Autonomy of the client-rationale: the right to refuse treatment is grounded in the ethical principle of respect for the autonomy of the individual. the client has the right to refuse treatment as long as hes competent and aware of the risks and complications associated with that refusal. the right to die is a difficult decision involving whether to initiate or withhold life-sustaining treatment for a client who is irreversibly comatose, vegetative, or suffering with end-stage terminal illness. the client may have signed an advance directive, making his wishes known. an advance directive is a document that provides guidelines for starting or continuing life-sustaining medical care, generally for a client who has a terminal disease or disability and cant indicate his own wishes. substituted judgment is an ethical principle used when a nurse makes a decision based on whats best for an incapacitated client.client needs category: safe, effective care environmentclient needs subcategory: management of carecognitive level: applicationreference: craven, r.f., and hirnle, c.j. fundamentals of nursing: human health and function, 5th ed. philadelphia: lippincott williams & wilkins, 2007, p. 1396.