Castration Ethics

In 2007, a 60-year-old Kentucky truck driver named Phillip Seaton went into surgery thinking he would be circumcised as a remedy for his infected foreskin. When he woke up from anesthesia, he discovered his penis had been amputated. Needless to say, he was totally pissed (... and let the puns begin!).

Lately, I've been paying particular attention to news stories regarding patient-physician disagreement. As a medical student, I'm learning how to think like a doctor. That said, I still have a billion years of school, residency, and fellowship ahead of me. I don't think like a doctor yet. To a large extent, I'm still able to think like a patient. In some ways, patient-physician conflict mirrors my own cognitive dissonance.

My first thought upon reading about this story was utmost sympathy for Seaton. I cannot begin to imagine how he felt when he discovered he was missing such an essential part of his body. My male friends assure me that waking up penisless "would seriously be the worst thing ever." Frankly, I'd be devastated if I somehow woke up without my pinky toe. Phillip Seaton, unsurprisingly, sued his doctor.

As I gathered more facts on the case, I learned that the doctor, John Patterson, decided to amputate because he discovered cancer during the surgery. Unfortunately for everyone following this story, Dr. Patterson explained that Seaton's cancerous penis resembled a rotten cauliflower. Although I have not yet learned about the physical manifestations of cancer, I'm willing to assume that "rotten cauliflower" penile cancer is a bad thing.

The patient's disease puts the flashy headline into perspective, but does not remove the issue of Informed Consent. Although the patient signed the necessary pre-operation paper work, did that mean he really understood the risks involved in the surgery? Was there explicit physician-patient dialogue regarding the possibility of amputation? Even if the surgery was medically valid, was it ethical?

Last week in my Healthcare Ethics class, the topic was Informed Consent. To paraphrase a sophisticated med school lecture: Informed Consent ensures that patients don't get shafted (hehe!). Without proper consent, a hospital doesn't have a leg to stand on.

And in the Kentucky case, the patient doesn't have a penis to... penis with. Or, to make myself sound a little more lucid and a lot more Latin: Primum non nocere. First, do no harm. This is what every physician promises during the Hippocratic Oath. Stealing a patient's penis without his permission -- regardless of the vegetable it resembles -- seems pretty harmful to me.

As it turns out, this case isn't quite so clear-cut (check, please!). On Wednesday, a jury ruled in favor of Dr. Patterson. I know how unjust this seems. How could they possibly rule in favor of the doctor who disfigured the genitals of an unconscious and unsuspecting truck driver? In a nutshell (hey-o!), the unexpected surgical procedure saved Seaton's life. Dr. Patterson, who actually amputated only one inch of penis, judged that Seaton's cancer would be fatal if it were not removed immediately. Furthermore, the jury ruled that Dr. Patterson acted within his legal limits because Informed Consent documents grant him the leeway to alter medical procedure if unforeseen circumstances arise.

Even though the jury reached a verdict, several questions still remain.

Was Seaton thoroughly informed about the risks involved with his surgery? Was the phrase "risk of penis amputation" included in the pre-surgery discussion? Should Dr. Patterson have woken the patient mid-surgery to ask permission? Was this an urgent matter? Was immediate surgery a matter of life or death? If so, did the physician make the right decision? Or did he drop the ball (ba-dum ching!)? Should physicians neglect their good intentions in favor of avoiding lawsuits? In a medical malpractice case, does anyone really win?

I don't think these questions have simple answers, but this is certain: Dr. Patterson's name and Phillip Seaton's body are both forever marred. And the reputation of the humble cauliflower? Totally screwed (zing!).