I've been on the palliative care service these last two weeks. Some interesting and challenging issues came up. I don't have time to flesh them out into individual posts. I would love some feedback from the GeriPal commmunity. I was consulted about a 62 year old woman with an unusual form of memory disorder: she couldn't form new memories (all cases completely altered to protect patient identity). She was stuck in a past that existed 8 years ago. She had end stage renal disease and was on dialysis. She knew that she needed dialysis to survive, because that was also true 8 years ago, and would agree to start each dialysis session. Shortly after starting a dialysis run, however, she'd stand up, forgetting why she was there, and try to go for a walk. The frequent need to re-orient her proved too much for the dialysis providers. They refused to continue dialysis. This case raised a number of issues. First, if she understands the risks and benefits of dialysis, b