Man with dementia who refused leg amputation left medics with ‘appalling dilemma’

The President of the High Court has said that medical staff treating an elderly man with dementia who would “rather die” that have his severely infected leg amputated have been placed in an “appalling dilemma”.

The remarks were made by High Court President 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 wishes.

The judge said that the case was “problematic” due to the lack of clarity regarding the man’s capacity to make any decision about his health.

Neither the man nor the facility involved can be identified for legal reasons.

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The judge was satisfied to grant a declaration that the facility and the professionals currently treating the man provide all necessary care and medical treatment to the man.

The judge made his decision following an application by the HSE for a declaration that giving the man all necessary care, but not to amputate the leg, was lawful.

The HSE sought the order arising out both the man’s serious health condition, and over the fact 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 given to the court that arising out of his dementia the court heard that the man leg was in a poor condition due to his failure to properly manage his diabetes.

After undergoing surgery on his limb, the man had put marmalade and hot drinks on his wounds, the court also heard.

The application concerns a man from the West of Ireland who is aged his seventies and has been in a medical facility for some time.

Outlining the man’s serious condition to the High Court, Donal McGuinness for the HSE said the man suffers from delirium caused by his dementia.

Counsel said that the leg is infected and considered “unsalvageable” by doctors.

He said the man was also at risk of a severe bleed after a graft on his leg broke down.

Counsel said the man had “consistently and persistently” refused to consent to the amputation, even when he was told he was at risk of bleeding to death.

However, Counsel said that when presented with his condition the man has told his doctors that “if I die, I die.”

He said, “you may as well throw me in the sea” and described having his leg amputated as “an effing crazy idea” because “you need two legs to walk”.

Despite man’s objections Counsel said the man’s family were in favour of having the amputation done and the court heard they were unwilling to take him out of hospital at the moment because of the risk involved.

The consultant surgeon in charge of the man’s care described the situation as “very difficult” adding that it was a “no win situation”.

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

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

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

The court heard that if his leg was removed, he would not be able to walk again given his overall health.

He would also be unlikely to be able to return to his home.

The matter will be back in court next month.