Advanced Occlusive Arterial Disease (Gangrene) in the Aged, and Decision‐Making for Amputation *

In aged patients with advanced occlusive arterial disease, organic brain syndrome, other serious disorders (especially diabetes), and spreading gangrene of a lower limb, the decision for amputation may be crucial for the patient's life. For the brain‐damaged patient, decision‐making is influenced by the sometimes conflicting attitudes of the patient's family, the attending physician, and the nursing‐home staff. Four illustrative cases are presented. The presence of gangrene posed overwhelming nursing problems. In the population of patients described, the decision for surgery was based less on objective medical criteria and more on the subjective attitudes of the physician and the families. The physician seemed to be influenced by the wishes of the family and by his attitude toward the aged in general. Serious consideration should be given to the correction of distorted ethical values in the treatment of the mentally ill aged.