Maria’s baby

Maria is a 76-year-old woman of Italian descent. She is the mother of four children, three daughters, and a son. She has moderate to severe dementia of Alzheimer's type but is otherwise healthy. Maria's youngest daughter is her caretaker in the daughter's home. Maria is fully ambulatory and with few exceptions toilets herself. When she is not agitated, she has been manageable in the daughter's home with close supervision. The daughter fears that further deterioration will make it difficult to keep her mother at home. Recently, Maria started to become agitated especially in the evening around dinner time and when asked to take medications. Two weeks ago, Maria was admitted to the inpatient geriatric behavioral health unit for uncontrolled agitation. On admission, Maria fussed about medications, argued with the nurses, and intimidated other patients. Now, her behavior is considerably improved. She is friendly and cooperative with treatment. In addition to adjusting her medications, the nursing staff offered her a realistic baby doll to hold. Holding the doll consistently calms her and has even allowed her to interact pleasantly with other patients. Over the 2 weeks on the unit, she became infatuated with the doll and refused to put it down unless someone agreed to watch it while she was away, acting as if it were her own child. The nurses believe that her improved behavior is related to the doll and encourage her to continue caring for it as a baby. They even play along and ask questions about her baby. Maria's daughter acknowledges her improved mood. However, she believes that it is undignified for her mother to be seen acting on the delusion that this doll is her baby. In addition, the daughter points out that her mother often asks for help caring for the baby. These requests have not been a problem on the unit - some patients even enjoy assisting with the doll's care. However, the daughter fears that this level of attention to the doll's faux-care will be unsustainable in her household. The daughter has her two school-age children to attend to in addition to Maria's care. The daughter is Maria's guardian and durable power of attorney. She has asked that the staff take the baby doll away: 1. Should the staff comply with the daughter's request? 2. Is Maria's giving care to a doll as though it were her baby undignified?