HCA 415 Module 3 Autonomy, Consent and Capacity Example

Course	HCA 415 Healthcare Ethics
Module	Module 3
Paper type	Capacity case analysis
Length	About 1,055 words, 6 pages
Format	APA 7 student paper
School	Aspen University
Program	Health Care Administration
Updated	September 2026

Free sample paper for HCA 415 Module 3

Can She Say No? Autonomy, Consent and Capacity in a Refused Hip Surgery

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Health Care Administration Program, Aspen University

HCA 415: Healthcare Ethics

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Month Day, Year

What this page is doingThe title poses the case's central question about when a refusal must be respected. APA 7 student title page.

Can She Say No? Autonomy, Consent and Capacity in a Refused Hip Surgery

Honoring the decisions of people who are able to decide for themselves is what respect for autonomy asks. The hardest cases arise when a patient refuses recommended care and clinicians doubt whether the patient can decide. This paper analyzes a composite case of an older woman with mild dementia who refuses surgery for a hip fracture, using the ethics of consent and a structured approach to decision-making capacity.

The Case

Mrs. E., 82, lives alone with help from her daughter. She has mild dementia and forgets appointments but manages daily tasks. After a fall, she has a hip fracture. The orthopedic surgeon recommends surgery, which offers the best chance of walking again; without it, she will likely be bedbound and at high risk of complications. Mrs. E. says, I am too old for an operation. Let me be. Her daughter wants the surgery done. Her surgeon asks the team to assess whether she can make this decision.

Respect for Autonomy

Respect for autonomy requires honoring informed, voluntary choices by people with capacity, even when others disagree (Beauchamp & Childress, 2019). It does not require honoring choices made without understanding or under pressure. The central question is whether Mrs. E.'s refusal is an autonomous choice or a product of her dementia.

Valid Consent and Refusal

A valid consent or refusal requires disclosure of relevant information, understanding, voluntariness and capacity. The surgeon explained the fracture, the operation, its risks, the expected recovery and the likely course without surgery. The team must now determine whether Mrs. E. understood and can decide.

Assessing Capacity

Capacity is specific to a decision and a time, and it is a clinical judgment, distinct from the legal finding of competence. Appelbaum's widely used framework looks for four abilities: stating a choice, grasping the information given, recognizing what the facts mean for her own life, and weighing options in light of one's values (Appelbaum, 2007). The table records the assessment.

Ability	Question asked	Mrs. E.'s response	Judgment
Communicate a choice	What do you want to do?	Consistently declines surgery over two days	Present
Understand	What did the surgeon tell you?	Describes broken hip, operation, recovery	Present
Appreciate	What will happen without surgery?	I probably won't walk again; I may stay in bed	Present
Reason	Why do you choose this?	Afraid of dying under anesthesia like her husband; would rather accept not walking	Present, based on her values

What this page is doingRecording each ability separately shows that dementia alone does not answer the capacity question.

The Sliding Scale

Many ethicists argue that the stringency of capacity assessment should rise with the stakes: a refusal of low-risk, high-benefit treatment deserves closer scrutiny than acceptance of it. Mrs. E.'s refusal carries serious consequences, so the team repeated the assessment on a second day, when she was rested and without pain medication effects, and found the same results.

Voluntariness

The team also checked for pressure. Mrs. E. was interviewed alone. She said her daughter loves her but does not understand her fear. There was no evidence of coercion from anyone. Her choice was consistent with values she had expressed before, including after her husband's death during surgery.

If She Lacked Capacity

Had Mrs. E. lacked capacity, a surrogate, usually a designated health care agent or a family member under state law, would decide using substituted judgment, choosing as the patient would have chosen, or, if her wishes were unknown, her best interests. Advance directives help surrogates. Surrogates are often needed: among older Americans studied near the end of life, seven in ten who faced treatment decisions could not make them, and those who had written living wills generally got the kind of care they had asked for (Silveira et al., 2010).

The Daughter's Role

The daughter's wish for surgery comes from love, but she is not the decision-maker while her mother has capacity. The team met with both, explained the assessment and invited Mrs. E. to share her reasons. The daughter began to understand her mother's fear.

Exploring the Refusal

Respecting autonomy includes making sure the choice is informed by accurate beliefs. The anesthesiologist explained how anesthesia and monitoring have changed and offered regional anesthesia, which avoids general anesthesia. Mrs. E. listened but still declined. Offering information is respectful; pressuring is not.

The Team's Resolution

The team accepted her refusal, documented the capacity assessment and conversations and arranged pain control, pressure sore prevention and physical therapy for transfers. A palliative care consultation helped plan for her goals. The team agreed to revisit the question if she changed her mind, which she remained free to do.

Administrative Implications

Administrators support these cases by ensuring access to ethics consultation, capacity assessment training, interpreters and palliative care, and by keeping advance directive processes simple. Clear documentation standards protect patients' choices and staff who honor them.

Counterargument

Some would argue that beneficence should override a refusal driven by fear. But fear based on personal experience is part of a person's values, and overriding a capable adult's refusal violates autonomy and, in most jurisdictions, the law. The team's job was to inform and support, not to override.

Documentation of Capacity

The record included each ability assessed, the questions asked, Mrs. E.'s words, the date and time of each assessment and who was present. Clear documentation protects the patient's choice if others later question it and shows that the team took the refusal seriously rather than accepting it without inquiry.

Revisiting the Decision

Capacity and choices can change. The team agreed to ask Mrs. E. again after pain was better controlled and after she had time to talk with her daughter and the anesthesiologist. Respecting autonomy includes allowing people to change their minds, and making it easy to do so without feeling pressured.

Supported Decision-Making

Some patients with cognitive impairment can make decisions with help: simpler explanations, written summaries, more time, a trusted person present or decisions broken into smaller steps. Supported decision-making keeps people deciding for themselves for longer and can strengthen, rather than replace, their autonomy.

Conclusion

Mrs. E.'s refusal was an autonomous choice: she communicated consistently, understood, appreciated the consequences and reasoned from her values, and she was free of pressure. A diagnosis of dementia did not remove her capacity for this decision. Structured capacity assessment, attention to voluntariness and respect for values allowed the team to honor her choice while caring for her needs.

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.

Silveira, M. J., Kim, S. Y. H., & Langa, K. M. (2010). Advance directives and outcomes of surrogate decision making before death. New England Journal of Medicine, 362(13), 1211-1218. https://doi.org/10.1056/NEJMsa0907901

Reading the HCA 415 Module 3 assignment instructions

The HCA 415 catalog listing centers on critical thinking about medical ethics, and with module instructions reserved for enrolled students, a capacity case was chosen to put autonomy and consent to work. Capacity assignments usually ask whether a patient can make a particular decision and what should happen if not. Check whether your prompt supplies the case. Use a structured framework, such as the four abilities, and apply each one with evidence from the case. Distinguish capacity from diagnosis, since many students assume dementia means incapacity. Address voluntariness and surrogates, and explain what documentation should show. State that capacity is a clinical judgment for a specific decision, separate from the legal finding of competence, and explain the difference in a sentence.

Inside the HCA 415 Module 3 example

Nineteen headings organize roughly 1,040 words, and a four-row table records the capacity assessment. It presents the case, then respect for autonomy and valid consent. The capacity assessment and table follow, then the sliding scale, voluntariness, what would happen if she lacked capacity, the daughter's role, exploring the refusal, the team's resolution, administrative implications and a counterargument. Documentation, revisiting the decision and supported decision-making come last, while a side comment on the table shows that dementia alone does not answer the capacity question. The capacity assessment is repeated on a second day, and the paper explains why that step matters when the stakes are high. Administrative implications close the main analysis before the added sections.

Reading the HCA 415 Module 3 grading rubric

Capacity analyses are commonly marked on correct use of a framework, careful application to facts, attention to voluntariness and a defensible conclusion. The four abilities are applied with the patient's own words. Voluntariness is checked by interviewing her alone. The conclusion follows from the assessment. A capacity framework article, an ethics text and a national study of advance directives carry APA references. Attention to the family and to revisiting decisions, both present here, also tends to earn credit. Clear documentation guidance shows the writer understands how capacity findings are recorded and defended. Treating the daughter respectfully, while keeping the decision with the patient, shows balanced judgment. The counterargument section shows balanced reasoning.

HCA 415 Module 3 help: mistakes that cost marks

The most common error is equating a diagnosis with incapacity. Assess the decision at hand. Students also skip voluntariness, though family pressure is common. Another gap is failing to consider what happens if the patient lacks capacity. Document each ability with evidence. If you would like a second reader, a tutor can go through your assessment with you and flag any ability judged without enough evidence. Explore the reasons behind a refusal, since fear or misinformation can sometimes be addressed. Offer information without pressure, and explain how the patient can change her mind later. Include what supported decision-making could add.

Write yours, or have the desk draft it

This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.

More HCA 415 and Health Care Administration sample papers

HCA 415 Module 3 questions, answered

What does HCA 415 Module 3 usually ask for?

Aspen's HCA 415 course applies critical thinking to medical ethics readings, and autonomy, consent and capacity are central topics, so a case analysis is typical. Check your Aspen classroom for the prompt.

What are the four abilities in capacity assessment?

Communicating a choice, understanding relevant information, appreciating the situation and its consequences, and reasoning about options.

Does a dementia diagnosis mean a patient lacks capacity?

No. Capacity is decision-specific; a person with mild dementia may still have capacity for a particular choice.

Where can I find a free HCA 415 Module 3 sample paper?

Scroll up for the hip fracture refusal analysis and its capacity table, the third of eight HCA 415 samples.

What is the sliding scale for capacity in HCA 415 Module 3?

The idea that the stringency of a capacity assessment should rise with the stakes, especially for refusals of high-benefit treatment.