Based on the scenario, work out a reasonable solution by applying the IDEA decision-making framework template.

Mdm Tan is a 74-year-old widow who lives by herself in a three-room HDB flat. She has five grown-up children living with their own families. She was mobile and ADL independent. She cleaned her house and cooked her own meals. She had a history of type 2 diabetes and hypertension and was on follow-up with her family physician for medications.

Five days ago, the toes on her right foot started to turn black and she developed a 5 cm wound at her right sole. She was not sure how she sustained this wound. There was minimal pain. Her son brought her to see a doctor and she was advised to be admitted for further management. On the third day of her hospitalisation, the doctor recommended below knee amputation (BKA) for Mdm Tan as the right leg cellulitis was spreading upwards despite IV antibiotics.

Mdm Tan was fearful that she may never be independent after the surgery and refused the surgery. Her children were supportive of the decision to amputate and are happy to take care of her after her surgery.

Ethics Worksheet – IDEA Ethical Decision-making Framework Adapted from Trillium Health Partners Regional Ethics Program (2013)
Step 1: Identify the Facts.

What are the relevant clinical/individual indications? (e.g. from medical/nursing, psychological aspects and individual preferences)
What are the contextual features?(e.g. family, religious or cultural factors)

What are the relevant legal stands?

What is the ethical issue?

Step 2: Determine the Relevant Ethical Principles.

Stakeholders

Principles/Criteria stakeholders believe are relevant to the issue Have stakeholders’ perspectives been sought/considered?
Patient

Significant Others
Medical
Nursing
(professional code)

Step 3: Explore the Options.

Option 1:

Option 2:Option 3:
Consistent with laws
Consistent with professional code Consistent with laws
Consistent with professional code Consistent with laws
Consistent with professional code
Benefits/Strengths:

Benefits/Strengths: Benefits/Strengths:

Harms/Limitations:
Harms/Limitations: Harms/Limitations:
What is the most ethically justifiable option?

Step 4: Act.

Documentation/Communication of Decision (Decision made & decision-making process: who, what, where, how):

Implementation Plan (e.g. referral for follow-up, support for patient/caregivers):

Evaluation Plan (how to evaluate the effect, the decision-making process; the outcome of implementation, etc.):

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