Answer:
A 27 year-old female is admitted with severe lower leg compartment syndrome. A fasciotomy will not be effective, and she needs a below-knee amputation. After explaining this to her, she refuses. Shocked and confused by this refusal, you ask if she understands the consequences. She recapitulates the consequences accurately, namely death, and refuses once more. You ask why, and she indicates that she simply does not want her legs cut off. You know that with advances in prosthetics and surgical amputation she will return to “baseline” or very close to it. Most people working in healthcare will grant that this is a moral dilemma in which two values, benefiting the patient and respecting her autonomy, conflict. It appears as if no matter what you do as a clinician, you will be violating at least one of these values.
