Experimental transfer of the ulnar nerve to the lower limb: forensic, medicai and ethical considerations

Abstract

The author, having noted a case before the Ethics Committee (EC) of the Brescia Generai Hospital (Italy), analyses the ethical problems inherent in this type of medicai practice. Aware that all clinical cases represent an experimentation, attention is tumed to the surgical ambit which has, as its principle aim, the contribution of a benefit to the patient who undergoes this "new" treatment. Firstly, the generai ethical rules which are applicable to experimentation are considered; in particular the principle of beneficence to the patient and the principle of autonomy. Secondly, the case referred to the EC is examined. A proposal to carry out a surgical technique on paraplegic patients by the transfer of the ulnar nerve with its three motor branches to the large gluteus muscle, the middle gluteus muscle and the front rectum muscle is analysed. This experimentation is to enable the patient to walk with the use of support apparatus from the knee down. The ethical problems which emerge are numerous: of first importance is to recognize that experimentation only on animals is not without unforeseen risks. Secondly, the fundamental ethical principles are not respected and also the physician-patient relationship (PPR) is neglected. The EC is putting itself in the role of intermediary in PPR which is fraught with numerous problerns. So, the ethics of experimentation must be verified in relation to the patient as a person with all his or her peculiarities.