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 ability and my
judgment and never do
harm to anyone”.

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

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

Issues -Surgical Ethics
O Autonomy
O Informed consent & difficulties
O Confidentiality
O Surgical research
O Excellent standards

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

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 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

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.
.

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

“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.