Use the following questions to guide your discussion of the preceding case’s ethical implications. 


â€Does it matter which stakeholder raises the issue of treatment redirection? What would have happened if Barney had objected to the treatment plan? Are the nurses, doctors, or Almeda herself to blame? 


â€Does the lack of advance directives complicate or simplify the process of treatment redirection?


• Is Barney a suitable surrogate decision maker to consent to treatment redirection to palliative care? 


â€Does a â€official†or â€legal†action need to be taken in order to proceed with a treatment redirection process?



â€What would Almeda prefer if she could contribute to the debate?


• Is Barney’s goal for Almeda sufficient to justify continuing aggressive curative treatment?


• Is there evidence in the case text that the attending physician tried hard enough to inform and persuade Barney to consent to treatment redirection? 


â€What should the nursing staff’s perspective have been if Almeda was gradually improving? What if she was neither improving nor deteriorating?


• What is it about the prospect of renal dialysis that causes the treatment-redirection process to accelerate? Why not after the gastric tube was placed? Or was it when the ventilator was turned on?