Question

CASE STUDY: Mrs. Kathy is a 68 years old patient with a long history of Type 2 Diabetes Mellitus who is admitted to the medical female unit with infected diabetic foot and progressive gangrenous tissue. After initiation assessment, her medical and surgical team have decided that it is time to amputate before septicemia develops and discussed this with the patient that if this condition left untreated may lead to critical complication and death. The treating team have tried to obtain an informed consent from the patient but she refused to sign and said” I don’t want to go for this surgery and I want to die as a whole person without any missing piece of my body”. The Surgeon got upset by the patient and called her son to come. When the son came over, he discussed the case with the surgeon the surgeon told him to sign the consent on behalf of his mother because she is irrational. The son talked with his mother trying to convince her to sign the consent for but she told him” It is my body son, I just don’t want this surgery of amputation and cannot imagine myself becoming dependent”, but her son in fear of his mother’s life agrees with the doctor and signs the consent.                                                                   

1. What do you think of her mental capacity? How did you reach to this conclusion? ( include measures you used to reach to your conclusion)     

The patient mental capacity. How did you reach to this conclusion? (Include measures you used to reach to your conclusion)   

Measure 1:

- What is the measure?

- Application to the case and your answer?

Measure 2:

- What is the measure?

- Application to the case and your answer?

Measure 3:

- What is the measure?

- Application to the case and your answer?

Measure 4:

- What is the measure?

- Application to the case and your answer?

  

Answer 1

In this case Mrs kathys mental capacity is good. She rejects amputation due to his fear of not able to do his activities alone, not able to go for work. She has not given advance directive nominating another person to take decision. But considering the ethical principle of non maleficence or do no harm , considering the best for the patient, her son was contacted to take a decision for her. The substitute decision maker on fear of complications, given informed consent for amputation. It prevents further complications sepsis and death. The ethical principle of beneficence also supports this action and so the patients informed consent was not taken.

Second measure was that a multidisciplinary approach is needed in this. After few months of amputation prosthetic implantation can be done and with the help of physiotherapy and social workers the patient can regain her normal activities. Through counselling the depression face also can overcome. This outweighs the riskfactors of not doing amputation.