| Course | HA400 Health Care Ethics, Law, and Governance |
|---|---|
| Unit | Unit 4 |
| Paper type | Patient rights analysis |
| Length | About 970 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | BS in Health Care Administration |
| Updated | October 2026 |
Free sample paper for HA400 Unit 4
Can He Decide? A Patient Rights Analysis of a Composite 81-Year-Old Stroke Patient Who Declines a Feeding Tube While His Daughter, Holding His Health Care Power of Attorney, Wants It Placed
[Student Name]
Purdue University Global
HA400: Health Care Ethics, Law, and Governance
Unit 4 Patient Rights Analysis
[Instructor Name]
[Date]
The patient, his daughter and the hospital are composite; the analysis demonstrates reasoning about rights for a course and is not legal or clinical advice, and state law on surrogates varies.
The Conflict
[Mr. T.], 81, was admitted [nine] days ago with a stroke affecting his right side. A swallow study shows he aspirates thin liquids and some solids. The speech therapist recommends a modified diet with careful feeding; the team has raised a feeding tube as an option to maintain nutrition while swallowing recovers, which may take weeks or may not happen. He says he does not want a tube. His daughter, [Ms. T.], was named in his health care power of attorney and asks the team to place one. The hospitalist asks the ethics consultant and the patient advocate whom to follow.
Gate 1: Does He Have Capacity for This Decision?
Capacity is a clinical judgment about a specific decision at a specific time; competence is a legal status decided by a court. A patient may lack capacity for a complex decision and keep it for a simpler one, and capacity can change as a patient recovers. Appelbaum (2007) sets out four abilities a clinician checks: stating a choice, grasping the facts disclosed, seeing that those facts are about his own body and future, and weighing the options in a way that hangs together. Applied to the composite record:
1. Communicating a choice: He has said "no tube" consistently over three days, to three clinicians, using speech that is slow but clear.
2. Understanding: Asked what the tube is, he describes how it goes into his stomach, that it would give him food while his swallowing improves and that without it he may lose weight or get pneumonia.
3. Appreciation: He says, "I know I could choke. I'd rather eat what I can and take my chances."
4. Reasoning: He compares the tube with careful eating and explains his choice in terms of what matters to him: tasting food and avoiding another procedure after his wife's experience with a tube before her death.
The hospitalist and a psychiatrist document that he has capacity for this decision. Once he is found able to decide, the daughter's power of attorney does not activate; it waits in the file for a day when he cannot speak for himself.
Gate 2: Whose Right Is It?
A capable adult has the right to refuse treatment, including artificial nutrition. Hospitals participating in Medicare must protect a patient's right to make informed decisions about care, including the right to request or refuse treatment, and must honor advance directives in line with state law (42 C.F.R. § 482.13, 2024). A health care power of attorney generally takes effect only when the patient lacks capacity. Because Mr. T. has capacity, the decision is his.
Gate 3: What Is the Daughter's Role Now?
The daughter has no legal authority to override her father while he can decide, but she still has a role. She can be present if her father agrees, share what she knows of his values and ask questions. The team should explain to her, kindly and clearly, why her father's decision governs and what would change if he lost capacity.
Gate 4: If He Loses Capacity Later
If his condition worsens and he can no longer decide, the daughter would become the decision-maker. Most states expect an agent to use substituted judgment, asking what Mr. T. would want, and to turn to the patient's best interests only when his wishes are unknown. Because her father has clearly stated his wishes, she would be expected to follow them, not her own preference.
The Ethical Weight of the Rights
Respect for autonomy supports honoring a capable patient's refusal, even when the team or family disagrees (Beauchamp & Childress, 2019). Beneficence asks the team to make sure the refusal is informed and to offer the best care that fits it, here a modified diet, swallowing therapy and symptom relief. Nonmaleficence warns against placing a tube over his objection, which would be a serious wrong as well as a legal battery.
What the Team Should Do
1. Write up how capacity was judged, ability by ability, quoting what he said.
2. Hold a family meeting with Mr. T.'s permission, led by the hospitalist with the social worker, to explain his decision and the daughter's role.
3. Offer careful hand feeding, swallowing therapy and a palliative care consultation.
4. Record his wishes in an advance directive or a portable medical order if he wishes, so they guide care if he later loses capacity.
5. Reassess capacity if his condition changes.
The Daughter's Perspective
Her request is likely rooted in fear of losing her father and a belief that a tube would keep him safe. Treating her request with respect, while being clear about who decides, can prevent conflict from growing. Many families accept a patient's decision more easily when they hear it from the patient, in the patient's own words.
Possible Objections
Some may argue that a stroke patient's choices are clouded by depression. If depression is suspected, it should be assessed, but depression does not automatically remove capacity; the question remains whether he can understand, appreciate and reason about this decision.
Conclusion
The analysis turns on one answer. Because Mr. T. can decide, he holds the right to refuse a feeding tube, the daughter's authority stays dormant and the team's work is to support his choice with the best care that fits it.
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.
42 C.F.R. § 482.13 (2024). https://www.ecfr.gov/current/title-42/section-482.13
The Purdue Global HA400 Unit 4 instructions
Unit 4 typically asks students to analyze a case involving patient rights, such as informed consent, refusal of treatment, advance directives or surrogate decision making. Prompts often require identifying the rights at stake, the people involved, the legal and ethical basis for each right and a recommended course for the organization. Many instructors expect students to distinguish capacity from competence and to explain when a surrogate's authority applies. Expect to cite a clinical source on capacity, a regulatory source on patient rights and an ethics source in APA style, with the case kept composite. Ordering the analysis by which right takes effect first helps the reader follow the logic and keeps the surrogate question in its proper place.
How this HA400 Unit 4 example is built
The sample states the conflict and its three parties, then settles capacity first, with a margin note on that choice. Capacity is defined against competence, and four abilities from a clinical review are applied to the patient's own words. The highlighted sentence explains that the power of attorney does not activate. A gate on whose right it is cites the federal hospital patient rights rule. Further gates cover the daughter's role now and if he loses capacity, with a margin note. Ethics, the team's five steps, the daughter's perspective with a third note, an objection about depression and a short conclusion on who holds the right follow.
Where the points sit in the HA400 Unit 4 rubric
Patient rights rubrics in HA 400 usually award points for identifying rights, explaining legal and ethical bases, applying them to the facts, addressing each party, recommending action, citing sources and writing clearly. Identification points depend on naming the specific rights at stake. Basis points go to accurate law and ethics. Application points reward using the patient's actual statements and condition. Party points require attention to the patient, the surrogate and the team. Recommendation points go to concrete steps for the organization. Source points need clinical, regulatory and ethics sources. Analyses that explain the sequence in which rights take effect, as with capacity before surrogacy, often earn the strongest marks.
HA400 Unit 4 help: mistakes that cost points
Students often lose points by starting with the family conflict and assuming the surrogate decides, without first asking whether the patient can. Another gap is treating a stroke or a diagnosis as proof of incapacity. Some papers state rights without showing their legal source. Others forget what happens if the patient later loses capacity. Assess capacity for this decision using the patient's own words, then decide who holds the right, what role others have and what the team should do. Write the family's view with respect, since the recommendation will need their cooperation. If depression or delirium is possible, say how it would be assessed rather than assuming it removes capacity. And document the patient's wishes so they guide care later.
Get an HA400 Unit 4 example written to your instructions
Paste the Unit 4 scenario and your rubric, and mention any state law or hospital policy the prompt specifies. Those facts drive the rights analysis, capacity first, with the surrogate's authority and the governance step placed where they belong, in 24-48h. Your first custom sample is free; the patient and family in it are composites. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
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HA400 Unit 4 questions, answered
Where can I find a free HA400 Unit 4 sample paper?
The whole HA400 Unit 4 patient rights analysis appears on this page, settling capacity before a composite daughter's power of attorney comes into play, with three sources. You can apply the same sequence to your own case.
What is the difference between capacity and competence?
Capacity is a clinical judgment about a specific decision; competence is a legal status decided by a court.
When does a health care power of attorney take effect?
Generally when the patient lacks capacity to make the decision, as determined by the clinical team.
Can a capable patient refuse a feeding tube?
Yes. A patient with capacity may refuse any treatment, including artificial nutrition, even if family members disagree.
What standard would the daughter use in HA400 Unit 4 if her father lost capacity?
Substituted judgment: she would follow his stated wish to avoid a tube rather than her own preference.