cause it. The Supreme Court drew this distinction in 1997 (Vacco v. Quill, 1997), holding that a state could permit patients to refuse life-sustaining treatment while prohibiting assisted suicide, and describing the difference between letting a patient die and making a patient die as widely recognized. Some people of faith and some clinicians still find the distinction thin, and a patient who shares that view should be offered a chaplain or other support. For this patient, though, she is not choosing to die; she is choosing not to spend her remaining time in a treatment that no longer serves her.
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
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Renal Physicians Association. (2010). Shared decision-making in the appropriate initiation of and withdrawal from dialysis (2nd ed.).
Vacco v. Quill, 521 U.S. 793 (1997).
What the NURS 6910 Week 8 instructions ask for
Ethics discussions in Week 8 typically present a palliative care dilemma and ask you to analyze it using ethical principles or a decision framework, then take a position. The first post is kept fairly short and sourced, and two replies follow later in the week. Identify the precise question first, such as capacity or permissibility. Apply a framework to the facts of the case rather than listing principles. Where a factor like depression could affect the decision, say how you would assess it. Take a clear position and support it with a guideline or legal source. In replies, engage with a classmate's reasoning, grant what is right in it and mark exactly where you differ. Keep the case facts you rely on visible, so readers can check your reasoning against them.
How the NURS 6910 Week 8 example is put together
The first paragraph gives the patient's words and the nephrologist's concern and states the two questions. The second applies Appelbaum's four abilities to her statements, italicizing each ability. The third treats depression as a question to assess, proposing a PHQ-9 screen from Kroenke and colleagues and a consultation. The highlighted fourth paragraph gives the position and cites the Renal Physicians Association guideline on withdrawal and palliative care. The post ends by asking how other units decide who tests capacity. The reply to Priya accepts a short delay for assessment and rejects an open-ended one. The reply to Daniel cites the Supreme Court's decision in Vacco v. Quill and acknowledges people who find the distinction thin.
Reading the NURS 6910 Week 8 rubric
Ethics posts are usually scored on analysis, use of evidence, a defensible position and peer engagement. Analysis credit goes to a framework applied to the case, so testing each capacity ability against what the patient says earns more than naming autonomy and beneficence. Evidence earns credit when a guideline or legal source supports the conclusion. A position is expected, and graders reward one that states its conditions, such as confirmed capacity. Acknowledging the strongest objection often adds points. Replies are graded on substance and respect, especially when they disagree. Timely posting, APA citations and staying within length limits complete the typical criteria for this discussion.
Common NURS 6910 Week 8 mistakes, and how to avoid them
Ethics posts lose credit when they list principles without applying any of them to the patient. Another loss is assuming that depression automatically removes capacity, or ignoring it entirely. Some writers stay neutral to be safe, and the thread then has no argument to push against. A reply that simply agrees gives the grader nothing to credit. Name the question, apply a framework to the patient's words, say how you would assess what could distort her decision, take a position with its conditions and cite a guideline or case. The desk can draft a post around the dilemma your prompt presents. Be careful with legal claims; describe what a case held, not what it might mean for every patient. When a guideline supports your conclusion, quote its recommendation in your own words and name its sponsor.
Get a NURS 6910 Week 8 example written to your instructions
Post the Week 8 discussion question here with the rubric, or the case your instructor attached. The desk returns a positioned initial post and two replies with substance in 24-48 hours, and the first sample is free. Replies can answer the actual posts in your thread when those are included. A different dilemma in the prompt simply becomes the case argued.
More NURS 6910 papers and MSN samples
- NURS 6910 Week 1: Discussion post
- NURS 6910 Week 2: Concept comparison paper
- NURS 6910 Week 3: Models of care analysis
- NURS 6910 Week 4: Eligibility and referral memo
- NURS 6910 Week 5: Goals of care plan
- NURS 6910 Week 6: Communication case
- NURS 6910 Week 7: Family assessment
- NURS 6910 Week 9: Spiritual and cultural assessment
- NURS 6910 Week 10: Palliative Case Analysis
- NURS 6910 Week 11: Reflection
- NURS 6730 Week 8: Discussion post
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NURS 6910 Week 8 questions, answered
What are Appelbaum's four abilities?
The capacity to express a choice, to understand relevant information, to appreciate how it applies to one's own situation, and to reason about options. Each is tested against what the composite patient says, which is how capacity is argued rather than asserted. Capacity is decision-specific, so a post can find someone capable of one decision and not another, and yours may need to.
Is stopping dialysis the same as suicide?
Mainstream bioethics and US law generally treat a capable patient's refusal of life-sustaining treatment, including dialysis, as distinct from suicide, because the underlying disease causes the death. The second reply sets out that distinction and cites a source for it. Your course may ask you to engage the objection seriously, and the reply does so rather than dismissing it.
Does depression mean she cannot decide?
Not automatically. Depression can impair appreciation or reasoning, so the example calls for it to be assessed, and names a screen and a consultation as steps the scenario supports. It also shows that a person can be sad about a burdensome treatment and still capable of refusing it. Rubrics tend to reward stating that distinction outright rather than leaving it implied.
Where can I find a free NURS 6910 Week 8 sample paper?
The whole post on the request to stop dialysis, both replies and four references can be read here free of charge. A post on the dilemma your course assigns can be requested.
How does the NURS 6910 Week 8 post handle the depression question?
It calls for a PHQ-9 screen and a psychiatry or palliative consultation, and explains that sadness about a burdensome treatment is not the same as losing the ability to decide.