Mr. Andrews (age 75) taught poetry in the Cook County school district.

He is recently widowed, his wife having passed away a year ago after a lengthy illness; she had breast cancer for the last five years of her life, and Mr. Andrews was her primary caregiver.

His wife was eventually unable to remain comfortable even with higher dosages of morphine.

After she refused further hydration or nutrition, she lapsed into a coma and passed away.

Mr. Andrews is suffering from Alzheimer's disease, incontinence, and mild hypertension.

He is currently in a skilled nursing facility that specializes in care for memory loss.

He requires assistance with activities of daily living (ADLs).

He is now considered one of most difficult on the dementia unit, but is still physically strong.

Mr. Andrews' immediate family is comprised of a sister and a son.

The sister is involved in his life and visits frequently; she has a good relationship with the staff.

Mr. Andrews recognizes his sister, who is able to calm him down but not always there.

His son lives across the country and has not been part of his father's life for years; the two have not spoken since his mother's funeral.

The son has, however, talked by phone with his aunt regarding his father's condition, every other month.

On hearing about his father's current condition, he has taken a new interest; he calls home several times a week, sends books, and asks the recreational therapist to spend time reading poetry with his father.

The son has visited several times and taken his father out, but he has never seen his father's aggressive outbursts.

Before being in the nursing home, Mr. Andrews had drawn up a will with advanced directives.

Living wills (advanced directives) and durable power of attorney (DPOA) are required prior to admission to a SNF or ALF facility.

Health Care DPOA is often referred to as health care proxy.

Mr. Andrews' living will stated that he did not want any invasive treatment; he did not want to suffer like his wife.

Mr. Andrew's had authorized his son as DPOA for finance and his sister as his DPOA for health care.

His sister went to Mr. Andrews' primary care provider for antipsychotics; the facility originally refused.

Mr. Andrew's son was furious; he ordered the nursing supervisor to stop antipsychotics and read more poetry. He stated that if they continued to medicate his father, he would move him to another facility.

What are the legal issues here? Who is empowered to make decisions regarding the use of medications? Why does the nursing supervisor think that medications to control agitation are wrong? Does the staff have any rights here? Should part of this job include being physically abused? What are the rules regarding occupational risks in this setting? What do you think would be best for Mr. Andrews, and why?