While conscious but not knowing her life was at risk, the patient was against amputation. Lawyer Lyn Boxall presents a case of doctors acting in the best interest of the patient when only an amputation could save her life.
Mdm LP, a diabetic, consulted Dr Tan at the Gleneagles Medical Centre in October 2005 complaining about pain in both feet1. She said she had been told by doctors at Singapore General Hospital and at Tan Tock Seng hospital that her right leg had to be amputated. She also had problems with her left foot. Dr Tan said she refused to consent to the amputation operation and wanted her legs saved at all costs. Mdm LP’s condition worsened over the next few days, but while she continued to be conscious and alert she again told Dr Tan to ‘save her legs at all costs’.
Several days later, Mdm LP was found to be in a septic shock and was ‘not rousable’. Dr Tan’s view was that her comatose state was caused by the septic shock arising from the infection in her legs. Before going into the coma, Mdm LP had not been told that she would die if her legs were not amputated – she went into a coma before any such discussion could take place.
After further operations to remove infected parts of her legs, Dr Tan concluded that amputation was the only option to improve the chances of Mdm LP’s condition. The position was further complicated by the risk that Mdm LP would not survive the amputation surgery.
In Singapore, a person who is sufficiently matured is entitled to give or withhold consent to any medical treatment and the doctors are entitled, if not obliged, to respect that person’s decision. No one else, however close by reason of kinship or friendship, is legally entitled to make that decision for the patient. Where a patient is incapable of giving or withholding consent, a third party may apply to the court to be appointed as the patient’s guardian to make decisions about medical treatment.
However, in the case of Mdm LP her only involved family member was a 16-year-old son and, in any event, the situation had become too critical from a medical perspective for there to be time for a guardian to be appointed.
The hospital applied to the court for a declaration that amputation of both of Mdm LP’s legs below the knee would be lawful – a tricky situation because Mdm LP had very clearly refused consent to the surgery, but without knowing that she would die without it. Meanwhile, the view of the doctors was that they would be acting in the best interests of their patient if they were to go ahead with the surgery in those circumstances. In other words, as the court said ‘it would not be unreasonable … for the doctors to regard the proposed amputation, which was the only hope of saving the patient’s life, to be in Mdm LP’s best interests’. Therefore, the doctors were able to proceed with the amputations.
Those who read this also read:
http://www.patientsengage.com/news-and-views/turning-life-support
http://www.patientsengage.com/news-and-views/last-days
1 The facts given here are taken directly from the judgment of the High Court in Singapore in Re LP (adult patient: medical treatment) [2006] 2 SLR(R) 13; [2006] SGHC 13.
