An elderly woman with chronic kidney disease told her daughters that if she ever ended up with dementia she wouldn't want to live like that. Years later she developed senile dementia and moved into a nursing home. Although she did not recognize family or friends, she enjoyed the company of others and the nursing home's cat. When her kidneys stopped functioning, staff at the nursing home expressed ambivalence about the value of kidney dialysis, yet asked her daughters whether their mother should be started on dialysis.
Should the daughters consider her previously stated wishes as an advance directive?
What questions should health care providers and family members ask to clarify patient values and preferences so that they can be more easily applied in the future?