Forcible Amputation in Delusional Patients
Each of two women had been advised by her physicians to have a gangrenous foot amputated to prevent the potentially fatal spread of infection. In both cases, the determination of the patients’ decisional capacity was a critical component in judging whether or not to honor their medical treatment decisions. In both situations, a person confronts a choice between two undesirable courses of action. The patients in these cases had no medically appropriate choice that also respected other valued outcomes, such as independence, a sense of dignity or control over one’s destiny.
- Under what circumstances might a decision to amputate over the patient’s objections be appropriate?
- Under what circumstances can a delusional or cognitively impaired patient give informed consent for medical treatment?
- Suppose the patient was not delusional but nonetheless believed that merely washing the wound with soap and water would make it better. Would it then be ethical to perform the amputation against her will?What role does rationality play in determining competence and giving informed consent?
- How can a patient’s wishes be acknowledged in a plan for treatment, even if she or he is deemed to lack decisional capacity?
Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)
