SURGICAL ETHICS DR. SANDESH NEUPANE, NEPAL

SURGICAL ETHICS, DR. SANDESH , NEPAL

1. SURGICAL ETHICS Dr. Sandesh Neupane 1 st year General Surgery Resident KIST Medical College and Teaching Hospital

2. Surgery, Ethics & Law Surgery can be defined as the action of man upon man. It can be conceived passionate art, where the matter worked with is living flesh science, where knowledge is dominated by the power of action Surgery intertwines with ethics and law unlike other contexts where inflicting harm might lead to criminal charges, performed with the intent to heal, not harm. If these actions inadvertently result in harm/death, they are viewed through the lens of medical intent rather than criminal liability.

3. As part of their duty to protect life and health to an acceptable professional standard, surgeons have a subsidiary responsibility to strive to improve operative techniques through research, to assure themselves and their patients that the care proposed is the best that is currently possible.

4. Origins of Surgical Ethics Concerns for patient welfare and the appropriate behavior of the physician are a part of the heritage of medicine originating with the Code of Hammurabi, a code of ethics dating from 2000 B.C. Ancient Mesopotamia and Egypt : The roots of surgical ethics can be traced back to ancient Mesopotamia and Egypt. On the tomb of Nenkh -Sekhmet, chief physician during the 5th dynasty in Egypt, an inscription reads: “Never did I do evil towards any person” . Greek Influence : Greek medicine was significantly influenced by ancient Egyptian practices. Hippocrates, around the fourth century BCE, wrote one of the earliest works on medical principles, including nonmaleficence, physician decorum, and the famous Hippocratic Oath.

5. Susruta : 1000BCE Sushruta’s belief that knowledge of both surgery and medicine as being essential to make a good doctor without both, a doctor “is like a bird with only one wing”. character of a surgeon: “a surgeon who has set out on this path should have witnessed operations, must be licensed by the king, should be clean and keep his nails and hair short, should be cheerful, well-spoken, and honest”

6. 1. Autonomy Respect for Autonomy End-of-Life Decisions : Patients have the right to refuse treatment, choose palliative care, or express their wishes regarding resuscitation. Shared Decision-Making : involves collaboration between patients and healthcare providers , espects autonomy by considering the patient’s values, preferences, and goals when making treatment choices. Informed consent Cultural Considerations : can vary across cultures. It’s essential to be culturally sensitive and respectful.

7. 2. Beneficence Obligation to act for the benefit of the patient. Surgeons have to follow professional obligations and standard. provide appropriate surgical intervention in response to a medical indication and following the consent of the patient

8. 3. Non-maleficence Obligation not to inflict harm on others. Surgery should minimize the possible harm. Surgeons must assess the nature and scope of risks and benefits. If the risk outweigh the potential benefits of performing surgery, then the surgeon has an obligation not to operate.

9. 4. Justice Equal access to health care for all. Limited resources and the time of surgeons devote to their patient must be evenly distribiuted to achieve a true benefit for the patient. There must not be discrimination on high profile or low profile case.

10. Informed Consent is process in which a participant in any clinical investigation is informed about the details of the study and any potential risks and benefits. is an ethical and legal requirement for any research /procedures In 1964, the first version of the Declaration of Helsinki, issued by the World Medical Association shared responsibility between the patient and practitioner.

11. Confidentiality Surgeons must not discuss clinical matters unless the patient agrees. If not maintained a grave offence . I t is not absolute . Surgeons are allowed to communicate private information to other professionals who are part of the healthcare team – provided that the information has a direct bearing on treatment. Patients cannot expect strict adherence to the principle of confidentiality if it poses a serious threat to the health, safety of others and public interest

12. A good Surgeon knows how to Operate. when to operator. The best Surgeon knows when not to operate.

13. Surgeon-Patient Relationship Trust and Communicatio n: Foundation of the relationship. Mutual Respect : Essential for collaboration. Informed Decision -Making: Providing patients with necessary information. Teamwork: Working together towards optimal outcomes. Support and Guidance : Throughout the treatment journey. Empathy: Understanding and addressing patients' concerns.

14. Good Standard 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. sustained further education is needed throughout a surgeon's career in the wake of new surgical procedures. to place the interest of the surgeon above that of their patient, an imbalance that is never moral or professional.

15. Ethical Considerations - New Techniques/Technology How is the safety of a new technology or technique ensured? What is the timing and process by which a new technology or technique is implemented at a hospital? How are patients informed before undergoing a new technology or technique? How are surgeons trained and credentialed in a new technology or technique? How are the outcomes of a new technology or technique tracked and evaluated? How are the responsibilities to individual patients and society at large balanced?

16. Ethical Issues in Surgery Surgical decision-making can be viewed as a two-part process. Firstly, there is the 'is it possible to treat' or 'how to treat' aspect, which is a matter of knowledge and technique (i.e. surgical science), an evidence-based practice. Secondly, the 'why treat' or 'what should be done' issues, which are a matter of surgical ethics and should be based on moral philosophy.

17. THE SURGICAL ETHICS CHALLENGES AND DILEMMAS Conflicts of Interest : Balancing duty to the patient with financial interests or relationships with pharmaceutical or medical device companies can be a dilemma. We must prioritize the patient's best interest above all else. Resource Allocation : situations with limited resources, such as organ transplants or critical care beds, deciding who receives treatment can be ethically challenging. Fair and transparent allocation systems are crucial. Professional Boundaries : Maintaining appropriate relationships with patients, avoiding conflicts of interest, and ensuring confidentiality can be challenging in today's interconnected world, especially with the rise of social media. Emergencies and Urgencies : Making split-second decisions in emergency situations can sometimes conflict with ensuring fully informed consent or considering alternative treatment options. Balancing the need for immediate action with ethical considerations is crucial. Professional Integrity: Ethical challenges may arise when colleagues or institutions engage in behavior that compromises patient care or professional integrity. Stark Law

18. References Sabiston Textbook of Surgery 21st Edition Bailey and Love’s Short Practice of surgery 27th Edition Sade, R. M., & Kavarana , M. N. (2017). Surgical ethics: today and tomorrow. Future Cardiology, 13(6), 567–578 Cardenas D. Surgical ethics: a framework for surgeons, patients, and society. Rev Col Bras Cir. 2020 Jun 15;47:e20202519.  Kumar, Abhinav & Kumar, B Nirmal. (2020). The Principles of Surgical Practice: Sushruta Samhita and its Importance to Present Day Surgery. Journal of Surgery: Open Access. 6. 10.16966/2470-0991.207. Roache, Rebecca. (2014). Why is informed consent important?. Journal of medical ethics. 40. 435-6. 10.1136/medethics-2014-102264. Arellano, Ana Lucia & Alcubilla , Pau & Leguízamo , Lina. (2023). Ethical considerations in informed consent. 10.5772/intechopen.1001319. AAOS, Code of Medical Ethics and Professionalism for Orthopaedic Surgeons

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