Ethical Dilemmas and Solutions in the Treatment of Foot Disease

Abstract

　When treating foot diseases, physicians are sometimes confronted by patients’ strong will to preserve their foot even if major amputation is considered inevitable. Physicians cannot force patients to be treated against their will even when it is inconsistent with medical relevance. What should medical staff do when they are caught in a dilemma between the patient’s autonomy and medical indication?
　This article discusses the ethical aspects of the treatment of foot diseases, applying the four principles of biomedical ethics to a hypothetical case of limb ischemia. In this case, as the patient wishes to preserve his foot for as long as possible, the principles of non-maleficence and beneficence conflict with the principle of autonomy. In order to find a practical solution enabling patient-centered decision making in this conflictive case, medical staff must repeatedly ask the patient about his values and reconsider their own values behind medical recommendation. In addition, macroscopic and long-term perspectives are necessary such as the accumulation of medical evidence for foot diseases and improvement of the medical service system.