FEU-NRMF

INSTITUTE OF MEDICINE • Good communication

Bioethics 2 - Whether or not the patient has understood what has been
Milagros F. Neri, M.D., MA, MPH, MS stated;

- Avoiding overly technical language in descriptions and
ETHICAL ISSUES IN SURGERY
explanations;

- The provision of translators
Salient Ethical Guidelines
- Asking patients if they have further questions
• Patient’s best interest takes on added importance

- Patients completely dependent on the surgical team
Confidentiality
• Informed consent is especially important
• Generally speaking, such respect means that surgeons must not
- Surgery is a major bodily invasion
discuss clinical matters with relatives, friends, employers and
• Learning procedural skills differ from learning cognitive skills
others unless the patient explicitly agrees.
- Trainee has manual control of the procedure and can make
• Surgeons are allowed to communicate private information to
a mistake before a supervising surgeon can intervene
other professionals who are part of the health-care team –
• Individual surgeons are held responsible for the outcome of
provided that the information has a direct bearing on
surgery
treatment.
- Surgeons must justify why they operated and how the case

was managed
Research vs. Innovation

• Surgeons must always ask themselves in such circumstances
Informed Consent
whether or not the innovation in question falls within the
Disclosure
boundaries of standard procedures in which they are trained.
1. What type of surgery is proposed and how it might correct
• If so, what may be a new technique for them will count not as
their condition;
research but as an incremental improvement on personal
2. What the proposed surgery entails in practice;
practice.
3. The anticipated prognosis of the proposed surgery;
• Some innovations, however, are major differences in standard
4. The expected side-effects of the proposed surgery;
practice, pose more than minor risks to patients, and have not
5. The unexpected hazards of the proposed surgery;
been previously described in textbooks and articles.
• Any alternative and potentially successful treatments for their
• Such innovations should be reviewed by peers, and patients
condition other than the proposed surgery, along with similar
should consent to the innovative nature of the procedure.
information about these;
• Clinical trial in surgery is designed to ensure that findings about
• The consequences of no treatment at all.
outcomes are systematically compared with the best available
• Disclosure: Teaching
treatment and that favorable results are not because of
- Patients should be informed of the trainees’ role during
arbitrary factors (e.g. unusual surgical skill among researchers)
surgery and how they will be supervised.
which cannot be replicated.
- “Dr. X is a senior resident and will be performing portions

of your operation; I will be assisting and supervising Dr. X

throughout.”

• Changes in the operation due to unanticipated findings
- Blanket consent to change the operation if unexpected
findings occur
- Contact the next of kin in the waiting area or by phone to
discuss the proposed changed in care
- Changes in the operation due to unanticipated findings
need to be distinguished from cases in which the operation
needs to be changed because of a complication.
- In such instances, should proceed with the operation and
explain to the patient afterwards what was done because
of the intraoperative complications.

Comprehension
• A quiet venue for discussion should be found.
• Written material in the patient’s preferred language should be
provided to supplement verbal communication.
• Patients should be given time and help to evaluate their own
understanding and to come to their own decision.
• The person obtaining the consent should ideally be the surgeon
who will carry out the treatment.
• It should not be – as is sometimes the case – a junior member
of staff who has never conducted such a procedure and thus
may not have enough understanding to counsel the patient
properly.



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