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Case Study
Conjectural Mixed Motives Does FB’s caregiver burden undermine his legitimacy as surrogate decision-maker?

AB is a seventy-four-year-old man with longstanding chronic kidney disease related to diabetes. Six months ago, his kidney disease progressed, and he began hemodialysis three times weekly. Since then, he has been hospitalized five times for various problems. FB begins asking the health care team if withdrawing dialysis is now appropriate. FB has struggled with his role as primary caregiver. His father never wanted to be in a nursing home and FB respects this wish, but he has experienced difficulty with his employer, family stress, and fatigue—all of which are exacerbated by his father’s occasional angry outbursts, refusals of care, and unwillingness to help. The health care team requests an ethics consultation: Does FB’s caregiver burden undermine his legitimacy as surrogate decision-maker?

AB is a seventy-four-year-old man with longstanding chronic kidney disease related to diabetes. Six months ago, his kidney disease progressed, and he began hemodialysis three times weekly. Since then, he has been hospitalized five times for various problems. FB begins asking the health care team if withdrawing dialysis is now appropriate. FB has struggled with his role as primary caregiver. His father never wanted to be in a nursing home and FB respects this wish, but he has experienced difficulty with his employer, family stress, and fatigue—all of which are exacerbated by his father’s occasional angry outbursts, refusals of care, and unwillingness to help. The health care team requests an ethics consultation: Does FB’s caregiver burden undermine his legitimacy as surrogate decision-maker?

Matthew DeCamp, Jennifer K. Walter, and Susan Dorr Goold, "Conjectural Mixed Motives," Hastings Center Report 41, no. 1 (2011): 11-12.