Mr. Parker is an 88-year-old resident of your LTC home with end-stage Alzheimer’s. He is wheelchair bound and spends most of his days sleeping in his wheelchair near a window facing the garden. He needs to be spoon fed but has recently started to refuse to eat. Mr. Parker has three children, one of whom – his only daughter -- is very involved in the care of her father. The team approaches the daughter about her father refusing to eat, and feels that his refusal is legitimate. Thus, they propose changing the plan of care to palliation. The daughter absolutely refuses, claiming that “you cannot kill my father, I want everything done to keep him living!” The director of nursing (DON) for the facility has turned to you, as the executive director, for guidance, asking these questions. Do we know whether the resident is capable to make his own health care decisions? Are there any known wishes from Mr. Parker? What would he want? What are his values? Is his daughter the substitute decision-maker? Can she, in this role, demand treatment and expect that you comply? Because of the potential legal and reputational liability, the corporate counsel has recommended you respond the DON in writing. Prepare a 4-10 page APA style memorandum, double spaced addressing the DON and daughter’s issues. Cite relevant sources. Be sure to include a cover page, and abstract.

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