Marion is a 92-year-old patient who weighs 79 pounds. She has had poor eating habits for at least ten years and has refused all attempts by her daughters to improve her nutrition. In addition, Marion had been a heavy smoker all her life and suffered frequent respiratory problems. During the past two years, she has become quite forgetful, has suffered a broken hip as a result of a fall out of bed, and has been treated for pneumonia. Her daughters, who have their own family responsibilities and cannot bring their mother to live with them, found an excellent nursing home near them run by Catholic nuns. In spite of Marion’s protests, she entered the nursing home.

During her third week in the nursing home, Marion develops a cough, high temperature, and respiratory problems. She is hospitalized with a diagnosis of pneumonia. Marion immediately becomes disoriented and attempts to remove her intravenous and oxygen tubing. Since she tries to climb out of bed, her daughters must remain at her side. The attending physician tells the daughters that in addition to treatment for pneumonia, Marion will also need to have a pacemaker inserted to regulate her heartbeat. However, Marion would then be unable to return to the nursing home, since the facility is not equipped to care for someone recovering from surgery.

After thoughtful discussions with other family members, Marion’s daughters tell the physician that they do not want to put their confused mother through the surgical