Doctors have been given permission by a judge to amputate a mentally-ill man's infected foot "against his wishes".
London's Court of Protection heard the man, who has schizophrenia and is being treated by East Lancashire Hospitals NHS Trust, could die without surgery.
Mrs Justice Lieven said the man, who is in his 60s "doesn't want to lose his foot" but "doesn't want to die".
Ruling that an operation was in his best interests, she said he lacked the mental capacity to make the decision.
The judge, who spoke to the man over the telephone from the court room, heard evidence from specialists and legal arguments from lawyers representing the trust and the man.
She said she had not taken the decision to allow the operation "lightly", adding: "I am conscious I am making a decision to amputate someone's leg against their wishes."
The court was told a written ruling, outlining the reasoning behind the judge's decision, would be published in the near future.