Ethics in the Practice of Medicine

Mr. Pete seeks to amputate his leg even though there is nothing wrong with it. In order to look at the ethical issues from this case, the ethical principles must be considered. The first principle is the principle of beneficence. This principle requires that one is to act according to what is good. It also relates to the utility principle that requires ethical theories to try to achieve good at its highest level (Rainbow). This is because a person would gain from the greatest good. Amputating Mr. Pete’s leg and giving him a peg leg presents just the opposite of this. It is not beneficial to him; rather it would make it hard for him to walk.

The second principle is the Respect for Autonomy. This principle requires an ethical theory to let people make their own decisions and to rule what they want for their lives. A person is allowed to choose the lifestyle that he wants. In this case, the physician either chooses to convince a person into making a decision that would be more beneficial or just comply with the person’s wishes. Mr. Pete is determined to amputate his leg even though it presents more harm than benefit. My dilemma is whether to give him what he wants or not. The third principle is the principle of Least Harm. This deals with cases where no choice is beneficial.

Therefore, the choice that is least harmful to the people involved should be made. Mr. Pete states that no one can stop him from amputating the leg. Moreover, he states that he has considered other means but was scared and chose the safest. In this case, if I refuse to amputate Mr. Pete’s leg he could choose to amputate himself or choose some other means that are not safe. This could lead to injury or even death. Incase of death, it could lead to more damage to his family than having his leg amputated. In this case, the theories of ethics would determine whether the surgery is ethically right or wrong. There are two main ethical theories to be considered, the Utilitarianism ethics and Deontological ethics (Moreland).

The Utilitarianism theory suggests that an act is ruled morally right or wrong, by viewing the consequences of the action, for example, an action would be morally right if results to happiness. In the case of Mr. Pete, it would be morally correct to perform the amputation, because that is what makes him happy and satisfies his desires. On the other hand, the Deontological theory requires a person to follow their duty or obligation and from this decide what is morally correct. For example, it is the duty of a doctor to remove from harm rather than cause harm to a patient. In this case, by amputating the leg I would be causing more harm to Mr. Pete, which contradicts with my duty.

Another ethical perspective to consider is the principle of Autonomy, which requires that a person be allowed to make his or her own decisions. Refusing to carry out Mr. Pete desire would be breaking this principle. I would seek alternate opinions from other people such as Mr. Pete’s family. This would be in order to assess his decision and know whether it might be affected by other things or problems. I would ask the family his behavior and mental health for the past years. In this, I would know his mental stability on making a great decision. I would be able to know how the surgery would affect the family and his relationship to the family. I would ask a third opinion from a lawyer or law administrator.

The lawyer would advise me on the legal consequences of amputating a healthy leg. I would also ask the lawyer if there are any laws regarding this, if any, what they stipulate. This would help me make a decision that would not jeopardize my career or the practice. The next opinion would be from a physiatrist. A physiatrist is a doctor who deals with pain medicine, physical medicine and rehabilitation. They treat the patient entirely and not just the symptoms. I would ask them problems associated with the amputation of a leg, both physically and mentally, since they deal with such patients. In overall, the doctor would help me know, how the amputation would affect Mr. Pete’s mental and physical health. Lastly, I would consult Mr. Pete’s family doctor if he has one.

The doctor has been treating Mr. Pete’s for a few years and would be able to advise me on Mr. Pete’s decision and mental health. This would be according to how lately he behaves, and the years he has been treated by the doctor. Cosmetic surgery is surgery on the body to improve the appearance of an individual or their beauty. The main difference between this kind of imputation and cosmetic surgery is that amputation makes the person disabled, while cosmetic surgery only seeks to enhance the beauty. Cases of amputation of limbs would lead to the person not being able to perform well. Cosmetic surgery does not make a person disabled unless the surgery went wrong.

Apotemnophilia is desire or love for an amputation. It is also associated with BDD, Body Dysmorphic Disorder. People who have BDD are often obsessed about their physical defects, which others cannot see (Mental Health Canada). Amputation has been associated with BDD in cases where a person wanted to amputate their limbs, because they felt, it was not accordance to their bodies or it was ugly. Others who suffer from these disorders say they would feel complete without the particular limb, as this state is their identity. However, both cosmetic surgery and apotemnophilia seek to achieve what in their eyes is beauty or a sense of identity.

 

I would perform this surgery, if there are no other solutions for the treatment of this disorder and if the patient is of sound mind. One of the solutions that critics give for these desires to cut limbs is psychotherapy. However, according to study, most patients who undergo therapy to deal with this disorder report that they are left more frustrated as they cannot reach their desire through their desire and amputation has been denied. There also many cases where individuals who have been to convince a doctor to amputate their legs often amputate it themselves. Others go to the black market where the people performing the amputation have no regard for the law or ethics.

There have also been cases of people injuring their limb, mostly by immersing it in ice, hence damaging it. Consequently, the doctor is forced to carry out the procedure and finally amputates the particular area. In cases where the right procedure has not been carried out in amputating the leg, it ends up in injury or even death. Mr. Pete expresses that he has considered going to Mexico, but considered it might not be. He also says that he had thought about cutting the leg himself, but was too scared. In amputating his leg, I would be following the principles of ethics of Autonomy, Least Harm and the principle of Justice. The principle of autonomy gives an individual the right to make decisions regarding his body.

Mr. Pete expresses that he has had the desire to amputate his leg since he was a little boy, in order to get a peg leg. He finally makes the decision to have it amputated. He seems intelligent, and if he is also of a sound mind, there is no reason to deny him what he wants. At his age, he is also mature and has already cleared his parental duties of raising his children. People who desire amputations have been proved to be of good mind. “The obvious prejudice in this claim being the assumption that anyone wishing for an amputation automatically must be irrational. Psychological and psychiatric evaluations of these patients have proved that they are not only competent, but completely rational beings (J Med Ethics, 2).”

By amputating the leg, I would be meeting the principle of Least Harm. This principle requires that one perform an act that would be least harmful. If I refuse to amputate his leg, Mr. Pete might choose to amputate it himself or go to a specialty where he would not be given proper medical treatment. This could lead to further injury of his body, besides the amputated leg. Therefore, by amputating his leg under the proper medical conditions, I would be providing the least harmful option. Lastly, but not least I would be meeting the ethics principle of Justice. This principle requires that justice be provided. In following the principle of Autonomy, I would have met the principle of justice.

In respect to the Utilitarian theory of ethics, this would be a good approach. The theory requires action or treatment that would lead to another good, such as the satisfaction of a person’s desires. Mr. Pete desires to amputate his leg for a peg leg. A survey shows that most people report feeling satisfaction, happiness and completion after an amputation. “The six of First’s subjects who had received major limb amputations reported that following their respective procedures, they no longer had any desire for any amputation , and they felt better than they ever felt” (Partridge, 8).

 

 

 

 

 

 

Work Cited

“Body Dysmorphic Disorder” Mental Health Canada, Inc., 21 Nov 2007. Web. 5 June 2012.

J Med Ethics “Apotemnophilia: ethical considerations of amputating a healthy limb.” Journal of Medical Ethics. (2012). Web. 5 June 2012.

Moreland, J.P. “Ethics Theories: Utilitarianism Vs. Deontological Ethics”. CRI, 17 April 2009. Web. 5 June 2012.

Partridge, Chris. On the Moral Permissibility of Voluntary Amputation. Bowling Green State University (Bowling Green, OH). Web. 5 June 2012.

Rainbow, Catherine. Descriptions of Ethical Theories and Principles. Davidson College, 2002. Web. 5 June 2012

 

 

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