Table 1 Compact Deliberation Framework applied to Mrs. W

What is known about the patient’s aims and preferences?

• Urge to walk and to move freely

• Desire to lead her own former life, NOT to live in a nursing home

• Wish to die (she says daily “I hope I will not wake up tomorrow”)

• Quality of life and well-being more important than extending life; therefore important to keep her as comfortable as possible

Mrs. W. and Mrs. W.’s daughter in the function of proxy decision maker

Will the (surgical) intervention be effective?

• Operating hip fracture in a patient with dementia has a bad prognosis [8, 9]

• Little chance of operating the sub prothetic fracture successfully so Mrs. W. can walk again

• Great chance of complications (blood loss, delirium, incontinence a.o.)

• Rehabilitation will be complex because of her dementia [10]

Physician

Will the intervention support the aims and preferences of the patient?

• Little chance she will be able to walk independently

• Surgical treatment will not make any difference concerning her having to live in a nursing home

• Probably surgical treatment will increase suffering

Mrs. W.’s daughter in the function of proxy decision maker

In view of the aims and preferences, will the risks and benefits be in balance?

• In close contact with her proxy decision maker it was decided that the risks and benefits are not in balance since Mrs. W.’s most important wish to return to her former life as non-demented person, is impossible to achieve

• There is a much more effective treatment to relieve suffering, namely palliative care.

Physician together with Mrs. W.’s daughter in the function of proxy decision maker