Mr. Rand is a 78-year-old gentleman who was admitted to the hospital after being found unresponsive in his room at his long-term care facility. He has a long history of cardiac and respiratory issues, which he has been managing well, but recently his condition has worsened. Although he lives in a care facility, Mr. Rand has been able to maintain a high level of independence and takes great pride in it.

Upon admission, it was determined that Mr. Rand had experienced respiratory failure and would require prolonged mechanical ventilation. During his hospitalization, it was also discovered that his renal function had deteriorated, necessitating the start of dialysis. Unfortunately, the long-term care facility where Mr. Rand has resided for the past few years informed the hospital that they are unable to care for him in his current condition, given his need for dialysis and continued ventilator support.

The hospital has reached out to multiple facilities across the country, but none have been able or willing to accept him. Because he is ventilator-dependent, Mr. Rand needs to remain in the ICU. However, aside from his need for mechanical ventilation and dialysis, there is no other medical reason to keep him in the hospital at this time.

Mr. Rand expresses a strong desire to return to his long-term care facility, which he considers his home. However, he also recognizes the reality of his medical situation and is open to exploring other options as long as they support his goal of recovery. He hopes to stay close to home but is also focused on his long-term health and recovery. He has now been hospitalized for over two months, and there is no clear timeline for his discharge.

Given these circumstances, the medical team has sought guidance from the ethics committee to determine if continuing Mr. Rand’s hospitalization is appropriate or if it has become futile.