Ethical issues in surgical practice
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COVE R STO RY
Ethical Issues in Surgical Practice Nomikos IN
In recent years there has been increasing emphasis on the need for surgeons to be familiar with the fundamentals of ethical surgical practice. Several factors have served to enhance this trend. As surgical practice continues to change, the patient-surgeon relationship is subject to increasing pressure and there is a growing need to comply with society’s requirements. A definitive factor in the necessity for incorporating ethics in our daily practice is the recognition of personal autonomy and of the respect that each individual deserves. The fundamental concept of ethical behavior is to always attempt to do the right thing. An ethical problem differs from a tragedy in that a tragedy is a situation in which there is only one poor choice. An ethical problem arises when there are mutually exclusive solutions to a problem and each alternative contains elements of both right and wrong [1]. When we look at the relationship of surgeons with “ethics” we should realize that we apply ethics in our daily practice even without recognizing this all of the time. We, as surgeons, are called upon to make rapid life and death decisions, often without sufficient time to obtain in-depth information from the patient and family. We, as surgeons, are expected to deliver bad news, to make decisions about the indications for or against a surgical procedure, and we must obtain informed consent. We, as surgeons, are required to assist patients at the end of life, as decisions about interventions to maximize the quality of their remaining life are made. Determining the quality of life preferred by the patient is not easy because patients and their families have varying opinions of what constitutes “satisfactory quality of life” some of which may be different from the surgeon’s judgment of the patient’s current and expected quality of life. Finally, we, as surgeons, have trouble sleeping the night before an anticipated complicated surgical procedure, and not infrequently during this procedure we will need to make the decision of not turning back! [2]. For all of the abovementioned reasons the surgeon is more accountable than other physicians, and also has much more to account for. Clear evidence of the surgeon’s accountability is the fact that Nomikos IN, MD, FACS Director and Chairman, Department of Surgery, “Metaxa” Memorial Cancer Hospital, Piraeus Greece Corresponding author: Nomikos N Iakovos, 55 Psarron St., Korydallos, 18120 Piraeus Greece e-mail: [email protected] Received Nov 30, 2017; Accepted Dec 10, 2017
Hellenic Journal of Surgery 89
when the patient of an internist dies, the natural question that his or her colleagues ask is, “what happened?”, while when the patient of a surgeon dies, his or her colleagues ask, “what did you do?” [3]. An index of the increasing awareness about ethical issues is the incremental frequency of ethics related publications in the medical and surgical literature [4]. The fundamental principles of our current understanding of ethics are f
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