Mrs. G is an 85-year-old resident of a Jewish long-term care facility who has vascular dementia, controlled heart failure, and diabetes mellitus. She is bed bound and occasionally recognizes her daughter with a slight smile. The gastrostomy feeding tube she received two years ago has begun leaking and needs to be replaced. Her daughter, who has become her surrogate since the recent death of Mrs. G's husband, has indicated that if the tube were to come out, she would not consent to the insertion of a new tube: a decision she feels would be in accord with her mother's wishes. She would not, however, request that the tube be deliberately removed. The staff are concerned that, by not replacing the tube, they would be failing to maintain the current level of treatment, and she would starve. They feel that this would amount to taking the mother's life, without any substantial decline in her clinical condition. The daughter acknowledges the concern and devotion of the staff and her mother's unchanged clinical status, but reiterates her belief that her mother would prefer to be allowed to die rather than be force fed through a gastrostomy tube.