The patient has the inviolate right to refuse any medical treatment for himself if he has capacity, even if the medical evidence is that the procedure would be life-saving. Therefore, the most appropriate course of action is to respect the patient’s wishes and not perform the amputation. It is definitely not appropriate to perform the procedure anyways even to save the patient’s life. There is no evidence that the patient lacks capacity to make his own medical decisions and the patient displays no psychiatric symptoms that would suggest he is not capable of comprehending the information you are providing or making a rational decision. Likewise, a court order to obtain consent against the patient’s desires is not appropriate.