PL EN
REVIEW PAPER
Problem of informed consent to amputation in a female patient with gangrene of lower limbs – ethical aspects
 
More details
Hide details
1
Klinika Chorób Wewnętrznych, Samodzielny Publiczny Szpital Kliniczny nr 1 w Lublinie
2
Zakład Etyki i Filozofii Medycyny Uniwersytetu Medycznego w Lublinie
 
Med Og Nauk Zdr. 2012;18(3):189–192
 
KEYWORDS
ABSTRACT
Introduction:
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

 
REFERENCES (14)
1.
Appelbaum P. Assesment of patients› competence to consent to treatment. N Eng J Med. 2007; 357(18): 1834-1840.
 
2.
Atras A, Marczewski K. Znaczenie świadomej zgody pacjenta na działania medyczne. Zdr Publ. 2004; 114(3): 350-355.
 
3.
Beauchamp T, Childress J. Zasady etyki medycznej. Warszawa, Wydawnictwo Książka i Wiedza; 1996: 131-200.
 
4.
Etchells E, Sharpe G, Walsh P, Williams J, Singer P. Bioethics for clinicians: 1. Consent. Can Med Assoc J. 1996; 155(2): 177-180.
 
5.
Kodeks Etyki Lekarskiej z dnia 2 stycznia 2004 (tekst jednolity; zawierający zmiany uchwalone w Toruniu 20 września 2003 przez Nadzwyczajny VII Krajowy Zjazd Lekarzy). http://www.nil.org.pl/__data/a... pdf_file/0003/4764/Kodeks-Etyki-Lekarskiej.pdf (dostęp: 30.03.2010).
 
6.
Ustawa o zawodach lekarza i lekarza dentysty (tekst jednolity). Dziennik Ustaw 2008, nr 136, poz. 857.
 
7.
Ross N. Improving surgical consent. Lancet 2004; 364(9436): 812-813.
 
8.
Etchells E, Sharpe G, Elliott C, Singer P. Bioethics for clinicians: 3. Capacity. Can Med Assoc. 1996; 155(6): 657-661.
 
9.
Patryn R, Sak J, Kiciński P, Kołodziejczyk B. Etyczne i medyczne aspekty stosowania preparatów krwi u Świadków Jehowy. Zdr Publ. 2007; 117(4): 485-489.
 
10.
Dunn L, Nowrangi M, Palmer B, Jeste D, Saks E. Assesing decisional capacity for clinical research or treatment: a review of instruments. Am J Psychiatry. 2006; 163: 1323-1334.
 
11.
Etchells E, Darzins P, Silberfield M, Singer P, McKenny J, Naglie G, i wsp. Assesment of patient capacity to consent to treatment. J Gen Intern Med. 1999; 14: 27-34.
 
12.
Fassai S, Bianchi Y, Stiefel F, Weber G. Assesment of the capcity to consent to treatment in patients admitted to acute medical wards. BMC Med Ethics. 2009; 10(15) http://biomedcentral.com/1472-... (dostęp: 30.03.2010).
 
13.
Czarkowski M. Jak zakładać szpitalne komisje etyczne. Pol Merk Lek. 2010; 165: 207-210.
 
14.
Komitet Doradczy Etyki Klinicznej Instytutu Pomnika – Centrum Zdrowia Dziecka w Warszawie. http://www.czd.pl/index.php?op... content&view=article&id=605&Itemid=389 (dostęp: 10.11.2011).
 
eISSN:2084-4905
ISSN:2083-4543