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Mr. Evans is 55 years old and has had diabetes for more than 20 years. He has not managed his diabetes well and has subsequently suffered many complications. Mr. Evans does not regularly test his blood glucose level, so he does not always get the appropriate amount of insulin. In addition, he does not eat properly. He picks up fast food during his lunch break and he binges on various snack foods before he eats his dinner, or sometimes instead of eating his dinner. Mr. Evans is now dealing with long-term complications of diabetes and is seeking health care because of a neglected leg ulcer. He tried to treat it at home with over-the-counter remedies, but it did not improve, and it is now infected. Part of his foot is gangrenous, and an amputation is recommended. The first time the surgery is mentioned, Mr. Evans becomes outraged and refuses to discuss it. He says he is “not going to leave this earth without all his parts.” After further discussions with Mr. Evans, it is clear that he understands the consequences of his condition. He is more annoyed by the drainage from the ulcer than worried about the progressive gangrene. 1. What do you think is the right course of action? 2. Does Mr. Evans really understand his current situation and the likely consequences? 3. Just because he disagrees with medical recommendations, does this mean that he is incompetent? 4. Does the level of risk if treatment is refused make any difference in the health professional’s response? 5. Do you think he should be treated without his permission? 6. Should his wishes be supported at all costs? 7. What if Mr. Evans’s refusal is based on religious or cultural beliefs? 8. What are the nurses responsibilities?
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