Problem of informed consent to amputation in a female patient with gangrene of lower limbs – ethical aspects
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Klinika Chorób Wewnętrznych, Samodzielny Publiczny Szpital Kliniczny nr 1 w Lublinie
Zakład Etyki i Filozofii Medycyny Uniwersytetu Medycznego w Lublinie
Med Og Nauk Zdr. 2012;18(3):189–192
Lower limb ischemia is a clinical syndrome with a complex etiology. Critical ischaemia usually leads to rest pain in the extremities, it may also lead to a necrosis and gangrene. In the case of multi-level, scattered atheromatous changes in the arteries of the lower extremities with co-existing gangrene, amputation is an effective and life-saving treatment. In this report, the case of 70-year-old patient is described with type 2 diabetes, atherosclerosis, and critical lower limb ischemia, who was admitted to hospital with septic shock and extensive gangrene involving the foot and lower leg. Based on the advice of the surgeon, the patient was qualified for the amputation of both lower limbs at the thigh. Due to the severe general condition, the patient was treated in an intensive care unit. After stabilization of cardiovascular function, amputation of the lower limbs was proposed. The patient did not express her consent to such treatment, therefore, conservative treatment was applied. At the explicit request of the patient, she was discharged home after several weeks of hospitalization with progressive gangrene of both extremities. The presented clinical case was not only a medical challenge, but also a source of ethical dilemmas. In particular, attention should be paid to the discussion of problems related to the issue of informed consent, patient autonomy, respect for the right to self-determination, and assessment of competence to decide about own fate. Obtaining an informed consent is both a principle of medical deontology as well as a basis of the legality of a physician›s action. In order to consider a consent as conscious, it must be expressed voluntarily by a competent patient who has obtained the necessary information about own medical situation. Key words: lower limb gangrene, amputation, informed consent, autonomy, ethics, bioethics, deontology

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