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Ricky is a 49-year-old man who has Down syndrome. He functions at about the cognitive level of a 5-year-old. His mother has cared for him his whole life. She is now 79 years old and can no longer take care of him due to her failing health, and so he has been admitted to your long-term care facility. Ricky's mother is the only family he has; there is no one else. Ricky has just been diagnosed with rectal cancer, and his mother has decided to not treat his cancer. It is at stage III, but the doctors told her that it could probably be cured with aggressive treatment. She is afraid that he will not understand why they are hurting him "down there" and feels that this is the best option for him, but she is often very sad about this choice. Today is a particularly hard day for both Ricky and his mom. He is having pain and the pain medication makes him very constipated, which then hurts him more because of the pressure on the tumor. When you walk into the room to help Ricky onto the toilet, his mother cries and confides in you that she.
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