B103-01 Electrical Burns and Ethical Conflicts, When Is Enough Enough? A Case Series

Abstract Rationale electrical burns, due to their high morbidity and mortality, can arise bioethical conflicts in the clinical decision-making process. These patients have long hospital stays, clinical management uncertainty and the decision to amputate usually is not clear. As physicians, we aim to fulfil the objective of saving lives because it is what we have been taught. However, electrical burn patients test this precept, generating ethical challenges that need to be explored. Case Presentation we report two previously healthy males who suffered electrical burns while working. Both patients had burns that compromise 40% of the total body surface and had ABSI scores with a high likelihood of mortality. The first patient was sedated, his family reported previous verbal expressions rejecting life with bilateral upper limb amputation. However, interdisciplinary evaluation determined that amputation was necessary to control necrosis and prevent further clinical decline. The surgery resulted in bilateral transhumeral amputation. Following recovery, the patient expressed acceptance of the outcome and willingness to pursue rehabilitation. The second patient remained awake and explicitly requested full life-sustaining treatment. Progressive necrosis led to upper and lower limb compromise and multiple infections despite aggressive management. Ultimately, further amputations were deemed non-beneficial due to lack of viable tissue coverage, high surgical futility, and extremely low rehabilitation potential. A multidisciplinary board recommended transition to comfort-focused care, and finally passed away. On the other hand, the first patient survived with a bilateral transhumeral amputation of his upper limbs. Discussion These contrasting outcomes illustrate that conventional bioethical principles alone may be insufficient when evaluating catastrophic burn injuries. Autonomy may conflict with beneficence when prior wishes are unclear or when insisting on maximal intervention leads to disproportionate suffering. Likewise, preserving life at all costs may not align with meaningful recovery or acceptable quality of life. Structured shared decision-making—incorporating patient values, family perspectives, and clinical expertise—supported by bioethics consultation is essential in navigating these decisions. Recognizing functional diversity and potential for rehabilitation helps define treatment goals and identify the threshold at which interventions become futile. This abstract is funded by: None