Yong Loo Lin School of Medicine

Centre for Biomedical Ethics

Name (as registered): Tharun Ragupathi
Group No. : P
Matriculation No. : A0133576B
Session Topic: Help MEQ Practice Essay
(All answers are to be typed on this page-double sided is allowed if necessary)


The case here presents a dilemma in that amputation of both Vitthals legs may prevent his death (or at least
extend life), but Virtual flatly refuses surgery, stating that he has no wish to live without his legs. At first
glance, it might seem that the obvious course of action is to amputate Vitthals legs in order to preserve life.
However, it must be remembered that there are several other factors that must be considered the presence of
a substitute decision maker, Vitthals state of mind at the time of refusal and the conflict between the medical
ethics principles of autonomy and beneficence.

With Vitthals wife still alive and well, it seems easy to identify a substitute decision maker to decide whether to
go ahead with the amputation or not. Vitthals wife has also insists that all should be done to save her husband.
In the event that Vitthal has designated his wife as his substitute decision maker, it must be remembered that
she will likely seek out the attending physician for information to make a decision (even if she is already leaning
towards getting the amputation done). In the event this happens, the physician in question should provide all
necessary information to her and (to the best of his ability) not impose his/her own opinions on the person.
However, in this scenario, Vitthal has stated explicitly that he does not wish to live without his legs, and his wife
concedes that he did not wish to have the amputation as well. Thus it seems that listing Vitthal for surgery is an
inappropriate course of action, given that Vitthals refusal is already on the record.

Vitthal stated explicitly that he did not want his legs amputated as he has no wish to live without his legs. If
clinicians already know that an incapable patient (in this case, Vitthal in his unconscious state) would refuse
treatment if capable, then emergency treatment (amputation) should not be administered. Though Vitthals
refusal of amputation was stated only verbally without a signed and dated advance directive and his emotional
state at the time of refusal may not have been the most ideal, the fact that Vitthal has made his wishes known
must be respected. If capable, it is highly likely that Vitthal would refuse amputation, even if the risks of not
amputating were made known to him as it would not change his view that life without legs is not worth living.

The conflict between autonomy and beneficence arises as it is both important to recognize Vitthals right to self-
determination as well as to act in a way that would promote his well-being. In order to resolve this conflict (or at
least make the decision-making process a little easier) we can look at the long term effects of breaching Vitthals
autonomy. It is likely that this would diminish his confidence in the medical team and make him less likely to
seek help in the future in the event of complications, which would be going against the principle of beneficence.
Thus it appears that the best course of action would be to not list Vitthal for surgery.

I feel Vitthal should not be listed for surgery.