What is under discussion now | Is it ethical to amputate without informed consent?

Healthcare professionals are frequently confronted with ethically challenging situations during the course of caring for the sick especially during emergencies. Such situations present as ethical/moral dilemmas.

A 49 year old lady sustained a very severe injury to her left lower limb in a motorcycle accident was taken to a regional referral hospital in critical condition. She had already lost a lot of blood and was in shock. The bleeding was contained and she was resuscitated. When her condition stabilized further assessment of her injuries was done. Her left leg and foot were mangled with irreparable damage to the major arteries and nerves. The orthopedic surgeon on duty decided that the only lifesaving option for her was a below knee amputation of the left lower limb. The decision made was based on the severity of the injury and the anticipated complication of fulminate infection (gas gangrene). Socially, she was the second of three wives in a polygamous marriage and a mother of six.

She was counseled and given all the necessary information about the severity of her injuries, treatment options, anticipated complications, and the decision to amputate her left leg below the level of the knee. She seemed to understand everything and was agreeable with the decision however she insisted that her husband had the last say. So, she would not consent to the amputation before getting her husband’s permission. The husband was invited by the bed side and was given all the necessary information. He vehemently objected to the amputation and told the emergency team that he could not go home with “half a wife”. He even threatened to abandon her in hospital should the surgery be done.
The healthcare professionals tried to convince the family in vain. The patient was requested to sign some documents indicating that she had refused to consent to the amputation but she refused. It was decided that she be referred to a tertiary hospital but she declined citing financial limitations. Meanwhile she already had lost a lot of blood and her condition was deteriorating. The case was reported to the hospital Medical Director who gave the surgeon a go-ahead to do what was best for the patient and this was documented in the patient’s medical case file. She eventually underwent a below knee amputation of her left lower limb and was discharged 4 days later. No follow-up on her was done.

1. Identify the facts in the case
2. Discuss the ethical issues posed by this case
3. Discuss the legal issues posed by this case
4. What should have been done differently?