Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case. And next week, we'll reveal how you all made the call. And stay tuned, bioethicist Jacob M. Appel, MD, JD, will weigh in next week with an ethical framework to help you learn and prepare.
The following case is from Appel's 2019 book, :
Margaret, a 40-year-old teacher, is a new patient of Dr. McCoy, a prominent orthopedic surgeon. At their initial appointment, when he asks how he can help her, Margaret replies, "I want you to amputate my left foot."
Further discussion and examination reveals that Margaret's foot is physically healthy and not a source of pain or disability. Margaret elaborates: "All my life, I've had this strange feeling that my left foot -- right here, below the ankle -- did not feel like it was part of my body. I have been to psychiatrists and neurologists, but nobody can explain it. To me, even though the foot functions just fine, it feels like having a foreign object attached to my leg."
"Then last year, I went online and discovered that there are other people out there like me who suffer from 'foreign limb syndrome' -- who have limbs or appendages that feel like they do not belong. We are sort of like patients who want sex-change operations, only far fewer medical professionals take us seriously."
"Can you please amputate my foot safely? I will be glad to undergo a complete psychiatric evaluation first to show you I am not mentally ill. Honestly, if no surgeon will help me, I would do it myself with a saw -- but I am afraid I might bleed to death."
See the results and what an ethics expert has to say.
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
And check out some of our past Ethics Consult cases: