Surgical Ethics

Dr. Murali . U. M.S.M.B.A

Learning Outcomes

O Define ethics

O Identify the issues in surgical ethics

O Explain the importance & boundaries of

autonomy, informed consent and confidentiality

O Describe the regulation and maintenance

aspects of surgical research and good surgical

practice.

Ethics - Defined O The word ethics is derived from the Greek word ethos which means “ character “.

O To put it formally ethics is the branch of philosophy that defines what is good for the individual and for society and establishes the nature of obligations, or duties, that people owe themselves and one another.

Ethics - History O Greek healers in the 4th Century B.C., drafted the Hippocratic Oath and pledged to –

O “prescribe regimens for the good of my patients according to my abil ity and my judgment and never do harm to anyone”.

Surgical Ethics

O Ethics is an essential discipl ine in the practice of

surgery.

O Represents your best understanding of moral

responsibil ity.

O Evolves as reasoned reflection on cl inical experience.

O Role of the Surgeon is to act as the patient’s f iduciary .

(person to whom property or power is entrusted for

the benefit of another)

Surgical Ethics

O Ethical study investigates what should be our character

and conduct.

O Morality is subject to re-examination and improvement.

O Ideas of justice and fairness require crit ical assessment

and improvement.

O Ethical argument should maintain relevance and

integrity.

Issues -Surgical EthicsO Autonomy

O Informed consent & difficulties

O Confidentiality

O Surgical research

O Excellent standards

Autonomy

O Respect the autonomy of patients & their abil ity to make

choices about their treatments.

O I t recognizes rights of patients to self-determination.

O So patients have right to make choices over their

surgical care.

O Respect for autonomy is the basis for informed consent

and advance directives.

.

Information

O Explanation of the patient’s disease

O Explanation of untreated natural history

O Recommendation of most appropriate surgery

O Discussion of risks and benefits

O Anticipated outcome – prognosis

O Treatment alternatives.

Consent - principles

O Venue – calm & quite place

O Consent form – Pt’s language

O Time – take own decision

O Principal person – Surgeon

O Entry – case record.

Attention

O Information – accurate & reasonably complete.

O Avoidance – technical language

O Provision of Translators

O Clarification of doubts.

Practical Difficulties

O Refusal or waiver by patient

O Temporary Unconsciousness patients

O Children less than 18 yrs are minors and are

legally incompetent.

O Incompetence – other kind .

End of Life - Issues O In unusual circumstances (close to death) that no evidence

shows that a specific treatment desired by the patient will

provide any benefit from any perspective, the physician need

not provide such treatment.

O If there are no treatment options i.e. the pt is brain dead

and the family insists on treatment – if there is nothing that

the physician can do; treatment must stop.

O Noted in case sheet along with senior clinician’s agreement

.

Confidentiality

O The principle of confidentiality is that the information a patient

reveals

to a surgeon is private and has l imits on how and when it can

be

disclosed to a third party.

O The patient (and the person treating the patient) have right to

dignity.

O Breaking confidential ity

- If the patient is threat to self or others

- Other team members – improving treatment options

- Public interest

- Court order

.

Research O Surgeons have a subsidiary responsibil i ty to

improve operative techniques through research, to

assure their patients that the care proposed is

best.

O The administration of such regulation is through

research ethics committees, and surgeons should

not participate in research that has not been

approved by such bodies.

.

Good Standards

O To optimise success in protecting l i fe and health

to an acceptable standard, surgeons must only

offer special ised treatment in which they have been

properly trained.

O To do so wil l entail sustained further education

throughout a surgeon’s career in the wake of new

surgical procedures.

O To do otherwise would be to place the interest of

the surgeon above that of their patient, an

imbalance that is never morally or professionally

appropriate.

.

“The fundamental contract in surgery is an undertaking by one individual to cure another by operation, in the expectation of reward”

J.Cook “The Delegation of Surgical Responsibility”

References

OBailey & Love’s - Short Practice of Surgery

26th edition.

OInternet websites .