Judge permits doctors to amputate leg of man facing life-threatening infection

High Court Reporters

A High Court judge has permitted doctors to amputate the leg of a man at risk of life-threatening consequences if the limb is not removed.

Mr Justice Barry O’Donnell on Friday made the order in circumstances where the man, who is in his 60s, lacks capacity to make decisions related to the treatment of his leg.

The tissue in his lower left limb is necrotic, or dead, and is the primary cause of his suffering with delirium, the court heard. His lack of capacity mainly arises from this delirium, which is causing him to have delusional and disordered thoughts.

The infection is a result of complications arising from attempts to remedy a blockage in a graft, inserted in the man’s left leg during an earlier femoral bypass. A fermoral bypass is a procedure used to reroute blood through a graft around a blocked blood vessel.

Solicitor Natasha McKenna, appearing for the hospital where the man is being treated, said the man’s views on the amputation have fluctuated.

However, according to a consultant psychiatrist who assessed him, the man is unable to understand clinical information conveyed to him, or to weigh that information. The psychiatrist told the court that attempts to treat his delirium have been unsuccessful.

A consultant vascular surgeon, familiar with the man’s care, told the judge it was a matter of time before the man developed a life-threatening infection if an amputation was not carried out.

The surgeon said a below-knee amputation may suffice, but it was not possible to say until the point of surgery. It was possible that an above-knee amputation would be necessary, he said.

The surgeon added that the prospect of rehabilitation in his lower limb was non-existent.

Solicitor Niall McGrath, the man’s court-appointed advocate, said the man’s family was supportive of the surgery taking place.

Mr Justice O’Donnell said he was satisfied, on the evidence before the court, that the man is lacking capacity to make decisions related to his treatment.

The judge said he believed the court’s intervention was required in order to protect the man’s constitutional rights, including his right to life, and right to bodily integrity. He granted the orders sought by the hospital.

The judge said the case presented a “stark choice” between granting permission for the amputation and allowing the man to live out his life with an amputated limb, or not permitting the operation, in which case the man’s delirium will likely increase, and he will likely suffer a life-threatening infection and the ongoing pain of a necrotic limb.

The judge said his orders were predicated on the man’s continued lack of capacity up to the operation, due to happen on Tuesday.

He adjourned the case to next week.