If there is more than one SDM what should you do if they disagree

Develop 3-4 pages Memorandum to evaluate the managerial issue into the case and to answer to ALL the questions. Make sure to provide credible evidence supporting your recommendations and conclusions. Do not copy the case in the memo. Case scenario and question attached in pdf.

Mrs. Beaudoin, who is 97 years old, was admitted to your LTC facility 6 years ago.
Shortly after becoming a resident, she suffered a cardiac arrest and was found to be
unresponsive by the staff; CPR was initiated for a total of 20 minutes prior to return of
spontaneous circulation. She has an advanced directive stating that she agrees to “transfer
to an acute care facility”, but other options, such as CPR and intubation, were not
explicitly addressed in this document. She has no formal Power of Attorney.
Initially, Mrs. Beaudoin had lived at your facility watching TV for most of the day. She
was wheelchair bound and required assistance with most activities of daily living
(ADLs). Her husband lives at your facility with her and is quite frail with moderate
dementia. Mrs. Beaudoin is frequently visited by her large extended family, which
comprises 4 children and 5 grandchildren. She is known to have cancer throughout much
of her body, moderate dementia, a very bad heart, and type-2 diabetes.
After her cardiac arrest and a short stay in the Hospital ICU, Mrs. Beaudoin is brought
back to your facility able to breathe on her own, but with a moderate to severe brain
injury caused by lack of oxygen after her cardiac arrest; this has left her unable to
communicate in any meaningful way with others. She is receiving thickened fluids as her
source of nutrition and hydration, but is only able to
consume about half of the calories that would be needed to keep her at her current
weight. Unfortunately her health begins to decline further shortly after returning.
The team decides to hold a family conference with the resident’s children and proposes a
plan of treatment that would focus on comfort care only, excluding CPR if needed again.
The patient’s eldest daughter does not agree and states that her mother is “a fighter” and
wanted to live to be 100 years old so that she could be spotlighted on The Today Show
(the mother fondly remembers Willard Scott). The daughter asks that her mother be
transferred back to the acute care hospital to receive the care of “experts” and so that she
could be seen by a surgeon for surgery and chemotherapy for her cancer.
The treating physician discusses the case over the telephone with the on-call oncologist at
the hospital. The oncologist agrees that the prognosis is extremely poor and likely the
resident would not benefit from further invasive treatment. The hospital oncologist holds
a conference call with the family and team at the LTC home. She identifies himself as an
expert in the field. The older daughter reiterates her requests to the oncologist.
o What are some of the ethical issues in this case?
o Who is the appropriate substitute decision-maker (SDM) in this case?
o If there is more than one SDM, what should you do if they disagree?
o Because we know Mrs. Beaudoin’s desire to live to be 100, must we ensure
that “everything is done” in an attempt to prolong her life?