Surgical ethics

Asso.Prof of Surgery at International Medical School, MSU, Malaysia.
Mar. 30, 2015

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Surgical ethics

  1. Surgical Ethics Dr. Murali. U. M.S.M.B.A
  2. 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.
  3. 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.
  4. 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 ability and my judgment and never do harm to anyone”.
  5. Surgical Ethics O Ethics is an essential discipline in the practice of surgery. O Represents your best understanding of moral responsibility. O Evolves as reasoned reflection on clinical experience. O Role of the Surgeon is to act as the patient’s fiduciary . (person to whom property or power is
  6. 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 critical assessment and improvement. O Ethical argument should maintain relevance and
  7. Issues -Surgical Ethics O Autonomy O Informed consent & difficulties O Confidentiality O Surgical research O Excellent standards
  8. Autonomy O Respect the autonomy of patients & their ability to make choices about their treatments. O It 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
  9. 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 .
  10. 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 .
  11. Attention O Information – accurate & reasonably complete. O Avoidance – technical language O Provision of Translators O Clarification of doubts .
  12. 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 .
  13. 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 .
  14. Confidentiality O The principle of confidentiality is that the information a patient reveals to a surgeon is private and has limits 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 confidentiality - If the patient is threat to self or others - Other team members – improving treatment options - Public interest
  15. Research O Surgeons have a subsidiary responsibility 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. .
  16. Good Standards O To optimise success in protecting life and health to an acceptable standard, surgeons must only offer specialised treatment in which they have been properly trained. O To do so will 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
  17. “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”
  18. References OBailey & Love’s - Short Practice of Surgery 26th edition. OInternet websites.