Opinion | Ethics Consult: Approve a Horn Implantation in Patient’s Skull?

Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.

Maddie is a prominent member of the body-modification community in her city. She has piercings in her ears, nose, eyebrows, and septum, and in numerous other places. She also has well over 100 distinct tattoos. What she really wants, however, is a large fiberglass horn implanted in her skull so she can “look like a dinosaur.”

She makes an appointment with Gene Daneeka, MD, a prominent plastic surgeon. She wants Daneeka to screw the horn into her skull surgically — a procedure for which she will pay cash. This is not a risk-free procedure. It requires general anesthesia, which carries some danger, and could result in blood loss or infection. And this particular operation has also never been done before, so there may be unanticipated consequences. Daneeka tentatively agrees to perform the surgery, pending approval from the ethics committee at his hospital.

Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.

And check out some of our past Ethics Consult cases:

Is Doctor Liable for Withholding Patient’s Diagnosis From Family?

Tell Family About Corpse Mix-Up at the Morgue?

Should Doc Illegally Assist Suicide in Dire Circumstance?