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July 11, 2011

Honoring Patients' Wishes for Less Health Care

Author Affiliations

Author Affiliation: Department of Family Medicine, T. J. Samson Hospital, Glasgow, Kentucky.

Arch Intern Med. 2011;171(13):1200. doi:10.1001/archinternmed.2011.134

My patient was a 99-year-old nursing home resident with advanced dementia and very little awareness of her surroundings. She was well known to me, having been a resident in this nursing home for approximately 10 years. While making routine rounds at the nursing home, I was advised that she had developed some discoloration and skin breakdown of her feet. On examination it was obvious that she had developed gangrenous changes in both feet, an ominous sign in this elderly woman. I contacted her niece and nephew who served as co–powers of attorney and discussed treatment options with them. Recognizing the seriousness of the condition and that their aunt had enjoyed almost no quality of life for many years, we agreed that only supportive comfort measures should be implemented.

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