Surgical ethics: a framework for surgeons, patients, and society

The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

South-East Asian Journal of Medical Education, 2018

This review article is based on concepts of medical ethics related to the day-today practice of surgery. Over the last two decades, with the development of advanced surgical methods, robotic surgeries, or telesurgeries, etc. there is increased reporting of associated ethical issues as well. Nevertheless, the ethical issues encountered by surgeons are reasonably different and critical when compared to what physicians face during their practice. There are extensive deontology literatures available for physicians while the same is not available sufficiently for surgeons. In this review, we have discussed the common queries asked by practicing surgeons who had faced medico-legal litigation and had come to us for consultation. This discussion is made in the light of comparison with ethical issued faced by practicing physicians. In the practice of medicine just fulfilling the basic ethical requirements, e.g. autonomy, beneficence, non-maleficence, is often sufficient. However, for surgical practice the ethical requirement is beyond the level of such basic deontological requirements. Hence, in this paper we have tried to search and discuss all deontological dimensions of surgical practice, e.g. Normative ethics: concerned with a moral course of action for a surgical practice, Meta-ethics: concerning determining the truth and reference of moral values, and the Applied ethics: concerning what a person is obligated to do in a specific situation or a particular domain of action. Hopefully, these will be useful to guide the surgeons' behaviours in particular circumstances encountered during their surgical practice.

The surgeon is a unique medical professional in that “any operation performed harms before healing. Consequently, by striving to minimise this necessary temporary injury to the patient while maximising the therapy's curative potential, surgeons have forever engaged in ethical deliberations.” Surgeons are responsible for all activities related to patients' treatment and care in surgical units, and it is therefore important for them to act in the best and correct way toward patients, relatives, and colleagues.

Current problems in surgery, 2013

This monograph is designed to provide surgeons with a broad overview of the common ethical problems that they are likely to encounter in their daily practice. It also demonstrates a method for approaching these problems. Finally, it presents cases that illustrate some of these problems and provides guidance to finding rational solutions.

Bioethics, 2002

Surgical ethics have generally been framed as general medical ethics applied to surgical contexts. This model is helpful, but may miss some of the special features of the surgical process and relationship. It is suggested in this paper that there are five categories of experience and relationship which are especially important in surgery ± rescue, proximity, ordeal, aftermath and presence. The sense of rescue, the feeling of relational proximity, the ordeal and the aftermath of surgery are things which the patient experiences. Understanding these experiences allow surgeons to understand what may be asked of them in an ethical sense. Recognition of the reality and validity of each category in the surgical process highlights the importance of presence, the acts by which the surgeon demonstrates that he is present to the patient throughout the surgical process and its aftermath. While the teaching of communication skills may never compensate for insensitivity, the ideal of presence as virtue and duty can be taught by precept and example.

Annals of Thoracic Surgery, 2000

Background. Discussion of ethical issues occurs much less often in the surgical than in the medical literature. The reasons for this “ethics gap” are unknown.Methods. Our clinical faculty ranked the ethical and legal acceptability of four treatment options in two cases of surrogate decision making. Only one option in each case was ethically and legally unacceptable (treating despite objection by the surrogate decision maker).Results. Surprisingly often, faculty mistakenly believed the ethically unacceptable option to be acceptable, and the legally unacceptable option to be acceptable. Surgeons were not ethically different from other physicians. Surgeons (19 of 31, 62%), however, were significantly (p < 0.05) more likely than internists (18 of 51, 35%) or pediatricians (4 of 18, 22%) to believe, mistakenly, that operating on the baby without parental consent was legally acceptable.Conclusions. This pilot study did not identify why the surgical literature contains a relative dearth of ethics discussion. Broader investigations are needed, because it is important that we understand the reasons for the gap. Surgeons’ strong ethic of personal responsibility for patients’ welfare should be transmitted to young trainees, a goal best achieved by discussing and writing about ethics. Moreover, our legal data suggest that a gap may also exist between surgeons and other physicians in understanding health law.

Surgery, 2010

2001

A thesis submitted in conformity with the requirements for the degree of Master of Arts Graduate Department of Human Development and Applied Psychology Ontario Institute for Studies in Education of the University of Toronto OCopyright by Jayadeep Patra 2001 National Library Bibliothèque nationaIe du Canada Acquisitions and Acquisitions et Bibliographic Services services bibliographiques 395 Wellington Street 395. rue Wellington Ottawa O N K1A O N 4 Ottawa ON K I A ON4 Canada Canada Our 6& Nccm r é f d r e n~~ The author has granted a nonexclusive licence dowing the National Libraly of Canada to reproduce, Ioan, disûibute or sell copies of this thesis in microform, paper or electronic formats. The author retains ownership of the copyright in this thesis. Neither the thesis nor substantial extracts fiom it may be printed or otherwise reproduced without the author's permission.

Mount Sinai Journal of Medicine, 2009

The Heart Surgery Forum, 2019

There is an old saying that history only makes sense in retrospect. I am sure that I am as susceptible to this adage as any other person. However, I will tell the story of my long history as an amateur medical ethicist, which is, to this day, how I would describe myself. My interest in the ethics of medicine, particularly as these ethical principles apply to interventions or procedures, started at a young age, fairly frequently going to the hospital with my father, a General and Thoracic Surgeon. I think that I found myself agreeing to accompany him, when invited, presuming that doing so would be a chance to spend some time with my dad, who was, throughout my childhood, either a surgical resident or a busy practicing surgeon. I will admit that I probably also figured that, at least late at night on the way home, we would stop by some establishment where we could get burgers and fries. However, I will start my reminiscences and reflections on these issues with a more recent story, as...