When a patient requests to stop treatment and is believed to be competent, which is the most appropriate step?

• A. Refuse and continue treatment.
• B. Ignore patient and discuss with family only.
• C. Immediately involve legal representation.
• D. Acknowledge the request, assess capacity, and document the decision.

Answer: (D)

Respecting patient autonomy while ensuring genuine understanding is the essential idea here. When a patient who is believed to be competent asks to stop treatment, the appropriate step is to acknowledge the request, assess decision-making capacity for this specific decision, and document both the capacity assessment and the patient's choice. Capacity means the patient can understand the situation and consequences, appreciate the options, reason about them, and communicate a clear decision. If capacity is intact, their choice should guide care, with clinicians providing information about prognosis, goals of care, and available alternatives (such as comfort-focused measures) and ensuring the decision is voluntary. Documentation creates a clear record of the discussion and the rationale for honoring the decision. If capacity is uncertain or impaired, involve appropriate surrogates or substitute decisions as needed. The other options do not honor patient autonomy or proper ethical and legal processes: refusing without assessing capacity, discussing only with family, or immediately involving legal representation without first confirming the patient’s capacity and wishes.