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Respect for autonomy requires verifying that refusals are informed and voluntary. A structured capacity assessment confirms the patient can understand relevant information, appreciate consequences for personal circumstances, reason about options, and communicate a stable choice. The APRN should optimize contributors that can impair capacity (uncontrolled pain, delirium, severe depression, hypoxia), provide clear information using teach-back, and explore values/goals to ensure alignment. If capacity is intact, an informed refusal is ethically and legally valid; document the discussion, risks/benefits, and availability of supportive/palliative care. Treating against will (Option A) or seeking legal compulsion (Option C) without evidence of incapacity violates ethics and law. Deferring to family (Option D) is appropriate only when the patient lacks capacity and a surrogate is designated. Offer ongoing relationship-centered support; preferences may evolve, and patients should know they can revisit decisions anytime. This approach maintains trust, reduces conflict, and centers care on what matters most to the patient.