Mr. Smith is a ventilator- and feeding tube-dependent 76-year-old Black male suffering
from advanced Parkinson's-like symptoms. Before his admission to the intensive care
unit (ICU), Mr. Smith developed aspiration-induced pneumonia, resulting in placement
on vent support and the administration of tube feeding. After 7 weeks in the medical
ICU, he is not responding well to medication and his condition is deteriorating. Mr.
Smith has moderate to severe dementia, and periodically lapses in and out of consciousness.
Mr. Smith's wife of 5 years has been actively involved in care decisions, as has his
27-year-old daughter from a previous marriage. Mr. Smith also has a 46-year-old son
who lives out of state, and has not been reachable despite numerous attempts by family
and social work. Mr. Smith is faced with the prospect of placement in a skilled nursing
facility, with continued tube feeding and ventilator support, or withdrawal of life
support in the ICU, with the likelihood of imminent death. Mr. Smith periodically
appears to be uncomfortable, as he sometimes winces and grimace when suctioned. Mr.
Smith's wife and daughter both want continued aggressive care in the ICU setting,
resisting nursing home placement. The ICU attendant, Dr. Jones, thinks that Mr. Smith
should be made do-not-resusitate, and that all technological support should be withdrawn.
He believes that the focus of care should be on comfort. Dr. Jones and Mrs. Smith
have had several tense discussions about this, and are now barely speaking to each
other.
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