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KEY POINTS

Key Points

  • image The physician should document that the patient or surrogate has the capacity to make a medical decision.

  • image Sufficient details regarding diagnosis and treatment options should be disclosed to the patient so that the patient can provide informed consent.

  • image Living wills are written to anticipate treatment options and choices in the event that a patient is rendered incompetent by a terminal illness.

  • image The durable power of attorney for healthcare identifies surrogate decision makers and invests them with the authority to make healthcare decisions on behalf of patients in the event that they are unable to speak for themselves.

  • image Surgeons should encourage their patients to complete a living will and clearly identify their surrogates early in the course of treatment.

  • image Earlier referrals and wider use of palliative and hospice care may help more patients achieve their goals at the end of life.

  • image Seven requirements for the ethical conduct of clinical research studies have been articulated: value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for enrolled subjects.

  • image Individuals working together on research endeavors should have clear discussions early in the planning process about authorship, and those discussions should be continued throughout the project or study.

  • image Disclosure of error is consistent with recent ethical advances in medicine toward more transparency, 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

WHY ETHICS MATTER

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.

Figure 48-1.

Bust of Aristotle. Marble, Roman copy after a Greek bronze original by Lysippos from 330 B.C. (From http://en.wikipedia.org/wiki/File:Aristotle_Altemps_Inv8575.jpg: Ludovisi Collection, Accession number Inv. 8575, Palazzo Altemps, Location Ground Floor, Branch of the National Roman Museum. Photographer/-source Jastrow [2006] from Wikipedia.)

DEFINITIONS AND OVERVIEW

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 principalist approach as articulated by Beauchamp and Childress.2 In this approach to ethical issues, moral dilemmas ...

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