RT Journal Article SR Electronic T1 Case conference. Earning his heroin but seeking release while the surgeon advises amputation. JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP 43 OP 48 DO 10.1136/jme.13.1.43 VO 13 IS 1 YR 1987 UL http://jme.bmj.com/content/13/1/43.abstract AB A man aged 80 years presented with painful ischaemia (inadequate blood supply) affecting his left lower leg. There was no effective medical treatment. The surgeons recommended amputation. The patient refused, in spite of suffering severe pain for fifteen months, because he wished to die, and he tried to bring this about by various means.