Surgical Ethics

Dr. Mugenya
 Learning Outcomes

• Define ethics
• Identify issues in surgical ethics
• Explain importance & boundaries of
autonomy, informed consent and
confidentiality
• Describe regulation and maintenance aspects
of surgical research and good surgical practice.
 Definition of Ethics
• The word ethics is derived from the Greek
word ethos which means “ character “.
• Hence ethics is branch of philosophy that
defines what is good for individual and for
society and establishes nature of obligations
or duties, that people owe themselves and
one another.
 History of Ethics
• Greek healers in the 4th century B.C., drafted
the Hippocratic Oath and pledged to :–
“Prescribe regimens for the good of my
patients according to my ability and my
judgment and never do harm to anyone”.
 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 the patient’s
attorney (person to whom property or power is
entrusted for)
 Surgical Ethics…
• Ethical study investigates what should be our
character and conduct.
• Morality is subject to re-examination and
improvement.
• Ideas of justice and fairness require critical
assessment and improvement.
• Ethical argument should maintain relevance.
 Surgical Ethics Issues
• Autonomy
• Informed consent
• Confidentiality
• Surgical research
• Excellent standards
 Autonomy
• Respect the autonomy of patients & their ability
to make choices about their treatments.
• It recognizes rights of patients to self
determination.
• So patients have right to make choices over
their surgical care.
• Respect for autonomy is the basis for informed
consent and advance directives.
 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
• Alternative treatment(s).
 Principles of Consent
• Venue – Calm & quiet place
• Consent form – Patient’s language
• Time – Take own decision
• Principal person – Surgeon
• Entry – Case record / documentation
 Attention to Consent
• Information – Accurate & reasonably
complete.
• Avoidance – Technical language
• Provision of Translators
• Clarification of doubts
 Practical Difficulties for Consent
• Refusal or waiver by patient
• Temporary unconsciousness patients
• Children less than 18 yrs are minors and are
legally incompetent.
• Incompetence – Other kinds: eg unsound
mind, etc.
 End of Life Issues
• In unusual circumstances (close to death) that no
evidence shows that specific treatment desired by the
patient will provide any benefit from any perspective,
physician need not provide such treatment.
• If there are no treatment options, i.e. patient is brain
dead and the family insists on treatment :– if there is
nothing that physician can do, treatment must stop.
• You should note in case sheet along with senior
clinician’s agreement.
 Confidentiality
• The principle of confidentiality is that information
patient reveals to surgeon is private and has limits on
how and when it can be disclosed to third party.
• The patient (and the person treating the patient) have
right to dignity.
• Breaking confidentiality:
- If the patient is threat to self or others
- Other team members – improving treatment options
- Public interest
- Court order
 Research
• Surgeons have subsidiary responsibility 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.
 Good Standards
• 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.
• 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 moral or professional.
 References
• Bailey & Love’s - Short Practice of
Surgery—26 edition.
th
 .

THANK YOU