The document outlines the principles of surgical ethics, emphasizing the importance of defining ethics, respecting patient autonomy, informed consent, and confidentiality. It discusses the historical context of surgical ethics, the responsibilities of surgeons, and the necessity of ongoing education and regulation in surgical research. Key issues addressed include ethical dilemmas like patient refusal, confidentiality considerations, and the role of surgeons in adhering to accepted ethical standards.

1. Surgical ethics
Dr Karthik K

2. Learning objectives
• Define ethics
• Identify issues in surgical ethics
• Explain the importance and boundaries in
autonomy, informed consent and
confidentiality
• Describe regulation and maintenance aspects
of surgical research and good surgical practice

3. Ethics - definition
• Greek word : Ethos = character
• To put it formally it is 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
• Greek healers in 4th
century BC formulated
Hippocratic oath and pledged
• “Prescribe regimens for the good of my
patients according to my ability and my
judgement and never do harm to anyone”

5. Surgical ethics
• Ethics is an essential discipline in the practice of
surgery
• Represents your best understanding of moral
responsibility
• Evolves as reasoned reflection on clinical
experience
• Role of the surgeon is to act as patient’s fiduciary
– (person to whom property or power is entrusted for)

6. Surgical ethics
• Ethical study investigates what should be our
character and conduct
• Morality is subject to reexamination and
improvement
• Ideas of justice and fairness require critical
assessment and improvement
• Ethical argument should maintain relevance

7. Issues - Surgical ethics
• Autonomy
• Informed consent and difficulties
• Confidentiality
• Surgical research
• Excellent standards

8. Autonomy
• Respect the autonomy of patients & their ability
to make decisions about their treatments
• It recognizes rights of patients to self
determination
• So the patients have the right to make choices
over their surgical care
• Respect for autonomy is the basis for informed
consent

9. Information
• Explanation of the patient’s disease
• Explanation of untreated natural history
• Recommendation of most appropriate surgery
• Discussion of risks and benefits
• Anticipated outcome – prognosis
• Treatment alternatives

10. Consent principles
• Venue – calm and quiet place
• Consent form – pt’s language
• Time – take own decision
• Principal person – surgeon
• Entry – case record

11. Attention
• Information – accurate & resonably complete
• Avoidance – technical language
• Provisions of translators
• Clarification of doubts

12. Practical difficulties
• Refusal or waiver by patient
• Temporary unconscious patient
• Children less than 18 years are minors and are
legally incompetent
• Incompetence – other kind

13. End of life issues
• In unusual circumstances 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
• If there are no treatment options i.e. pt is brain dead
and the family insists on treatment – if there is
nothing that a physician can do; treatment must stop
• Noted in case sheet with senior clinician’s agreement

14. Confidentiality
• Principle: the information a patient reveals to a
surgeon is private and has limits in how and when
it can be disclosed to a third party
• The patient and the doctor has to maintain dignity
• Breaking confidentiality
– If the pt is threat to others
– Other team members : improving treatment options
– Public interest
– Court order

15. Research
• Surgeons have a subsidiary responsibilty to
improve operative techniques through
research, to assure their patients that the care
proposed is best
• 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
• To optimize success in protecting life and health to an
acceptable standard, surgeons must only offer
specialized treatment in which they have been
properly trained
• To do so will entail sustained further education
throughout a surgeon’s career in the wake of new
surgical procedures
• 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 correct

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
resposibilty”

18. Sources
• Bailey and love’s short practice of surgery

19. THANK YOU