Fran is a 68 year old female patient with a history of diabetes. Fran separated from her husband, Derek, 3 years ago (although they are not divorced) and over the past few years they have seen each other rarely. Fran now lives in the downstairs self-contained 'granny flat' of her daughter, June. Her son, Marcus, lives a 1 hour drive away. They talk on the telephone at least once a week and Marcus often visits his sister and Mum.
Although Fran has suffered from peripheral vascular disease over a number of years, she has continued to maintain an independent lifestyle and regularly goes out with friends and enjoys weekly games of bowls at her local club.
Fran was recently admitted to hospital with arterial ulcers and sepsis. Due to septic shock, she was intubated and sent to the intensive care unit. Nursing staff on her treating team have been the main point of contact for the family during their daily visits. Fran is currently unconscious and is not expected to regain consciousness until the sepsis resolves. The treating team advise Fran's family that due to the advanced stage of her condition, a decision needs to be made quickly about which treatment option should be chosen for Fran. The treating team advises that the options are:
1) Fran can have her leg amputated. This is seen to be the safest option as it minimises the risks of sepsis. However, in order to regain mobility and independence a significant period of recovery and rehabilitation would be necessary.
2) The treating team can attempt to revascularise her leg. This will potentially save the limb, but raises the risk of Fran's condition deteriorating if the sepsis does not resolve.
Marcus says that he wants what is best for his Mum and that means the safest option. He does not want his Mum to suffer any further complications and believes that the amputation should be carried out immediately. Being the eldest child, Marcus feels that he should be the one who makes decisions for his Mum. Fran's husband, Derek, also agrees with Marcus.
However, June believes that what has been most important to Fran in the past few years has been her ability to live independently, including her weekly social interaction at the bowls club. June says that although nothing was ever put into writing her Mum often said that, if necessary, she wanted June to make decisions for her so that she is not, 'stuck in bed like those poor people in a nursing home who have no life'. Therefore, June wants the treating team to try revascularising Fran's leg.
Analyse the relevant ethical and legal issues in relation to this scenario by applying the ethical decision-making framework provided in this unit.