Mr. Rattan has been a resident at Ocean Wind, a retirement community offering a range of options for accommodation, for the last ten years since his partner died. Currently he has a studio apartment in the assisted living wing, which provides assistance with ADLs.
Mr. Rattan has been diagnosed with dementia. In the last few months his younger daughter, who typically visits on her way home from work, has become concerned that his current living situation doesn’t meet his needs and wants him to move into the locked dementia unit in a different wing of the building. She has started to make arrangements for Mr. Rattan to move.
When his daughter talks with him about moving, Mr. Rattan seems amenable to this option. But twice when staff have come to discuss moving with him he refuses, saying that he’s comfortable where he is and that he doesn’t want to spend the extra money.
Mr. Rattan’s elder daughter and son have both called Ocean Wind to reinforce that Mr. Rattan has told them he doesn’t want to move and that they want his wishes to be respected. Mr. Rattan does not have an personal directive in place.
Staff have expressed some concerns about Mr. Rattan, indicating that he seems frequently to be confused and disoriented at the end of the day. They are also considering requesting a capacity assessment, but there is disagreement about whether that is an appropriate next step.
The manager at Ocean Wind has contacted you as the chair of the ethics committee looking for support with this case.
What will make this case clinically challenging?
What will make this case ethically challenging?
How might the ethics committee support Ocean Wind in addressing these challenges?
What would change (if anything) if Mr. Rattan had a personal directive identifying his son as the substitute decision maker?