Beneficence does not mean health professionals are obliged always to do what their patients want. It could be argued that removing a healthy limb wreaks havoc on an already overstretched NHS, in which waiting lists are growing, and social services that would have to support an unnecessary disability.
And where does this disability end? Elliott pointed out that while medical or surgical treatment may relieve the condition, it may only provide short-term relief, with the patient either refocusing concerns on the perceived defect or becoming preoccupied with a different aspect of their body. The NHS is a finite resource and there is a distinction between distributions of healthcare that are just and those that are unjust.
If surgery was justified, why did the NHS trust refuse to host similar operations after the second patient had surgery? When patients go against medical advice, it is often thought unwise but their wishes are respected. Mr Smith underwent several psychological evaluations, all of which deemed him to have capacity, so it could not be said that requesting the amputation meant he lacked capacity.
If a patient is well informed and has capacity, positive steps should be taken to try to facilitate making competent decisions. In terms of beneficence and non-maleficence, not removing the healthy limb could be considered as harmful as doing so. In some cases patients undertake mutilating surgical procedures as a last resort when all other interventions and requests have failed.
Mental illness is no less severe than a physical life-altering illness. Mr Jenkins has indicated that while he was concerned that, by amputating healthy limbs, he was harming his patients, ultimately, he was more concerned that they would kill or seriously injure themselves if surgery did not take place Elliott, Since Hippocratic times, doctors have been required to do what is best for their patients, but who decides what is best?
It could be that removing a healthy limb would worsen quality of life because the person will become disabled. The strongest argument yet in support of Mr Smith and Mr Jenkins is that of therapeutic benefit. Elliott argued in favour of healthy-limb amputation on the grounds that Mr Smith was suffering from a mental disorder that caused considerable distress. Providing certain safeguards are observed particularly in terms of ensuring the patient has capacity and informed consent is obtained , amputation is an acceptable way of treating these patients.
Mr Jenkins was faced with a decision fraught with ethical dilemmas. Biomedical ethics often affect nursing practice, and this article has presented some key arguments on both sides about healthy-limb amputation. However, many other perspectives could be considered; to continue this debate. Oxford: Oxford University Press. Basingstoke: Palgrave MacMillan. Having your leg amputated can be traumatic. And learning to live with new limits can be hard and frustrating. Many people feel depressed and may grieve for their former lifestyle.
It's important to understand these feelings. Talking with your family, friends, and health professionals about your frustrations is an important part of your recovery.
You may also find that it helps to talk with a person who has had an amputation. Remember that even though you've lost a limb, it doesn't change who you are or prevent you from enjoying life.
You'll have to adapt and learn new ways to do things. But you can still work and take part in sports and activities. And you can still learn, love, play, and live life to its fullest. Many organizations can help you adjust to your new life. For example, you can go to www. This care sheet gives you a general idea about how long it will take for you to recover.
But each person recovers at a different pace. Follow the steps below to get better as quickly as possible. Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take. Call anytime you think you may need emergency care. For example, call if:. Call your doctor or nurse call line now or seek immediate medical care if:.
Watch closely for any changes in your health, and be sure to contact your doctor or nurse call line if you have any problems. Author: Healthwise Staff. Care instructions adapted under license by your healthcare professional.
If you have questions about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Important Phone Numbers. Topic Contents Your Recovery How can you care for yourself at home?
When should you call for help? Where can you learn more? Top of the page. Your Recovery An above-the-knee amputation is surgery to remove your leg above the knee. How can you care for yourself at home? Be active. Talk to your doctor about what you can do. Sepsis can affect blood flow and cause tissue to die, especially in the toes, fingers, hands and feet. Severe sepsis can be deadly if antibiotic medicines cannot control the infection.
One cause of sepsis is meningococcal bacteria, which cause a serious form of meningitis — an inflammation of the coverings of the brain and spinal cord. Methicillin-resistant staphylococcus aureas MRSA , also a bacterium, can cause a severe condition called necrotizing soft tissue infection , or fasciitis.
This is not a procedure, but a term that refers to a missing or incompletely formed hand, foot, arm or leg that is present at birth. The surgical approach depends on the affected body part, the reason for the amputation and the extent of bone and tissue damage.
A finger amputation may be a small but intricate procedure working with skin, tendons and nerves to allow fine motor function and optimal use of the hand. The removal of an arm or leg can call for major surgery, requiring skill in handling and stabilizing all the different tissues of the body part including skin, blood vessels, muscles, nerves, tendons and bone.
To remove a finger, toe, foot, hand, arm or leg, the surgeon may cut through the bone or detach disarticulate a joint, separating bones where they meet such as in the knee or elbow. The amputation may take place in stages. A revision procedure may be necessary to address tissue breakdown, chronic pain, scarring or other health issues. Orthopaedic and orthopaedic oncologic surgeons work with a plastic and reconstructive surgeon, along with a range of nurses and surgical technologists, to perform a surgical amputation procedure.
Together, they remove the diseased or damaged body part, and then work with the remaining bone and soft tissue to shape the stump. The surgical team may form the soft tissue at the end of the limb to help accommodate a prosthetic, or leave bone in place for subsequent osseointegration OI.
If the rehabilitation care plan includes a prosthetic artificial device, the amputation should ensure that a prosthesis fits and functions properly. The surgeons remove the limb, and anchor muscles to the cut end of the bone and cover it with skin. Surgeons remove a body part and insert a steel implant into the stump of the leftover bone. A prosthetic can attach to that implanted piece. When used for a leg amputation, this procedure can enable the leg and hip bones to absorb weight bearing instead of the soft tissue left behind, so standing and walking feel more natural to the patient.
During rotationplasty , which might be a choice for some patients with a tumor in bone or soft tissue, surgeons remove the part of the limb where the cancer is, and any healthy tissue below the tumor is turned around and re-attached.
A rotationplasty can rotate the lower leg and re-connect it so that what was the ankle joint becomes a substitution for the knee. Successful rotationplasty can allow some patients to use a prosthetic lower leg, and enjoy mobility and even participation in activities and sports. The Johns Hopkins Hospital is one of the few places in the U. Working together, experts in orthopaedics, plastic surgery, prosthetics, rehabilitation, physical and occupational therapy, and mental health work with patients facing amputations of the thigh, leg or arm, including those with double both limbs amputations.
Whether or not you plan to use a prosthetic, the healing process and a customized rehabilitation plan can provide you with the best chance to resume your life activities. The post-amputation stump must be kept bandaged, clean and dry until the stitches sutures can be removed.
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