RT Journal
A1 Bale P
T1 HOnoring patients' wishes for less health care
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2011
FD July 11
VO 171
IS 13
SP 1200
OP 1200
DO 10.1001/archinternmed.2011.134
UL http://dx.doi.org/10.1001/archinternmed.2011.134
AB 
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.