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Who makes the decision if the patient lacks capacity? Multiple healthcare professionals offer varying perspectives on the ethical and legal dilemma surrounding the care of a 93-year-old comatose patient (JH). A conflict exists between JH's legally appointed Power of Attorney (POA), his hired caregiver, who wants aggressive treatment, and his son, who advocates for comfort care only. The central issue is whether to honor the POA's decision despite concerns about potential conflicts of interest and the medical futility of continued aggressive treatment. Legal and ethical frameworks are explored, along with a proposed six-step process for resolving such disputes, highlighting the complexities of surrogate decision-making in end-of-life care. Ultimately, the case underscores the need for clear advance directives and a collaborative approach to navigating difficult medical and ethical decisions.
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