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Case #5: Mrs. Moody

     When Dr. Brown first met Mrs. Moody, she was 70 years old. She came to his office accompanied by her daughter who reported that her mother was experiencing problems with her short-term memory. Testing revealed that Mrs. Moody’s short-term memory was moderately impaired, but that her judgment and decision-making abilities were still fine. During a physician-directed discussion, with her daughter present, she said she would not want to be kept alive if she was no longer able to recognize family members.

      Three years later, Mrs. Moody’s thinking ability had continued to deteriorate, and she required nursing home care. After being in the nursing home for a year, she was no longer able to recognize her daughter, who had been visiting her daily since her admission. At that point her daughter reminded Dr. Brown of her mother’s advance directive. Dr. Brown advised the nursing home staff and medical team that life prolongation was no longer a goal.  He told the staff to stop measuring her vital signs and discontinued her medicines.

       About three months later Dr. Brown received another call from Mrs. Moody’s daughter.  She asked, “Why did you write orders for a pneumonia shot for my mother? Doesn’t that directly contradict her stated preference?” While handling the mountains of paperwork that came across his desk each day, Dr. Brown had signed a number of routine pneumonia vaccination orders that week – hers included – without even thinking about it. He apologized.  Mrs. Delaney died peacefully a couple of months later with her daughter by her side.

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