Jeffrey Segal, MD, JD

Patients often make requests for procedures that run counter to the doctor’s better judgment. Acceding to a patient’s wish, even after informing of dire consequences, can create a cascade of legal headaches for the accommodating doctor.

An extreme example is illustrated by a rare condition known as body integrity identity disorder (a subset categorized by the esoteric label – apotemnophilia- great trivia question). Here, the patient suffers from the desire / compulsion to have his limb amputated; the premise being that he would be happier living life as an amputee. Many such individuals seek surgical treatment; and most surgeons balk at participating. A rare cohort will bend if the patient has failed all other types of treatment, such as psychotherapy or medication. Not surprisingly, just informing the patient there are significant risks of amputation, such as bleeding, infection, phantom limb pain, and death will not immunize the doctor if such risks materialize.

“Just doing what the patient wants” made headlines recently. Here, a woman with six children allegedly had eight embryos implanted by a fertility clinic.

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