You see the primary challenge in this case as how to interpret the ethical commitment to respect autonomy ->respect for autonomy. Given that Mr. Hendricks’ advance directive is old and that fact that his preferences seem to have changed as he has adapted to life with his disease, you feel that his current wishes and enjoyment of his quality of life should play a significant role in determining treatment. If Mr. Hendricks had a closer relationship with his nephew and there were more recent expressions of a desire to avoid curative interventions even if he was enjoying a high quality of life with dementia, you might approach the situation differently, but in the absence of these contextual features it seems appropriate to respect the wishes of the person Mr. Hendricks is now as opposed to the person he was then. This interpretation of respecting autonomy is also aligned at this point with what a focus on beneficence, with its attention to best interests, would indicate, although at a future point these might come apart.
You emphasize in your report that the particular decisions that follow from a focus on Mr. Hendricks’ current preferences will shift with context. It is not to say that Mr. Hendricks has Capacity to make all of his health care decisions, but that the general thrust of decision making should be toward maintaining the current quality of life that he enjoys. If, for example, the apparent quality of Mr. Hendricks’ life seemed to decline in his estimation then it might be closer to the situation that Mr. Hendricks envisioned when he first drafted his advance directive, such that its contents might be more applicable.
You mention to the team that this approach to the case might challenge the strong commitment to respecting autonomy through the use of advance directives that they have developed as health care providers. You encourage the team to continue the discussion about how best to understand and respect patient autonomy, and how that relates to beneficence and best interest. You note that the team did a particularly good job of disagreeing effectively and respectfully with each other, and note that there are Education sessions available around various aspects of this case, including Moral Distress and advance directives.