You are the new director of risk management at Little Falls Hospital, which is a 450-bed tertiary care facility in a major urban area in the Northeast. The hospital is an integrated health system that provides the full array of inpatient and outpatient services. The hospital enjoys a reputation for quality care in the area.

As the new risk manager, you have been briefed about a patient care case that needs your attention.

• The patient is a 45-year-old woman, Lydia, who is currently paralyzed and can only communicate through head nods as a result of a car accident over six months ago.
• The patient is currently on a ventilator for respiratory assistance and receives tube feedings.
• The professionals in the hospital are uncertain as to whether the patient is capable of understanding information and making her own decisions.
• It is reported that the patient has an advance directive, but no one has been able to secure a copy of the document.