Mr. Mattis is a 43-year-old man with a history of diabetes. He has struggled to consistently manage his condition, which has contributed to a significant decline in his health. Two weeks ago, he was admitted to the hospital after suffering a heart attack.

As a complication of his diabetes, Mr. Mattis has developed severe diabetic ulcers on his left foot and leg. The condition has progressed to the point that the medical team is recommending an above-the-knee amputation.

Mr. Mattis retains decision-making capacity and has repeatedly stated that he does not want his leg amputated. When asked to explain his decision, he does not provide a detailed rationale but remains consistent in his refusal. The medical team has explained that, without amputation, his condition will continue to deteriorate and will likely result in his death. In response, Mr. Mattis calmly states that he understands the consequences but still does not want the surgery.

The medical team conducts an extended family meeting with Mr. Mattis and his two sons. During the meeting, the team explains that amputation is medically indicated and is believed to be in Mr. Mattis’s best interest. Despite these discussions, Mr. Mattis continues to refuse consent for the procedure.

At the conclusion of the meeting, Mr. Mattis’s sons speak privately with the attending physician and consulting surgeon. They state that if their father’s condition deteriorates to the point that he loses medical decision-making capacity, they would consent to the amputation on his behalf.

The attending physician and surgeon request an ethics consultation regarding how the team should proceed if Mr. Mattis later loses decision-making capacity and the question of amputation arises again.