Learning Objective

1. Define the presentation and discuss prognosis of large intraparenchymal hemorrhage.
2. Discuss indications and contraindications for Dobhoff tubes as opposed to surgical nutrition (percutaneous endoscopic gastrostomy tube), as well as risks of medical enteral nutrition.
3. Verbalize the  differences in care and resources provided by palliative care and hospice care services.
4. Discuss the role for advance care planning conversations (including designated surrogate decision makers), appropriate timing and venue for these conversations, and appropriate paperwork to fill out.
5. Describe decision making approaches including paternalism, shared decision making, patient choice.
6. Articulate the ethical, legal, and local guiding principles behind a declaration of medical futility in the setting of medical  futility, and the effects this may have on the community.