1. The physician should document that the patient or surrogate
has the capacity to make a medical decision.
2. The physician discloses to the patient details regarding the
diagnosis and treatment options sufficient for the patient to make
an informed consent.
3. Living wills are written to anticipate treatment options and
choices in the event that a patient is rendered incompetent by a
4. The durable power of attorney for health care identifies surrogate
decision makers and invests them with the authority to make health
care decisions on a patient’s behalf in the event that
patients are unable to speak for themselves.
5. Surgeons should encourage their patients to clearly identify
their surrogates early in the course of treatment.
6. Seven requirements for the ethical conduct of clinical trials
have been articulated: value, scientific validity, fair subject
selection, favorable risk-benefit ratio, independent review, informed
consent, and respect for enrolled subjects.
7. The Association of American Medical Colleges stresses three key
points regarding potential conflict of interest: full disclosure,
aggressive monitoring, and misconduct management.
8. Disclosure of error is consistent with recent ethical advances
in medicine toward more openness with patients and the involvement
of patients in their care.
Dedicated to the advancement of
surgery along its scientific and moral side.
June 10, 1926, dedication on the Murphy Auditorium, the first home
of the American College of Surgeons
Ethical concerns involve not only the interests of patients,
but also the interests of surgeons and society. Surgeons choose
among the options available to them because they have particular
opinions regarding what would be good (or bad) for their patients.
Aristotle described practical wisdom (Greek: phronesis)
as the capacity to choose the best option from among several imperfect
alternatives (Fig. 48-1).1 Frequently, surgeons
are confronted with clinical or interpersonal situations in which
there is incomplete information, uncertain outcomes, and/or complex
personal and familial relationships. The capacity to choose wisely
in such circumstances is the challenge of surgical practice.
Bust of Aristotle. Marble, Roman copy after a Greek bronze
original by Lysippos from 330 b.c.
Ludovisi Collection, Accession number Inv. 8575, Palazzo Altemps,
Location Ground Floor, Branch of the National Roman Museum. Photographer/source
Jastrow (2006) from Wikipedia (accessed March 8, 2009).]
Biomedical ethics is the system of analysis and deliberation
dedicated to guiding surgeons toward the “good” in
the practice of surgery. One of the most influential ethical “systems” in
the field of biomedical ethics is the principlist approach as articulated
by Beauchamp and Childress.2 In this approach to
ethical issues, moral dilemmas are deliberated by using four guiding
principles: autonomy, beneficence, nonmaleficence, and justice.2