The Case.

KS is a 76-year-old Burmese woman who presented to the hospital with right-sided weakness that had begun two days prior. Although KS had been diagnosed earlier with dementia and had a medical history of stroke, she was living at a nursing home and was able to walk on her own and use her right arm to feed herself. Since her last stroke three years ago, she had also developed aphasia, and her speech has been minimal. During her current hospitalization, KS was found to have a cerebral hemorrhage, but after consultation with neurosurgery, the team determined that no medical interventions were available, and a higher level of care was not required. She also presented with other medical conditions, including severe hypertension, chronic kidney disease, and depression. The patient's blood pressure has remained high. She has now failed a swallow evaluation and is refusing the insertion of a nasogastric feeding tube. The patient has a younger sister who believes, from a cultural perspective, that only the patient should make her medical decisions. As a result, she feels helpless in assisting the team. The medical team has asked for an ethics consultation to direct the patient's care and to guide decisionmaking.