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Following a massive stroke, Mr. Smith was transported from the Rope nursing facility to a local hospital by

ambulance on July 4, 2004. Smith, 94 years of age, had been a resident at the Rope nursing facility for the past 12 years. Before being placed in Rope, Smith had been living with Mr. Curry, a close friend, for the previous 8 years. He had an advance directive indicating that he would never want to be placed on a respirator.

    Smith's son and only child, Barry, who now lives in Los Angeles and had been estranged from his dad for more than 20 years, was notified by Curry that his dad had been admitted to the hospital in a terminal condition. Smith had mistakenly been placed on a respirator by hospital staff contrary to the directions in his advance directive, which had been placed on the front cover of Smith's medical chart. Curry, who was legally appointed by Smith to act as his health care surrogate decision maker, called Barry and explained that, according to his dad's wishes and advance directives, he was planning to ask hospital staff to have the respirator removed. Barry asked Curry to wait until he flew in from California to see his dad. Curry agreed to wait for Barry's arrival the following day, July 5. After arriving at the hospital, Barry told Curry that he would take responsibility for his dad's care and that Curry's services would no longer be needed. Barry told hospital staff that he objected to the hospital's plan to remove his father from the respirator. He said that he needed time to say goodbye to his dad, which he did by whispering his sorrows in his dad's ears. Smith, however, did not respond. Barry demanded that the hospital do everything that it could to save his dad's life, saying, "I don't know if Dad heard me. We have to wait until he wakes up so that I can tell him how sorry I am for not having stayed in touch with him over the years." Smith's physicians explained to Barry that there was no chance Smith would ever awaken out of his coma. Barry threatened legal action if the hospital did not do everything it could to keep his dad alive. Smith's physician again spoke to Barry about the futility of maintaining his dad on a respirator. Barry remained uncooperative. The hospital chaplain was called to speak to Barry, but had little success. Finally, hospital staff requested an ethics consult.

  What should be done with this ethical dilemma?

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