Man with dementia who refused leg amputation left medics in ‘appalling dilemma’ – The Irish Times

The Supreme Court President said medical staff treating an elderly man with dementia who “would rather die” if his badly infected leg were amputated were faced with a “horrific dilemma”.

The comments were made by the President of the High Court, Mr Justice David Barniville, on Monday after he ruled that the hospital and medical staff treating the man do not have to amputate the man’s leg against his will.

The judge said the case was “problematic” due to a lack of clarity regarding the man’s ability to make decisions about his health.

For legal reasons, neither the man nor the facility can be identified.

The judge was content to issue a statement that the facility and professionals currently treating the man are providing the man with all necessary care and medical treatment.

The judge made his decision following a request from the HSE to find that it was lawful to give the man all necessary care but not to amputate the leg.

The HSE sought the order both because of the man’s serious health condition and because the man had clearly expressed his view that despite the risks involved, including the risk of death, he did not want his leg removed.

Evidence was presented to the court that due to his dementia, the court heard the man’s leg was in poor condition because he had not properly managed his diabetes.

After an operation on his limb, the man applied jam and hot drinks to his wounds, the court also heard.

The application concerns a man from the west of Ireland, in his seventies, who has been in a medical facility for some time.

Explaining the man’s serious condition to the Supreme Court, Donal McGuinness of the HSE said the man was suffering from delirium caused by his dementia.

The lawyer said the leg is infected and considered “unsalvageable” by doctors.

He said the man was also at risk of severe bleeding after a graft ruptured on his leg.

The attorney said the man “consistently and adamantly” refused to consent to the amputation, even when told he was at risk of bleeding to death.

However, the attorney said the man told his doctors when confronted with his condition, “If I die, I die.”

He said, “You might as well throw me in the sea,” and described amputating his leg as “a freakin’ crazy idea” because “you need two legs to walk.”

Despite the man’s objections, the attorney said the man’s family supported having the amputation performed, and the court heard they were not ready to remove him from the hospital at the moment because of the risk involved.

The specialist surgeon responsible for the man’s care described the situation as “very difficult” and added that it was a “no win situation”.

The doctor said amputation was clearly indicated, but the patient was very clear that he would rather die.

He said medical staff are trying to respect the man and his decisions, including his decision that life without his leg had no value.

The court was told that the man was not in pain and had expressed the view that he might change his mind about the proposed amputation should that situation change.

The court heard that if his leg were removed, he would not be able to walk given his general health.

It is also unlikely that he will be able to return to his homeland.

The matter will be heard again in court next month. Man with dementia who refused leg amputation left medics in ‘appalling dilemma’ – The Irish Times

Dais Johnston

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