1. CASE STUDY #3 JUSTICE & FUTILITY Tena Alonzo, MA M. Zuhdi Jasser, MD Kelly Shepard, M.Div.

2. CASE #3 EF, 95 yo male resident of long-term care facility for 3½ years; has moderate-severe dementia –Dependent in all Instrumental Activities of Daily Living (IADLs) –Dependent in most Activities of Daily Living (ADLs) Wheelchair-bound –Mini-Mental Status Exam 8/30 (normal at least 24) Does have court-assigned public fiduciary

3. CASE #3 (cont.) Presents to emergency room with recurrent shortness of breath and cough Workup demonstrates heart failure exacerbation with possible overlying pneumonia Emergency department physician recommends hospitalization This is EF’s 4 th admission in the past 3 months for essentially the same condition

4. CASE #3 (cont.) No advance directives or living will is available When asked what he wants, EF replies, “I want to feel better.”

5. CASE 3 – QUESTION #1 EF has decision-making capacity for hospitalization 1.TRUE 2.FALSE

6. CASE 3 – QUESTION #2 In the absence of advance directives, EF must be hospitalized 1.TRUE 2.FALSE

7. CASE 3 – QUESTION #3 Bioethical concerns must be reviewed from the perspective of: 1.Long-term care facility staff 2.Payor source 3.Patient 4.Physician 5.Public fiduciary

8. CASE 3 – QUESTION #4 The hospitalist can refuse admission based on an argument of futility 1.TRUE 2.FALSE

9. CASE 3 – QUESTION #5 If admitted to the hospital, EF is likely to be discharged to: 1.His original long-term care facility 2.A new long-term care facility for sub- acute/rehabilitative care 3.An acute rehabilitation hospital 4.He will never be discharged because he will never be medically stabilized