Review the snippit from this case. Complete your own Case Review Critique.

Introduction As the population ages, Alzheimer disease will create a growing population of patients who are ultimately unable to make their own medical decisions. Alzheimer disease is the fifth leading cause of death in people older than 65 years. The number of people living with dementia worldwide is estimated at 35.6 million, and this number is expected to double by years. Mr. A had the equivalent of Functional Assess- ment Staging of Alzheimer Disease. Mr. A was admitted to hospice. At Mr. As hospice interdisciplinary team meeting, his nurse and social worker raised the concern that Mr. As daughter, his appointed health care agent, had given instructions to the nursing home staff to withhold food and drink from her father. Given the stroke and severity of Mr. As dementia, he could no longer verbally communicate his needs, but he willingly opened his mouth and ate food when offered. It was not possible to assess whether he would oppose not receiving food. Mr. As hospice nurse and social worker, and nursing home staff, were not comfortable with the request to withhold food. Therefore, a family meeting was held with Mr. As daughter. Case Description Mr. A was an 80-year-old man with Alzheimer dis- ease. He had been living in a nursing home for four months But three months ago, he had new-onset hemiplegia and worsening aphasia. He was presumed to have had a stroke, but a diagnostic workup was not pursued. Mr. A was alert but not verbal, appeared to no longer recognize his daughter, and developed dysphagia that required a modified diet and slow hand-feeding. Mr. As daughter felt that she had waited a reason- able amount of time since the presumed stroke to determine that her father had not recovered to an acceptable quality of life. She advocated that her father would not want any medical intervention to pro- long his life and viewed fully assisted hand-feeding as a life-prolonging intervention. Mr. As daughter relayed conversations that she had with her father about other family members who had died in similar situations. She felt conflicted because her intention was not to hasten her fathers death, but she felt that she would be honoring his wishes by withholding food and drink. She

felt frustrated with medical providers who would not allow her to uphold her fathers wishes and made her feel deplorable as if she was not acting in his best interest. Mr. As Living Will, completed nearly a decade earlier, enumerated that he did not want medical in- terventions, such as resuscitation, artificial feeding tubes, and did want to withhold or withdraw life- sustaining treatment that serves only to prolong the process of my dying if [he] should have a terminal condition or a state of permanent unconsciousness. Mr. A also had clearly elected his daughter as his sur- rogate. The Living Will did not explicitly state to stop handfeeding him. The nursing home staff was concerned about causing Mr. A discomfort by starving him, especially because they believed that he was expressing a desire to eat and drink. All medical providers were unsettled that fulfilling Mr. As daughters request possibly meant condoning neglect and endangering a vulnerable older adult. Think about the following questions and then complete your case critique form. Is It Ethically Justifiable for Caregivers to Withhold Food and Drink from the Patient? Is It Ethically Justifiable for a Surrogate to Refuse Food and Drink on the Patients behalf.